亚强刺激电流在肌松监测中的应用研究

Application of submaximal current stimulation to monitoring neuromuscular blockade

目的：研究四次成串（ＴＯＦ）亚强刺激法的临床可行性。方法：将ＴＯＦ超强与亚强刺激法所检测的阿曲库铵阻滞时效及两者监测残余神经肌肉阻滞的能力进行比较。９０例择期手术患者随机分为五组，每组１８例，ＴＯＦ刺激电流分别为６０、５０、４０、３０、２０ｍＡ。结果：（１）用亚强刺激测得的Ｔ１值（ＴＯＦ中的第一个颤搐反应高度）虽降低，但可能在监测非去极化阻滞中无实际意义；（２）ＴＯＦ亚强较超强刺激法所检测的阿曲库铵阻滞时间延长，恢复时间缩短，但其均值差异均在４．９分钟以内。（３）ＴＯＦ亚强刺激法检测残余神经肌肉阻滞的能力显著强于ＴＯＦ超强刺激法。结论：为减轻或避免超强刺激所致的不适感，可用ＴＯＦ亚强刺激法监测非去极化阻滞。

Objective:The purpose of this study was to assess feasibility of monitoring non depolarizing neuromuscular blockade (NMB) with trian of four (TOF) at submaximal current stimulation (CS).Methods:The efficacy of NMB induced with intravenous atracurium 0 5mg/kg and the capacity of detecting residual NMB were compared when TOF with supramaximal and submaximal CS were used.Ninety adult patients,ASA class Ⅰ or Ⅱ, were randomly divided into five groups (n=18),receiving TOF at 60、50、40、30、and 20mA respectively,TOF and double burst stimulation (DBS) were applied to the ulnar nerve in wrist and elbow.Results:(1) T 1 (first twitch height of TOF) at submaximal CS is lower than that at supramaximal CS,but it has not clinical significance for monitoring of non depolarizing NMB;(2)the duration of NMB induced with atracurium was averagely prolonged for 4 6 minutes and the recovery time was shortened for 4 9 minutes at submaximal CS,however,they are not important to the duration of NMB induced with long and intermediate action non depolarizing relaxants;(3)the capacity of detecting residual NMB at submaximal CS is higher than that at supramaximal CS.Conclusions:In order to relieve patients suffering induced by supramaximal CS,TOF with submaximal CS is applicable to monitoring of non depolarizing NMB.