RELATIONSHIPS OF DIFFERENT PARAMETERS USED FOR THE MEASUREMENT OF NEUROMUSCULAR BLOCKADE

监测神经肌肉阻滞剂的作用对其合理和安全的使用变得越来越重要。为了了解这些药物及其活性代谢物的浓度和作用，有必要对各种参数进行综合评价。在这个项目中，我们首先开发了两种集成在手中的传感器，它们既实用又能抵抗外部干扰。破伤风消退和TOF消退被认为反映了神经肌肉阻滞剂的突触前作用。但这两个参数是否反映了同样的现象尚不确定。我们比较了拇内收肌强直性收缩和鱼际下肌的脑电图TOF。强直收缩在神经肌肉阻滞恢复过程中表现出突触前刺激作用，而TOF未表现出这种现象。足部肌电图常用于测量神经肌肉阻滞时，监测拇内收肌是不可能的。我们比较了足部肌内收肌的单次抽搐和肌电图的TOF。新斯的明恢复维库溴铵时，足部TOF的恢复速度比拇内收肌慢，但最终足部T1超过拇内收肌的恢复。因此，足部肌电图T1不一定反映拇内收肌单次抽动恢复良好。在一名19岁无肾男子中，我们测量了维库溴铵和3-OH维库溴铵浓度，并证明3-OH维库溴铵有助于该患者神经肌肉阻滞的缓慢恢复。我们开发了一种基于闭环系统的神经肌肉阻滞剂自动输注系统，该系统使用个人计算机并监测TOF，并被证明是临床有用的。

Monitoring of the action of neuromuscular blocking agents is becoming more important in their rational and safe administration. In order to know the concentrations and the action of these agents and their active metabolites, it is necessary to evaluate various parameters as a whole. In this project, first we developed two types of transducers incorporated in the hand, which are practical and resistant to external disturbances. Tetanic fade and and TOF fade are considered to reflect the presynaptic effect of neuromuscular blocking agents. But it is not certain if these two parameters reflect the same phenomenon. We compared the tetanic contraction of the adductor pollicis muscle and the TOF of EEG of the hypothenar muscle. Tetanic contraction showed presynaptic stimulating effect during the recovery from the neuromuscular blockade, but TOF did not show this phenomenon. EMG of the foot muscle is often used for the measurement of neuromuscular blockade when the monitoring of the adductor pollicis is not possible. We compared the single twitch of the adductor pollicis and the TOF of the EMG of the foot muscle. During the recovery from vecuronium by neostigmine, TOF of the foot was slower to recover compared with the adductor pollicis, but the T1 of the foot exceeded the recovery of adductor pollicis finally. Therefore T1 of the EMG of the foot muscle does not necessary reflect the good recovery of single twitch of the adductor pollicis. In a 19 year old anephric man, we measured both vecuronium and 3-OH vecuronium concentrations and demonstrated that 3-OH vecuronium is contributing to the slow recovery of neuromuscular blockade in this patient. An automatic infusion system of neuromuscular blocking agents based on a closed loop system using a personal computer and monitoring the TOF was developed and this was proved to be clinically useful.