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Eur J Anaesth：拇短屈肌和拇内收肌加速度监测用于阿曲库铵诱导的神经肌肉阻滞的比较:前瞻性观察研究

2020-01-28 anesthGH “罂粟花”微信号

拇短屈肌拇内收肌
关注

背景与目的神经肌肉阻滞(NMB)监测是避免残留NMB的关键。虽然拇内收肌是推荐监测的部位，但并非总是有效的。拇短屈肌可能是一个很好的选择。本研究旨在比较这两个部位NMB的起效和恢复情况。方  法将2016年1月至2017年9月期间，计划使用神经肌肉阻滞剂行全麻手术的60名患者纳入研究。最终仅对56例患者的资料进行了分析，其中11例患者在麻醉复苏时使用新斯的明和阿托品拮抗。注射阿曲库铵后，

背景与目的

神经肌肉阻滞(NMB)监测是避免残留NMB的关键。虽然拇内收肌是推荐监测的部位，但并非总是有效的。拇短屈肌可能是一个很好的选择。本研究旨在比较这两个部位NMB的起效和恢复情况。

方  法

将2016年1月至2017年9月期间，计划使用神经肌肉阻滞剂行全麻手术的60名患者纳入研究。最终仅对56例患者的资料进行了分析，其中11例患者在麻醉复苏时使用新斯的明和阿托品拮抗。注射阿曲库铵后，同时监测拇内收肌和拇短屈肌NMB的起效和恢复情况。主要结果指标——NMB的起效时间（定义为四个成串刺激[TOF]计数等于0）及NMB恢复时间（TOF=1、TOF=4、T4/T1比值=0.75、T4/T1比值＞0.90）。

结 果

拇短屈肌NMB起效时间较慢，平均为4.4±1.5min，拇内收肌为3.7min±1.2min (P≤0.0001)。拇短屈肌恢复到TOF=1的速度明显较慢，而TOF=4无差异。拇短屈肌NMB完全恢复(T4/T1>0.9)明显快于拇内收肌，平均恢复时间分别为59.5±9.9min和64.5min ±10.7min(P<0.0001)，两者之间相差4.9min。使用药物拮抗后，拇短屈肌（53.0± 12.2min）和拇内收肌（53.0±12.2min）NMB完全恢复之间的差异消除然而，在个别患者中，NMB的起效和恢复并不遵循相同的规律。

结 论

拇内收肌NMB无法监测时，拇短屈肌可作为NMB监测的替代选择。然而，在无药物拮抗情况下，应谨慎使用拇短屈肌监测，避免发生肌松残留。

原始出处：

Le Merrer M， Frasca D， Dupuis M，et，al.A comparison between the flexor hallucis brevis and adductor pollicis muscles in atracurium-induced neuromuscular blockade using acceleromyography A prospective observational study .[J].Eur J Anaesthesiol 2020 Jan；37(1) DOI：10.1097/EJA.0000000000001090

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    2020-04-10 snowpeakxu

    #拇短屈肌#

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    2020-11-30 1508842480_96220437

    #前瞻性#

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    2020-12-29 xiangyuzhou971

    #EST#

    0

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    2020-04-23 gjsgj

    #神经肌肉#

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    2020-08-10 ms7258648636991762

    #观察研究#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2045247, encodeId=3d17204524e78, content=<a href='/topic/show?id=05495612367' target=_blank style='color:#2F92EE;'>#拇短屈肌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56123, encryptionId=05495612367, topicName=拇短屈肌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Fri Apr 10 20:00:00 CST 2020, time=2020-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2006472, encodeId=3e5b20064e2d3, content=<a href='/topic/show?id=924a3264381' target=_blank style='color:#2F92EE;'>#前瞻性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32643, encryptionId=924a3264381, topicName=前瞻性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5cb32500112, createdName=1508842480_96220437, createdTime=Mon Nov 30 11:00:00 CST 2020, time=2020-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2051504, encodeId=b29f2051504d1, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Tue Dec 29 18:00:00 CST 2020, time=2020-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976181, encodeId=910019e61815a, content=<a href='/topic/show?id=a0a2e44994e' target=_blank style='color:#2F92EE;'>#神经肌肉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74499, encryptionId=a0a2e44994e, topicName=神经肌肉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=734374, createdName=gjsgj, createdTime=Thu Apr 23 06:00:00 CST 2020, time=2020-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688977, encodeId=b6f616889e7e3, content=<a href='/topic/show?id=b65f90588b8' target=_blank style='color:#2F92EE;'>#观察研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90588, encryptionId=b65f90588b8, topicName=观察研究)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e4fa28698173, createdName=ms7258648636991762, createdTime=Mon Aug 10 01:00:00 CST 2020, time=2020-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633552, encodeId=a064163355213, content=<a href='/topic/show?id=377824e1c0' target=_blank style='color:#2F92EE;'>#ANA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Mon Oct 19 11:00:00 CST 2020, time=2020-10-19, status=1, ipAttribution=)]
    2020-10-19 AspirantSuo

    #ANA#

    0