PDF(Pubmed)
Abstract：
UNASSIGNED: Current guidelines recommend quantitative neuromuscular block monitoring during neuromuscular blocking agent administration. Monitors using surface electromyography (EMG) determine compound motor action potential (cMAP) amplitude or area under the curve (AUC). Rigorous evaluation of the interchangeability of these methods is lacking but necessary for clinical and research assurance that EMG interpretations of the depth of neuromuscular block are not affected by the methodology.
UNASSIGNED: Digitised EMG waveforms were studied from 48 patients given rocuronium during two published studies. The EMG amplitudes and AUCs were calculated pairwise from all cMAPs classified as valid by visual inspection. Ratios of the first twitch (T1) to the control T1 before administration of rocuronium (T1c) and train-of-four ratios (TOFRs) were compared using repeated measures Bland-Altman analysis.
UNASSIGNED: Among the 2419 paired T1/T1c differences where the average T1/T1c was ≤0.2, eight (0.33%) were outside prespecified clinical limits of agreement (-0.148 to 0.164). Among the 1781 paired TOFR differences where the average TOFR was ≥0.8, 70 (3.93%) were outside the prespecified clinical limits of agreement ((-0.109 to 0.134). Among all 7286 T1/T1c paired differences, the mean bias was 0.32 (95% confidence interval 0.202-0.043), and among all 5559 paired TOFR differences, the mean bias was 0.011 (95% confidence interval 0.0050-0.017). Among paired T1/T1c and TOFR differences, Lin\'s concordance correlation coefficients were 0.98 and 0.995, respectively. Repeatability coefficients for T1/T1c and TOFR were <0.08, with no differences between methods.
UNASSIGNED: Quantitative assessment neuromuscular block depth is clinically interchangeable when calculated using cMAP amplitude or the AUC.
UNASSIGNED: Digitised EMG waveforms were studied from 48 patients given rocuronium during two published studies. The EMG amplitudes and AUCs were calculated pairwise from all cMAPs classified as valid by visual inspection. Ratios of the first twitch (T1) to the control T1 before administration of rocuronium (T1c) and train-of-four ratios (TOFRs) were compared using repeated measures Bland-Altman analysis.
UNASSIGNED: Among the 2419 paired T1/T1c differences where the average T1/T1c was ≤0.2, eight (0.33%) were outside prespecified clinical limits of agreement (-0.148 to 0.164). Among the 1781 paired TOFR differences where the average TOFR was ≥0.8, 70 (3.93%) were outside the prespecified clinical limits of agreement ((-0.109 to 0.134). Among all 7286 T1/T1c paired differences, the mean bias was 0.32 (95% confidence interval 0.202-0.043), and among all 5559 paired TOFR differences, the mean bias was 0.011 (95% confidence interval 0.0050-0.017). Among paired T1/T1c and TOFR differences, Lin\'s concordance correlation coefficients were 0.98 and 0.995, respectively. Repeatability coefficients for T1/T1c and TOFR were <0.08, with no differences between methods.
UNASSIGNED: Quantitative assessment neuromuscular block depth is clinically interchangeable when calculated using cMAP amplitude or the AUC.
摘要：
■目前的指南建议在神经肌肉阻断剂给药期间进行定量神经肌肉阻滞监测。使用表面肌电图(EMG)的监测器确定复合运动动作电位(cMAP)振幅或曲线下面积(AUC)。缺乏对这些方法的互换性的严格评估，但对于临床和研究保证EMG对神经肌肉阻滞深度的解释不受方法的影响是必要的。
■在两项已发表的研究中，研究了48例罗库溴铵患者的数字化EMG波形。EMG振幅和AUC由通过目视检查分类为有效的所有cMAP成对计算。使用重复措施Bland-Altman分析比较了服用罗库溴铵（T1c）之前的第一次抽搐（T1）与对照T1的比率和四组比率（TOFR）。
■在平均T1/T1c≤0.2的2419个配对T1/T1c差异中，有8个（0.33％）超出了预设的临床一致性范围（-0.148至0.164）。在平均TOFR≥0.8的1781个配对TOFR差异中，有70个（3.93％）超出了预定的临床协议范围（（-0.109至0.134）。在所有7286个T1/T1c配对差异中，平均偏倚为0.32(95%置信区间0.202-0.043)，在所有5559个配对的TOFR差异中，平均偏倚为0.011(95%置信区间0.0050~0.017).在配对的T1/T1c和TOFR差异中，Lin的一致性相关系数分别为0.98和0.995。T1/T1c和TOFR的重复性系数<0.08，方法间无差异。
■当使用cMAP振幅或AUC计算时,定量评估神经肌肉阻滞深度在临床上是可互换的。
■在两项已发表的研究中，研究了48例罗库溴铵患者的数字化EMG波形。EMG振幅和AUC由通过目视检查分类为有效的所有cMAP成对计算。使用重复措施Bland-Altman分析比较了服用罗库溴铵（T1c）之前的第一次抽搐（T1）与对照T1的比率和四组比率（TOFR）。
■在平均T1/T1c≤0.2的2419个配对T1/T1c差异中，有8个（0.33％）超出了预设的临床一致性范围（-0.148至0.164）。在平均TOFR≥0.8的1781个配对TOFR差异中，有70个（3.93％）超出了预定的临床协议范围（（-0.109至0.134）。在所有7286个T1/T1c配对差异中，平均偏倚为0.32(95%置信区间0.202-0.043)，在所有5559个配对的TOFR差异中，平均偏倚为0.011(95%置信区间0.0050~0.017).在配对的T1/T1c和TOFR差异中，Lin的一致性相关系数分别为0.98和0.995。T1/T1c和TOFR的重复性系数<0.08，方法间无差异。
■当使用cMAP振幅或AUC计算时,定量评估神经肌肉阻滞深度在临床上是可互换的。
