CAJ | 학술논문

目的：探讨使用加速度肌松监测仪（acceleromyography, AMG）定标和4个成串刺激（train of four ratio, TOF）基线值对麻醉后恢复室（post-anesthesia care unit, PACU）患者肌松残余效应监测准确性的影响，为PACU患者残余肌松的处理提供指导。方法选择择期全麻手术患者151例，静脉注射依托咪酯、芬太尼诱导后，使用TOF-Watch SX加速度肌松监测仪进行定标和连续测量TOF值5 min确定基线值。然后给予非去极化肌松药插管或置入喉罩。手术完成后，拔除气管导管或喉罩后转运至PACU继续肌松监测，记录TOF基线值（TOFb）和进入PACU时的实测TOF值（TOFa）。结果共145例患者完成观察，TOFb 0.93～1.29，平均1.07±0.06，其中132例TOFb＞1.0。 TOFa＜0.9者41例，肌松残余发生率为28.3%；修正后的TOF值（TOFr）＜0.9者61例，肌松残余发生率为42.1%，两种方法计算的肌松残余发生率的差异有统计学意义（χ2=6.049，P=0.019）。结论使用AMG时，确定TOF基线值可以提高肌松残余效应监测的准确性，有利于发现潜在的肌松残余患者。
목적：탐토사용가속도기송감측의（acceleromyography, AMG）정표화4개성천자격（train of four ratio, TOF）기선치대마취후회복실（post-anesthesia care unit, PACU）환자기송잔여효응감측준학성적영향，위PACU환자잔여기송적처리제공지도。방법선택택기전마수술환자151례，정맥주사의탁미지、분태니유도후，사용TOF-Watch SX가속도기송감측의진행정표화련속측량TOF치5 min학정기선치。연후급여비거겁화기송약삽관혹치입후조。수술완성후，발제기관도관혹후조후전운지PACU계속기송감측，기록TOF기선치（TOFb）화진입PACU시적실측TOF치（TOFa）。결과공145례환자완성관찰，TOFb 0.93～1.29，평균1.07±0.06，기중132례TOFb＞1.0。 TOFa＜0.9자41례，기송잔여발생솔위28.3%；수정후적TOF치（TOFr）＜0.9자61례，기송잔여발생솔위42.1%，량충방법계산적기송잔여발생솔적차이유통계학의의（χ2=6.049，P=0.019）。결론사용AMG시，학정TOF기선치가이제고기송잔여효응감측적준학성，유리우발현잠재적기송잔여환자。
Objective To recognize the importance of calibration of acceleromyography( AMG) and train of four ra-tio baseline value(TOFb) for the evaluation of residual neuromuscular block in post-anesthesia care unit(PACU). Methods One hundred and fifty-one patients received general anesthesia were enrolled. After the induction of etomidate and fen-tanyl, AMG monitoring was calibrated and TOF was continuously measured for 5 min to obtain TOFb. Then non-depolariz-ing muscular blocker (NDMB) was given to patients followed by endotracheal intubation or LMA. All patients were trans-ported to the PACU after extubation. TOFb and TOF value at the time of their arrivals at PACU were recorded. Results One hundred and forty-five patients completed the study. The average of the baseline value of TOF was 1.07±0.06. At the time of their arrivals at PACU, according to the actual TOF value(TOFa), 41 out of 145 showed TOFa<0.9, the incidence of residual neuromuscular block was 28.3%. However, after corrected by TOFb (TOFr), 61 had TOFr<0.9, the incidence of residual neuromuscular block was 42.1%. The difference between the incidences was statistically significant(χ2=6.049, P=0.019). Conclusion AMG should be calibrated and TOF baseline value is important for evaluation of residual neuromus-cular block. The potential residual neuromuscular block may be recognized.