没有。该项目没有收到任何资金。

在涉及人类参与者的研究中执行的所有程序均符合机构和/或国家研究委员会的道德标准以及 1964 年赫尔辛基宣言及其后来的修正案或类似的道德标准。
注意：检查可以使用低频曲线 （2-5 MHz） 或中高频线性探头 （6-12 MHz） 进行，具体取决于患者的体型、探头可用性和提供者的偏好。对于图形和扫描，使用了曲线探头（C35xp，SonoSite M-Turbo）。
1. 股四头肌扫描技术
<ol><li>股四头肌深度测量<ol><li>患者体位：将患者置于仰卧位（床头抬高至 30度），双腿伸展。</li>
		<li>探头选择：选择低频曲线或中高频线性探头。</li>
		<li>模式选择：将扫描仪上的预设（即检查类型）设置为肌肉骨骼 （MSK） 设置。</li>
		<li>探头放置：<ol><li>将探针横向放置在大腿前部，长度约为从髂前上棘 （ASIS） 到髌骨上缘的 60%（图 1）。</li>
			<li>当探针垂直于肌肉的长轴时，股四头肌会出现在皮下组织的深处和股骨的浅表。</li>
			<li>使用额外的接触凝胶以尽量减少潜在的软组织变形。</li>
		</ol></li>
		<li>图像优化：<ol><li>为防止因浅表水肿而高估肌肉厚度，请对超声探头施加用力按压而不会造成疼痛25。</li>
			<li>如果发现识别股直肌有任何困难，请让患者收缩大腿肌肉或伸展膝盖。股直肌位于浅表并穿过髋关节，与较深的股肌相比，将显示出不同的运动模式（补充视频 1）。</li>
		</ol></li>
		<li>股四头肌厚度的测量<ol><li>按超声机上的 Measure（测量）激活超声机的卡尺功能。</li>
			<li>使用光标测量 （1） 股中间肌深缘（就在股骨皮层的浅表）和 （2） 股直肌最浅筋膜之间的前后距离（图 2）。 注意：如果识别 1.1.6.2 中提到的结构有任何困难，可以在激活卡尺功能之前重复视频 1 补充中提到的步骤。股四头肌厚度是股直肌和股中间肌的肌肉厚度之和（图3）。</li>
		</ol></li>
		<li>图像采集：单击 “获取” 以保存此超声视图的视频剪辑。</li>
		<li>重复测量（步骤 1.1.6-1.1.7）3 次并取平均值以尽量减少可变性。</li>
	</ol></li>
</ol>2. 股直肌扫描技术
<ol><li>股直肌横截面积 （CSA） 测量<ol><li>患者定位：遵循步骤 1.1.1。</li>
		<li>探针选择：遵循步骤 1.1.2。</li>
		<li>模式选择：按照步骤 1.1.3 进行操作。</li>
		<li>探针放置：按照步骤 1.1.4 进行操作。</li>
		<li>图像优化：<ol><li>使用显示扫描内容右侧的垂直标尺调整深度。使用触摸控制面板底部的水平滑条调整增益，使股直肌在超声框架中居中，并清晰显示其边界和股骨下层。</li>
			<li>将股直肌识别为大腿前室内的低回声结构，中央回声线代表肌内肌腱。</li>
			<li>激活超声机上的卡尺功能，仔细跟踪股直肌的外围，以确定其横截面积。超声机将根据追踪结果计算并显示 CSA。</li>
		</ol></li>
		<li>图像采集：遵循步骤 1.1.6。</li>
		<li>重复测量 3 次并取平均值，以最大限度地减少可变性。</li>
	</ol></li>
	<li>股直肌周长测量<ol><li>患者定位：遵循步骤 1.1.1。</li>
		<li>探针选择：遵循步骤 1.1.2。</li>
		<li>模式选择：按照步骤 1.1.3 进行操作。</li>
		<li>探针放置：按照步骤 1.1.4 进行操作</li>
		<li>图像优化：<ol><li>使用显示扫描内容右侧的垂直标尺调整深度。使用触摸控制面板底部的水平滑条调整增益，使股直肌在超声框架中居中，并清晰显示其边界和股骨下层。</li>
			<li>将股直肌识别为大腿前室内的低回声结构，中央回声线代表肌内肌腱。</li>
			<li>激活超声机上的卡尺功能，仔细跟踪股直肌的外围，以确定其横截面积。超声机将根据追踪计算并显示周长（图 4）。</li>
		</ol></li>
		<li>图像采集：遵循步骤 1.1.6。</li>
		<li>重复测量 3 次并取平均值，以最大限度地减少可变性。</li>
	</ol></li>
</ol>

