Shorten G D, Merk H, Sieber T
Department of Anesthesia, Massachusetts General Hospital, Boston 02114, USA.
Can J Anaesth. 1995 Aug;42(8):711-5. doi: 10.1007/BF03012670.
It has been suggested that perioperative train-of-four (TOF) monitoring does not reduce the incidence of postoperative residual curarization (PORC). The purpose of this study was to examine whether the use of tactile assessment of the response of the adductor pollicis to supramaximal TOF stimulation of the ulnar nerve at the wrist during anaesthesia affected the incidence of PORC. Thirty-nine ASA I or II surgical patients were studied during thiopentone/fentanyl N2O/enflurane anaesthesia. Pancuronium (70-100 micrograms.kg-1) was used to facilitate tracheal intubation and additional pancuronium increments used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed according to random allocation, either with (Group A; n = 20) or without (Group B; n = 19) access to TOF monitoring. Patients in the two groups received neostigmine in similar doses (Group A: 53 micrograms.kg-1 (5.9); Group B: 55 micrograms.kg-1 (5.4)). On arrival of the patient to the recovery area, neuromuscular function was assessed electromyographically (using the Datex NMT 221 to measure TOF ratio) and clinically. The incidence of PORC (TOF ratio < 70%) was greater in Group B (47%) than in Group A (15%) (P = 0.029). We conclude that the use of perioperative TOF monitoring decreases the incidence of pancuronium-induced PORC.
有人认为围手术期四个成串刺激（TOF）监测并不能降低术后残余肌松（PORC）的发生率。本研究的目的是探讨在麻醉期间通过触觉评估腕部尺神经超强TOF刺激时拇收肌的反应是否会影响PORC的发生率。39例ASA I或II级外科手术患者在硫喷妥钠/芬太尼、N₂O/恩氟烷麻醉期间接受研究。使用潘库溴铵（70 - 100微克·千克⁻¹）辅助气管插管，并追加潘库溴铵以维持手术所需的肌肉松弛。根据随机分组，一组（A组；n = 20）可以进行TOF监测，另一组（B组；n = 19）不能进行TOF监测，评估追加潘库溴铵剂量的需求以及肌松逆转后的恢复情况。两组患者接受相似剂量的新斯的明（A组：53微克·千克⁻¹（5.9）；B组：55微克·千克⁻¹（5.4））。患者到达恢复区后，通过肌电图（使用Datex NMT 221测量TOF比值）和临床方法评估神经肌肉功能。B组PORC（TOF比值 < 70%）的发生率（47%）高于A组（15%）（P = 0.029）。我们得出结论，围手术期使用TOF监测可降低潘库溴铵所致PORC的发生率。
