Avaliação muscular por meio da ultrassonografia e função cardiorrespiratória em pacientes pós COVID-19
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Data
2023-06-29
Autores
Carvalho, Marcus Vinicius Sobral de
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A COVID-19 é causada pelo coronavírus SARS-CoV-2 e pode ser transmitida por gotículas e contato próximo. A doença afeta principalmente o sistema respiratório e pode levar à fraqueza muscular persistente após a alta hospitalar. Embora a maioria dos pacientes se recuperem, sintomas persistentes levam à Síndrome Pós-COVID-19, cujo tempo de recuperação é desconhecido. Objetivos: Avaliar os efeitos da gravidade da COVID-19 no sistema cardiorrespiratório e muscular e correlacionar com o tempo pós- infecção e o tempo após internação. Métodos: Participaram 37 pacientes com diagnóstico prévio de COVID-19 após período de transmissão, divididos em 2 grupos de acordo com histórico de internação (GI- Grupo Internação e GSI - Grupo sem Internação). Foram submetidos a avaliação da força muscular respiratória pela manovacuometria, força muscular periférica (Handgrip), avaliação dos volumes e capacidades pela espirometria, ultrassonografia para avaliação da espessura e excursão do diafragma e espessura do quadríceps e teste ergométrico (TE) para avaliação da capacidade funcional cardiorrespiratória. Resultados: Os resultados mostram diferença significativa na Pimáx (%), maior no grupo SI, mas sem diferença para a Pimáx real e Pemáx (real e %). Não houve diferença significativa para o handgrip e nenhum dos valores espirométricos. No TE, foi encontrado maiores valores para a FC obtida e FC prevista, além da percepção de esforço em membros inferiores e cansaço respiratório no primeiro estágio do TE. Na ultrassonografia foi encontrado diferença significativa para a excursão diafragmática na respiração tranquila (maior valor no grupo I) e na espessura do quadríceps (maior valor no grupo SI). Na análise de correlação com o tempo de internação, foi encontrado p=0,03 para a variável CVF %. Conclusão: Pacientes hospitalizados apresentaram menor força muscular inspiratória, maior cansaço em membros inferiores e respiratório, além de menor espessura do quadríceps. O tempo de internação mostrou interferir na CVF mesmo não estando diminuída.
Introduction: COVID-19 is caused by the SARS-CoV-2 coronavirus and can be transmitted through droplets and close contact. The disease primarily affects the respiratory system and can lead to persistent muscle weakness after hospital discharge. While the majority of patients recover, persistent symptoms give rise to PostCOVID-19 Syndrome, with an unknown recovery time. Objectives: To evaluate the effects of the severity of COVID-19 on the cardiorespiratory and muscular system and correlate with the post-infection time and the time after hospitalization. Methods: Thirty-seven patients with a previous diagnosis of COVID-19, outside the transmission period, participated in the study and were divided into two groups based on hospitalization history (HG - Hospitalization Group and NHG - Non-hospitalization Group). They underwent assessments of respiratory muscle strength using manovacuometry, peripheral muscle strength (Handgrip), measurements of volumes and capacities using spirometry, ultrasound evaluation of diaphragmatic excursion and thickness of the quadriceps muscle, and exercise test (ET) to evaluate cardiorespiratory functional capacity. Results: The results showed a significant difference in Pimax (%) with higher values in the NHG group, but no difference in real Pimax and Pemax (real and %). There were no significant differences in handgrip or any of the spirometric values. During the exercise test, higher values were found for achieved heart rate and predicted heart rate, as well as increased lower limb effort perception and respiratory fatigue in the first stage of ET. Ultrasound analysis revealed a significant difference in diaphragmatic excursion during quiet breathing (higher value in the HG group) and quadriceps muscle thickness (higher value in the GSI group). Correlation analysis with hospitalization time showed a significant correlation (p = 0.03) with the variable FVC%. Conclusion: Hospitalized patients had lower inspiratory muscle strength, greater fatigue in the lower limbs and respiratory tract, in addition to less quadriceps thickness. The length of hospital stay interfered with the FVC even if it was not reduced.
Introduction: COVID-19 is caused by the SARS-CoV-2 coronavirus and can be transmitted through droplets and close contact. The disease primarily affects the respiratory system and can lead to persistent muscle weakness after hospital discharge. While the majority of patients recover, persistent symptoms give rise to PostCOVID-19 Syndrome, with an unknown recovery time. Objectives: To evaluate the effects of the severity of COVID-19 on the cardiorespiratory and muscular system and correlate with the post-infection time and the time after hospitalization. Methods: Thirty-seven patients with a previous diagnosis of COVID-19, outside the transmission period, participated in the study and were divided into two groups based on hospitalization history (HG - Hospitalization Group and NHG - Non-hospitalization Group). They underwent assessments of respiratory muscle strength using manovacuometry, peripheral muscle strength (Handgrip), measurements of volumes and capacities using spirometry, ultrasound evaluation of diaphragmatic excursion and thickness of the quadriceps muscle, and exercise test (ET) to evaluate cardiorespiratory functional capacity. Results: The results showed a significant difference in Pimax (%) with higher values in the NHG group, but no difference in real Pimax and Pemax (real and %). There were no significant differences in handgrip or any of the spirometric values. During the exercise test, higher values were found for achieved heart rate and predicted heart rate, as well as increased lower limb effort perception and respiratory fatigue in the first stage of ET. Ultrasound analysis revealed a significant difference in diaphragmatic excursion during quiet breathing (higher value in the HG group) and quadriceps muscle thickness (higher value in the GSI group). Correlation analysis with hospitalization time showed a significant correlation (p = 0.03) with the variable FVC%. Conclusion: Hospitalized patients had lower inspiratory muscle strength, greater fatigue in the lower limbs and respiratory tract, in addition to less quadriceps thickness. The length of hospital stay interfered with the FVC even if it was not reduced.
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Palavras-chave
Covid-19, Força muscular, Capacidade funcional cardiorrespiratória, Sintomas persistentes, Ultrassonografia, Muscle strength, Functional cardiorespiratory capacity, Persistent symptoms, Ultrasound