围手术期虚弱评估的超声方案

<ol>
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作者均没有任何利益冲突需要披露。

先前的研究表明，POCUS 可用于估计肌肉厚度，包括股四头肌，其准确性可与 CT 扫描相媲美 26,27,28。股四头肌厚度的超声测量与虚弱相关，可用于预测某些术后结果23。此外，这种方法在其他诊断虚弱的方法可能不切实际的情况下很有帮助，例如在术前环境中，或者患者或提供者无法参加长时间的检查。
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随着全球平均预期寿命的延长，对 65 岁以上的患者进行的手术数量越来越多1。与年轻患者相比，虚弱在这些患者中更为常见，并且代表了对压力源（包括手术）的生理脆弱状态 2,3,4。在许多外科亚专业中，术前虚弱与术后不良事件的风险较高有关 5,6,7,8,9,10,11,12,13，包括更长的住院时间 10,14，丧失独立性15,16，再入院率17,18，成本增加14，死亡率 10,18,19,20。因此，围手术期医疗团队在术前决策时考虑患者的虚弱程度至关重要。
诊断虚弱最常用的方法包括 Fried 虚弱表型，它由五个因素组成，包括疲惫、虚弱（通过握力衡量）、慢走速度、体重减轻和低体力活动水平21。然而，该量表主要是为门诊服务设计的，在围手术期可能过于耗时。此外，它需要患者的合作，对于精神状态改变的患者来说是不切实际的。此外，CT 扫描用于评估肌肉质量以诊断肌肉减少症，这有助于评估虚弱程度。然而，虽然有效，但 CT 扫描在资源分配方面存在实际挑战，并使患者暴露于电离辐射，尤其是在围手术期。22 因此，需要床边测试，以快速准确地识别肌肉质量减少的术前患者，从而标记出手术风险较高的患者。
最近，Canales 等人报道了一种使用床旁超声在术前筛查虚弱的方法23。他们发现股四头肌厚度准确预测了虚弱，并且是术后出院到专业护理机构和谵妄的独立预测因子。股四头肌位于大腿前部，由四个肌肉腹部组成：股直肌、股内侧肌、股外侧肌和股中间肌24。在术前使用床旁超声进行虚弱筛查比 Fried 虚弱评估和 CT 成像更具优势。床旁超声实时提供生理参数（例如肌肉质量和质量）的客观测量，从而允许立即进行无创评估。这种方法更实用、更高效，并且适用于可能无法接受传统评估的患者，从而增强围手术期风险分层并改善结果23。
本文将详细介绍如何获得股四头肌的床旁超声测量值（包括探头选择、患者定位和故障排除），并讨论这种测量在围手术期环境中的影响。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>High Frequency Ultrasound Probe (HFL38xp)</td>
			<td>SonoSite (FujiFilm)</td>
			<td>P16038</td>
			<td></td>
		</tr>
		<tr>
			<td>Low Frequency Ultrasound Probe (C35xp)</td>
			<td>SonoSite (FujiFilm)</td>
			<td>P19617</td>
			<td></td>
		</tr>
		<tr>
			<td>SonoSite X-porte Ultrasound</td>
			<td>SonoSite (FujiFilm)</td>
			<td>P19220</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound Gel</td>
			<td>AquaSonic</td>
			<td>PLI 01-08</td>
			<td></td>
		</tr>
	</tbody>
</table>

identifying frailty using point-of-care ultrasonography: image acquisition and assessment

虚弱是手术患者一系列不良结局的重要预测指标，包括机械通气时间增加、住院时间延长、意外再入院、中风、谵妄和死亡。然而，在临床环境中用于筛查的可及工具是有限的。腰大肌计算机断层扫描是目前测量虚弱的标准成像设备，但它昂贵、耗时，并且患者会受到电离辐射。最近，床旁超声 （POCUS） 的使用已成为确定虚弱存在的潜在工具，并已被证明可以准确预测虚弱和术后结果。在本文中，我们将描述股四头肌的图像采集，并解释如何使用它们来确定虚弱和预测术后不良事件。我们将提供有关探头选择、患者定位和故障排除的信息。演示中的图像将用于展示 POCUS 技术和示例结果。本文将讨论这些图像在医疗决策中的使用和潜在的局限性。

