膈神经传导时间在麻醉复苏中的应用

The application of phrenic nerve conduction time in the resuscitation of anaesthesia

目的 :探讨膈神经传导时间 (PNCT)在麻醉复苏过程中对膈肌功能的监测作用。方法 :对 8例手术病人观察全麻使用肌松药前后颤搐性跨膈压 (Pdi(t) )和PNCT的变化。结果 :8例手术病人在全麻前 :Pdi(t) 为 ( 2 3 .7±2 4)cmH2 O ,左、右侧PNCT分别为 ( 5 7± 1 3)ms和 ( 5 6± 0 9)ms ;全麻使用肌松药后 :Pdi(t) 下降到 ( 11 5± 3 4)cmH2 O(下降率 5 1 5 %,P <0 0 1) ,而左、右侧PNCT则分别延长为 ( 6 1± 1 3)ms和 ( 6 4± 0 6 )ms ,并随Pdi(t) 的恢复而逐步缩短。结论 :肌松药诱发膈肌无力和引起双侧PNCT延长 ,且PNCT随着Pdi(t) 的恢复而缩短 ;PNCT的测定有助于间接监测全麻使用肌松药期间膈肌肌力的动态变化。

AIM: To investigate the application of phrenic nerve conduction time(PNCT) in the recovery of general anaesthesia. METHODS: Pdi (t) and PNCT were measured by cervical magnetic stimulation of phrenic nerves in 8 patients before and after the administration of muscle relaxant. RESULTS: Pdi (t) was reduced from (23.7±2.4) cmH 2O to (11.5±3.4) cmH 2O (reduction rate: 51.5%, P<0.01) after the administration of muscle relaxant. The PNCT were (5.73±1.33) ms on the left side and (5.63±0.91) ms on the right side before the administration of muscle relaxant and prolonged to(6.1±1.3) ms and(6.4±0.6) ms and shortened as the Pdi (t) recovered. CONCLUSIONS: Pdi (t) was reduced and PNCT was prolonged after the administration of muscle relaxant and the PNCT were shortened as the Pdi (t) recovered. The PNCT could be used to estimate the diaphragmatic function indirectly.