Claudius Casper, Viby-Mogensen Jørgen
Copenhagen University Hospital, Rigshospitalet, Department of Anaesthesia, Copenhagen, Denmark.
Anesthesiology. 2008 Jun;108(6):1117-40. doi: 10.1097/ALN.0b013e318173f62f.
This systematic review describes the evidence on the use of acceleromyography for perioperative neuromuscular monitoring in clinical practice and research. The review documents that although acceleromyography is widely used in research, it cannot be used interchangeably with mechanomyography and electromyography for construction of dose-response curves or for recording different pharmacodynamic variables after injection of a neuromuscular blocking agent. Some studies indicate that it may be beneficial to use a preload to increase the precision of acceleromyography, and to "normalize" the train-of-four ratio to decrease the bias in relation to mechanomyography and electromyography. However, currently the evidence is insufficient to support the routine clinical use of preload and "normalization." In contrast, there is good evidence that acceleromyography improves detection of postoperative residual paralysis. A train-of-four ratio of 1.0 predicts with a high predictive value recovery of pulmonary and upper airway function from neuromuscular blockade.
本系统评价描述了在临床实践和研究中使用加速度肌动描记法进行围手术期神经肌肉监测的证据。该评价记录了，尽管加速度肌动描记法在研究中被广泛使用，但在构建剂量反应曲线或记录注射神经肌肉阻滞剂后的不同药效学变量时，它不能与机械肌动描记法和肌电图法互换使用。一些研究表明，使用预负荷可能有助于提高加速度肌动描记法的精度，并“标准化”四个成串刺激比值，以减少与机械肌动描记法和肌电图法相关的偏差。然而，目前证据不足以支持预负荷和“标准化”的常规临床应用。相比之下，有充分证据表明加速度肌动描记法可改善术后残余麻痹的检测。四个成串刺激比值为1.0时，对神经肌肉阻滞所致肺和上气道功能恢复具有较高的预测价值。
