加速度法和肌力法在肌松监测中的比较  

Comparative study of mechanomyogruphy and acceleromyography in monitoring neuromuscular blockade

作　　者：张欢[1] 许幸[1] 张京范[1] 

机构地区：[1]北京医科大学第一医院麻醉科,100034

出　　处：《中华麻醉学杂志》1997年第9期523-526,共4页Chinese Journal of Anesthesiology

摘　　要：研究加速度法和肌力法的相关性;观察肌力法监测下,T_1/T_0和T_(4)/T_1的对应关系。方法:16例ASA Ⅰ～Ⅱ级择期手术病人,左右手随机与加速度神经刺激器或改良应力计相连,以超强刺激电流TOF刺激方式刺激双侧尺神经。诱导用异丙酚2～2.5mg·kg^-1、维库溴铵0.1mg·kg^-1、芬太尼0.1mg。持续输注异丙酚4～8mg·kg^-1·h^-1复合连续硬膜外麻醉。比较双拇内收肌T_1/T_0和T_4/T_1的恢复情况。结果:两种方法高度相关(r>0.7,P<0.001),回归图中加速度法95％可信区间较宽。加速度法在深度(肌力法T_1/T_0≤25％)、轻度(肌力法T_1/T_0>25％)阻滞时较肌力法T_1/T_0恢复滞后。肌力法监测下T_4/T_1和T_1/T_0存在曲线相关关系。当T_1/T_0已恢复到对照值时,T_4/T_1仅相当于70％左右。结论:两种方法存在高度相关性;使用肌力法监测肌松,其稳定性和重复性较之加速度法似更优越,T_4/T_1较T_1/T_0更敏感。objective: 1.To study the correlation between two methods of measurement neuromuscular blockade:the mechanomyography (MMG) and the acceleromyography (AMG);2.To observe the corresponding relationship between T_1/T_0 and T_4/T_1 with MMG during the recovery of neuromuscular transmission (NMT).Method:Sixteen patients served as subjects.Both arms were randomly connected to either accelograph or tension transducer.Supramaximal current in TOF were used to stimulate the ulnar nerves,The patients were anesthetized with propofol 2-2.5mg·kg^(-1),vecuronium 0.1mg·kg^(-1) and fentanyl 0.1mg,then propofol was continuously infused (4-8mg·kg^(-1)) combined with continuously epidural anesthesia to maintain.The recovery of T_1/T_0 and T_4/T_1 of both adductor pollicis were compared. Result:There was a high correlation (r>0.7,P<0.001) between AMG and MMG.The 95% confidence limit of AMG in regression analysis was wide.Regardless of deep or light blockade,the recovery of T_1/T_0 in AMG was more retardent than that in MMG,Using MMG,we also found a significant correlation between the ratio of T_1/T_0 and T_4/T_1.When T_1/T_0 recovered to control level,T_4/T_1 only recovered to about 70%.Conclusion:There is a high correlation between two methods;The stability and precision of MMG are better than those of AMG.T_4/T_1 is more sensitive than T_1/T_0 in evaluating the recovery of NMT.

关 键 词：加速度法 肌力法 神经肌肉接头 维库溴铵 肌松药 

分 类 号：R971.8[医药卫生—药品] R685.405[医药卫生—药学]