Zhu Pancheng, Song Zhen, Wong Stanley Sau-Ching, Zheng Yongping
Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China.
Rev Sci Instrum. 2024 Dec 1;95(12). doi: 10.1063/5.0243459.
In the post-anesthesia care unit, there is a high occurrence of residual neuromuscular blockade, which puts patients at risk of negative consequences such as hypoxia. Assessment based on the train-of-four ratio (TOFR) has been used to avoid residual neuromuscular blockade when the TOFR is greater than 0.9, measured at the adductor pollicis muscle (APM). The most commonly used quantitative neuromuscular monitoring (QNM) modalities include acceleromyography (AMG) and electromyography (EMG). However, the poor user-friendliness of current QNM methods hinders their widespread adoption. To overcome this, we developed a new monitoring method using ultra-fast ultrasound imaging to generate a two-dimensional map of muscle transient motion, i.e., sonomechanomyography (SMMG). SMMG of the APM and AMG of the thumb were used to get the TOFR of 20 normal adults. The results showed no significant difference between the left and right hands for both AMG and SMMG TOFR, with p-values larger than 0.05. In addition, the mean accuracy of SMMG TOFR (0.6% relative error) was higher than AMG (1.4% relative error). Moreover, the Bland-Altman plot showed that all the difference values were within the limits of agreement and the mean bias was 0.02, indicating that the two methods had a very good agreement. In particular, using SMMG did not require additional calibration before testing. Overall, the results demonstrated that the method has the potential as a new QNM approach for further clinical studies to benefit patients in need. To demonstrate its clinical potential, further studies are required to evaluate this method in patients during and post-anesthesia.
在麻醉后护理单元，残余神经肌肉阻滞的发生率很高，这使患者面临诸如缺氧等不良后果的风险。基于四个成串刺激比值（TOFR）的评估已被用于避免残余神经肌肉阻滞，当在拇收肌（APM）处测量的TOFR大于0.9时。最常用的定量神经肌肉监测（QNM）模式包括加速度肌电图（AMG）和肌电图（EMG）。然而，当前QNM方法的用户友好性较差，阻碍了它们的广泛应用。为了克服这一问题，我们开发了一种新的监测方法，使用超快超声成像来生成肌肉瞬态运动的二维图，即声机械肌电图（SMMG）。对20名正常成年人的APM进行SMMG和拇指进行AMG以获得TOFR。结果显示，AMG和SMMG的TOFR在左右手之间均无显著差异，p值大于0.05。此外，SMMG TOFR的平均准确度（相对误差0.6%）高于AMG（相对误差1.4%）。而且，Bland-Altman图显示所有差异值均在一致性界限内，平均偏差为0.02，表明这两种方法具有非常好的一致性。特别是，使用SMMG在测试前不需要额外校准。总体而言，结果表明该方法有潜力作为一种新的QNM方法用于进一步的临床研究，以使有需要的患者受益。为了证明其临床潜力，需要进一步研究在麻醉期间和麻醉后对患者评估这种方法。
