加速度肌松监测仪定标和TOF基线值对麻醉后恢复室患者肌松残余效应监测的影响  

Calibration of acceleromyography and TOF baseline value for evaluation of residual neuromuscular block in post-anesthesia care unit

作　　者：王佳艳[1] 孙学丽[1] 张晓娇[1] 刘明明[1] 黄秋瑞 徐娜[1] 王天龙[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《北京医学》2014年第8期666-668,共3页Beijing Medical Journal

摘　　要：目的 探讨使用加速度肌松监测仪（acceleromyography,AMG）定标和4个成串刺激（train of four ratio,TOF）基线值对麻醉后恢复室（post-anesthesia care unit,PACU）患者肌松残余效应监测准确性的影响,为PACU患者残余肌松的处理提供指导。方法 选择择期全麻手术患者151例,静脉注射依托咪酯、芬太尼诱导后,使用TOF-Watch SX加速度肌松监测仪进行定标和连续测量TOF值5 min确定基线值。然后给予非去极化肌松药插管或置入喉罩。手术完成后,拔除气管导管或喉罩后转运至PACU继续肌松监测,记录TOF基线值（TOFb）和进入PACU时的实测TOF值（TOFa）。结果 共145例患者完成观察,TOFb 0.93-1.29,平均1.07±0.06,其中132例TOFb〉1.0。TOFa〈0.9者41例,肌松残余发生率为28.3%;修正后的TOF值（TOFr）〈0.9者61例,肌松残余发生率为42.1%,两种方法计算的肌松残余发生率的差异有统计学意义（掊2=6.049,P=0.019）。结论 使用AMG时,确定TOF基线值可以提高肌松残余效应监测的准确性,有利于发现潜在的肌松残余患者。Objective To recognize the importance of calibration of acceleromyography（ AMG） and train of four ra-tio baseline value（TOFb） for the evaluation of residual neuromuscular block in post-anesthesia care unit（PACU）. Methods One hundred and fifty-one patients received general anesthesia were enrolled. After the induction of etomidate and fen-tanyl, AMG monitoring was calibrated and TOF was continuously measured for 5 min to obtain TOFb. Then non-depolariz-ing muscular blocker （NDMB） was given to patients followed by endotracheal intubation or LMA. All patients were trans-ported to the PACU after extubation. TOFb and TOF value at the time of their arrivals at PACU were recorded. Results One hundred and forty-five patients completed the study. The average of the baseline value of TOF was 1.07±0.06. At the time of their arrivals at PACU, according to the actual TOF value（TOFa）, 41 out of 145 showed TOFa＆lt;0.9, the incidence of residual neuromuscular block was 28.3%. However, after corrected by TOFb （TOFr）, 61 had TO0.9, the incidence of residual neuromuscular block was 42.1%. The difference between the incidences was statistically significant（χ2=6.049, P=0.019）. Conclusion AMG should be calibrated and TOF baseline value is important for evaluation of residual neuromus-cular block. The potential residual neuromuscular block may be recognized.

关 键 词：4个成串刺激 肌松残余 定标 TOF基线值 

分 类 号：R614[医药卫生—麻醉学]