Department of Anaesthesiology, University of Washington, Seattle, WA, USA.
Department of Anaesthesiology, University of Washington, Seattle, WA, USA.
Br J Anaesth. 2020 Jun;124(6):712-717. doi: 10.1016/j.bja.2020.02.022. Epub 2020 Mar 28.
Train-of-four twitch monitoring can be performed using palpation of thumb movement, or by the use of a more objective quantitative monitor, such as mechanomyography, acceleromyography, or electromyography. The relative performance of palpation and quantitative monitoring for determination of the train-of-four ratio has been studied extensively, but the relative performance of palpation and quantitative monitors for counting train-of-four twitch responses has not been completely described.
We compared train-of-four counts by palpation to mechanomyography, acceleromyography (Stimpod™), and electromyography (TwitchView Monitor™) in anaesthetised patients using 1691 pairs of measurements obtained from 46 subjects.
There was substantial agreement between palpation and electromyography (kappa = 0.80), mechanomyography (kappa = 0.67), or acceleromyography (kappa = 0.63). Electromyography with TwitchView and mechanomyography most closely resembled palpation, whereas acceleromyography with StimPod often underestimated train-of-four count. With palpation as the comparator, acceleromyography was more likely to measure a lower train-of-four count, with 36% of counts less than palpation, and 3% more than palpation. For mechanomyography, 31% of train-of-four counts were greater than palpation, and 9% were less. For electromyography, 15% of train-of-four counts were greater than palpation, and 12% were less. The agreement between acceleromyography and electromyography was fair (kappa = 0.38). For acceleromyography, 39% of train-of-four counts were less than electromyography, and 5% were more.
Acceleromyography with the StimPod frequently underestimated train-of-four count in comparison with electromyography with TwitchView.
可通过拇指运动的触诊或使用更客观的定量监测仪（如肌电图、加速度计或肌电描记术）进行四串搐颤监测。触诊和定量监测用于确定四串搐颤比的相对性能已得到广泛研究，但触诊和定量监测仪用于计数四串搐颤反应的相对性能尚未完全描述。
我们比较了在麻醉患者中使用 1691 对来自 46 名患者的测量值，触诊与肌电图、肌动描记术（Stimpod）和肌电图（TwitchView Monitor）的四串搐颤计数。
触诊与肌电图（kappa = 0.80）、肌动描记术（kappa = 0.67）或加速度计（kappa = 0.63）之间存在高度一致性。肌电图与 TwitchView 和肌动描记术最接近触诊，而加速度计与 StimPod 往往低估四串搐颤计数。以触诊为比较器，加速度计更有可能测量到较低的四串搐颤计数，其中 36%的计数低于触诊，3%的计数高于触诊。对于肌动描记术，31%的四串搐颤计数高于触诊，9%的计数低于触诊。对于肌电图，15%的四串搐颤计数高于触诊，12%的计数低于触诊。加速度计与肌电图之间的一致性为一般（kappa = 0.38）。对于加速度计，39%的四串搐颤计数低于肌电图，5%的计数高于肌电图。
与肌电图与 TwitchView 相比，Stimpod 加速度计经常低估四串搐颤计数。
