重复频率电刺激在术后拮抗肌松中的应用

Application of frequency electrial stimulation in the antagonist muscle

目的通过重复频率连续电刺激引起肌电图监测肌松拮抗,探讨全麻术后拮抗肌松的时机与策略。方法选择ASA分级I～II级全麻患者若干,无神经肌肉病变。术毕用南京伟思医疗科技有限公司产机电诱发电位仪,根据四个成串刺激(TOF)要求,给以上肢尺神经重复频率连续电刺激,记录小指展肌的复合动作电位。随即给予预给拮抗剂(新斯的明40μg/kg+阿托品0.01mg/kg)一半,每5min给予一次TOF,根据TOFR(T4/T1)的比值追加拮抗剂(为首次量的一半),直到TOFR≥0.75。拮抗时根据T1、T2、T3、T4四个肌颤搐出现的情况相应分为A、B、C、D四组,并对每组使用新斯的明的量、肌张力恢复时间作比较。结果A组16例,25min恢复到标准12例,占75%,新斯的明用量40μg/kg。B组28例,10min恢复到标准26例,占95%,新斯的明用量30μg/kg。C组22例,10min恢复到标准22例,占100%,新斯的明用量30μg/kg。D组14例,5min恢复到标准14例,占100%,新斯的明用量20μg/kg。B,C两组无统计学意义。A组、D组与B、C组在恢复时间及拮抗用量有统计学差异(P<0.05或P<0.01),A组恢复时间及拮抗剂用量多于D组(P<0.05或P<0.01)。结论在重复频率连续电刺激TOF监测下,肌颤搐出现个数多,拮抗后肌张力恢复越快,且用药量少。T1出现恢复≥25min,T2～T3出现恢复≥10min,T4出现5min即可。

Objective To guide postoperative anesthesia antagonist muscle timing and strategy through repetition rate caused by electrical stimulation EMG. Methods A number of ASA grade Ⅰ～Ⅱ and general anesthesia patients without liver dysfunction were selected. After operation,continuous electrical stimulation with repetition frenquency was given to the upper extremity ulnar nerve according to the train of four stimulation （TOF） request,using electric machine from Nanjing Weisi Medical Technology Co. Ltd. And the compound action potentials of the little finger abductor muscle were recorded. Then half dose of antagonist（40 μg/kg neostigmine and 0. 01mg/kg atropine） was given and TOF was also given very five minutes. In accordance with the ratio of T4 /T1（TFOR）,antagonist was added（half of the primary dose） until TOFR≥0. 75. When rivalry was undergoing,they were divided into A,B,C,D groups according to the situation of the four muscle twitch （T1,T2,T3,T4）. The dose of neostigmine and muscular tension recovery time of the four groups were compared. Results 12 of 16 cases in group A recovered to the standards in 25 minutes accounting for 75% and neostigmine dose was 40 μg/kg. 26 of 28 cases in group B recovered to the standards in 10 minutes accounting for 95% and neostigmine dose was 30 μg/kg. 22 cases in group C all recovered to the standards accounting for 100% and neostigmine dose was 30 μg/kg. 14 cases in group C all recovered to the standards accounting for 100% and neostigmine dose was 20 μg/kg. Differences in group B and C had no significance. Group A,D and group B,C had significant differences in recovery time and antagonist dose（ P〈0. 05 or P〈0. 01）,which group A was more than group D（P〈0. 05 orP〈0. 01）. Conclusion In TOF monitoring with repetition frequency electrical stimulation,the number of muscle twitches is larger,muscular tension restores faster and the medication is less. Recovery time of T1 is ≥25 minutes,of T2 and T3 is ≥10 minutes,of T4 is 5 minutes.