膈肌超声评估非胸腹部手术患者苏醒期肌松残余的临床研究  

Clinical study on diaphragmatic ultrasound evaluation of postoperative residual neuromuscular block in patients undergoing non-thoracoic abdominal surgery during the recovery period

作　　者：刘力玮 孔二亮 刘薇娜 方玉花 陶子颖 凤旭东 李雨恒 LIU Liwei;KONG Erliang;LIU Weina;FANG Yuhua;TAO Ziyin;FENG Xudong;LI Yuheng(Department of Anesthesiology,No.988 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army,Henan Province,Zhengzhou450042,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院麻醉科,河南郑州450042

出　　处：《中国医药导报》2025年第10期15-21,共7页China Medical Herald

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230701)。

摘　　要：目的研究膈肌超声指标评估非胸腹手术患者苏醒期肌松残余的应用效果。方法选取中国人民解放军联勤保障部队第九八八医院2023年10月至2024年10月全麻下行非胸腹择期手术患者80例,根据临床指征进行拔管,根据拔管时刻的肌松监测仪四个成串刺激(TOF)值将患者分为两组,TOF≥0.9为非术后肌松残余组(N-PRNB组),TOF<0.9为术后肌松残余组(PRNB组)。将超声探头依次置于患者右侧腋中线8~9肋间和锁骨中线与肋缘下交点两处,在麻醉诱导前与拔管时依次记录患者平静呼吸下呼气末与吸气末膈肌厚度(DT)、膈肌移动度(DE)、吸气时间,由此计算膈肌厚度恢复率(DTF)、膈肌收缩速度(DCS)与E-T指数。在恢复室记录各组患者拔管后不良事件发生情况。结果本研究共纳入80例患者,N-PRNB组42例,PRNB组38例,PRNB发生率为47.5%。诱导前,两组DTF、DE、DCS、E-T指数比较,差异无统计学意义(P>0.05);拔管时,N-PRNB组DTF、DE、DCS、E-T指数高于PRNB组(P<0.05)。简单线性回归分析表明,拔管时DTF、DE、DCS、E-T指数四项指标的β分别为0.443、0.091、0.072、0.029,提示4种超声指标均与TOF值呈正相关,其中与TOF值有良好的线性拟合关系(R2=0.572)。采用多元线性回归进一步对超声指标进行分析,结果显示拔管时DTF(β=0.409,95%CI:0.323~0.495,P<0.001)、DCS(β=0.037,95%CI:0.011~0.064,P<0.01)与TOF更为相关。拔管时DTF预测PRNB的截断值为42.5%,灵敏度为64.3%,特异度为94.7%。DCS预测PRNB的截断值为1.3 cm/s,灵敏度为73.8%,特异度为65.8%。结论膈肌超声指标与TOF显著相关,可作为评估术后肌松残余的辅助手段,其中DTF具有较高特异性。Objective To investigate the application effect of diaphragmatic ultrasound indicators in evaluating postoperative residual neuromuscular block in patients undergoing non-thoracic abdominal surgery during the recovery period.Methods Eighty patients who underwent elective non thoracoabdominal surgery under general anesthesia in No.988 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from October 2023 to October 2024 were selected.Extubation was performed based on clinical indications,and the patients were divided into two groups based on the train of four(TOF)values measured by the neuromuscular monitoring device at the time of extubation.TOF≥0.9 was used as the non muscle relaxation residual(N-PRNB)group,and TOF<0.9 was used as the muscle relaxation residual(PRNB)group.The ultrasound probe was sequentially placed at two locations on the patient’s right side:the 8-9 intercostals of the patient’s axillary midline and the intersection of the clavicle midline and the subcostal margin.The end-expiratory and end-inspiratory diaphragm thickness(DT),diaphragm excursion(DE),and inspiratory time were recorded during quiet breathing before anesthesia induction and at extubation.From these measurements,the diaphragmatic thickness fraction(DTF),diaphragmatic contraction velocity(DCS),and excursion-time index(E-T index)were calculated.The occurrence of adverse events of patients in each group afterextubation were recorded in the recovery room.Results A total of 80 patients were included in this study,with 42 in the N-PRNB group and 38 in the PRNB group,resulting in a PRNB incidence of 47.5%.Before anesthesia induction,there were no statistically significant differences in DTF,DE,DCS,and E-T index between the two groups(P>0.05).Compared with the PRNB group,the N-PRNB group showed higher DTF,DE,DCS,and E-T index values at extubation(P<0.05).Simple linear regression analysis revealed that theβcoefficients for the four indices(DTF,DE,DCS,and E-T index)at extubation were determined as 0

关 键 词：膈肌 超声 四个成串刺激 术后肌松残余 

分 类 号：R614[医药卫生—麻醉学]