As the average life expectancy rises globally, an increasing number of surgeries are performed on patients over the age of 651. Frailty is more common in these patients compared with their younger counterparts and represents a state of physiological vulnerability to stressors, including surgery2,3,4. Frailty in the preoperative setting has been linked with a higher risk for postoperative adverse events across many surgical subspecialties5,6,7,8,9,10,11,12,13, including longer hospital length of stay10,14, loss of independence15,16, readmission rates17,18, increased costs14, and mortality10,18,19,20. Therefore, it is of utmost importance for the perioperative healthcare team to consider a patient&#39;s frailty during preoperative decision-making.
The most commonly used method to diagnose frailty includes the Fried frailty phenotype, which comprises five factors including exhaustion, weakness (measured by grip strength), slow walking pace, weight loss, and low physical activity levels21. However, this scale was designed primarily for outpatient services and may be too time-consuming in the perioperative setting. In addition, it requires patient cooperation and is impractical in a patient with altered mental status. Moreover, CT scans are used to assess muscle mass for sarcopenia diagnosis, which can aid in frailty assessment. However, while effective, CT scans present practical challenges in resource allocation and expose patients to ionizing radiation, especially in the perioperative period.22&#160;Therefore, there is a need for bedside test that can quickly and accurately identify preoperative patients with diminished muscle mass, thus flagging those at higher surgical risk.
Recently, Canales et al. reported on a method for screening for frailty in the preoperative setting using point-of-care ultrasound23. They found that quadriceps muscle thickness accurately predicted frailty and was an independent predictor of postoperative discharge to a skilled nursing facility and delirium. The quadriceps muscle is located on the anterior thigh and is composed of four muscle bellies: the rectus femoris, the vastus medialis, vastus lateralis, and the vastus intermedius24. Using point-of-care ultrasound for frailty screening in the preoperative setting offers advantages over the Fried frailty assessment and CT imaging. Point-of-care ultrasound provides objective measures of physiologic parameters, such as muscle mass and quality, in real-time, allowing for immediate and non-invasive evaluation. This approach is more practical, efficient, and adaptable to patients who may not be able to undergo traditional assessment, enhancing perioperative risk stratification and improving outcomes23.
This paper will detail how to obtain the point-of-care ultrasound measurements of the quadriceps (including probe selection, patient positioning, and troubleshooting) and discuss the implications of this measurement in the perioperative setting.

作者聚焦：使用股四头肌床旁超声评估手术虚弱

使用床旁超声识别虚弱：图像采集和评估

Our research aims to assess frailty in surgical patients using point-of-care ultrasound measurements of the quadricep muscle. We seek to determine the accuracy of these measurements in predicting postoperative adverse events and their potential utility in clinical decision-making. Recent advancements in our field include the utilization of point-of-care ultrasound for bedside assessment of muscle mass and quality.This approach offers a non-invasive and expeditious alternative to traditional imaging techniques, enhancing perioperative risk evaluation in surgical patients. Experimental challenges include optimizing image acquisition techniques for consistent and accurate measurement of quadriceps muscle thickness, as well as ensuring reproducibility across different operators and patient populations. Compared to other techniques, such as the Fried frailty assessment and CT imaging, this protocol offers the advantage of enhancing that efficiency in the preoperative area for identifying those patients at potentially higher surgical risk secondary to frailty.In the future, our team will focus on further validating the use of point-of-care ultrasound and frailty assessment across different surgical populations and investigating interventions to improve outcomes in frail surgical patients.

通过实施该协议，使用实时超声测量股四头肌厚度，可以准确评估虚弱指标。按照本协议中概述的步骤，我们对患者进行了定位并选择合适的超声探头，以实现股四头肌的最佳可视化。
这项技术成功的关键是将探针精确放置在大腿前部，长度约为 ASIS 到髌骨上缘的 60%，探针垂直于肌肉的长轴23 （图1）。这允许清晰和清晰的股四头肌图...

在这里，我们提出了一种方案，使用床旁超声测量股四头肌厚度来评估围手术期的虚弱程度。这种方法为传统评估方法提供了一种实用、无创的替代方案，通过快速识别虚弱的患者，有可能加强围手术期护理。

Frailty is a significant predictor of a range of adverse outcomes in surgical patients, including increased mechanical ventilation time, longer hospital ...

identifying-frailty-using-point-care-ultrasonography-image

Research

JoVE Journal

Medicine

Identifying Frailty Using Point-of-Care Ultrasonography: Image Acquisition and Assessment

265 次观看.  George Washington University. 我们的研究旨在通过股四头肌的床旁超声测量来评估手术患者的虚弱程度。我们试图确定这些测量在预测术后不良事件方面的准确性及其在临床决策中的潜在效用。我们领域的最新进展包括利用床旁超声对肌肉质量和质量进行床边评估。这种方法为传统成像技术提供了一种无创且快速的替代方案，增强了手术患者的围手术期风险评估。实验挑战...