Pei Da-Qing, Zhou Hong-Mei, Zhou Qing-He
The Department of Anaesthesia, Bengbu Medical College, Anhui Province.
The Department of Anaesthesia, Second Affiliated Hospital, Jiaxing University, Zhejiang Province, China.
Medicine (Baltimore). 2019 Jan;98(2):e13940. doi: 10.1097/MD.0000000000013940.
Residual postoperative neuromuscular blockade is an important clinical issue. Neuromuscular monitoring is usually used to evaluate neuromuscular recovery in patients undergoing general anesthesia. However, this procedure is inconvenient and not widely adopted. We aimed to examine the correlation between grip strength and train-of-four ratio (TOFr) to examine whether assessing grip strength can be used clinically to monitor residual neuromuscular blockade.
One hundred twenty patients with ASA I or II scheduled for laparoscopic cholecystectomy under general anesthesia were enrolled in this study. All patients were randomly selected to receive standard anesthesia induction with either 0.6 mg·kg rocuronium or 0.2 mg·kg cisatracurium. Grip strength was tested in all patients using an electronic device before anesthesia and when TOFr values of 0.7, 0.8, and 0.9, and an hour later of TOFr value of 0.25. The time required for a change in TOFr values from 0.25 to 0.75 and 0.9 was evaluated. Spearman rank correlation analysis was performed to determine correlations between grip strength and TOFr.
Spearman rank correlation analysis indicated that there was a significant correlation between grip strength and TOFr during patient recovery from general anesthesia (correlation coefficient for grip strength recovery [rs] = 0.886). Subgroup analysis revealed that there were no differences in mean maximum grip value recovery between patients treated with rocuronium and those treated with cisatracurium when TOFr was 0.7, 0.8, and 0.9 or when the TOFr was 0.25 after 60 minutes (all P >.05). Recovery of TOFr from 0.25 to 0.75 and from 0.25 to 0.9 was longer in patients treated with rocuronium than in those treated with cisatracurium (both P <.001).
There was a strong correlation between grip strength and TOFr during recovery from general anesthesia. Evaluation of grip strength can be used as an additional strategy to evaluate postoperative residual neuromuscular blockade.
术后残余神经肌肉阻滞是一个重要的临床问题。神经肌肉监测通常用于评估全身麻醉患者的神经肌肉恢复情况。然而，该操作不方便且未被广泛采用。我们旨在研究握力与四个成串刺激比值（TOFr）之间的相关性，以探讨评估握力是否可在临床上用于监测残余神经肌肉阻滞。
本研究纳入了120例计划在全身麻醉下行腹腔镜胆囊切除术的ASA I或II级患者。所有患者被随机选择接受0.6 mg·kg罗库溴铵或0.2 mg·kg顺式阿曲库铵的标准麻醉诱导。在麻醉前以及TOFr值为0.7、0.8和0.9时，以及TOFr值为0.25一小时后，使用电子设备对所有患者进行握力测试。评估TOFr值从0.25变化至0.75和0.9所需的时间。进行Spearman等级相关分析以确定握力与TOFr之间的相关性。
Spearman等级相关分析表明，在患者从全身麻醉恢复过程中，握力与TOFr之间存在显著相关性（握力恢复的相关系数[rs]=0.886）。亚组分析显示，当TOFr为0.7、0.8和0.9时，以及60分钟后TOFr为0.25时，接受罗库溴铵治疗的患者与接受顺式阿曲库铵治疗的患者的平均最大握力值恢复情况无差异（所有P>.05）。罗库溴铵治疗的患者TOFr从0.25恢复至0.75以及从0.25恢复至0.9的时间比顺式阿曲库铵治疗的患者更长（均P<.001）。
在全身麻醉恢复过程中，握力与TOFr之间存在很强的相关性。握力评估可作为评估术后残余神经肌肉阻滞的一种额外策略。
