《nmtyage》ppt课件.ppt

1、神经肌肉传导监测NMT,GE Healthcare 朴松哲 2006-09-16,Neuromuscular Transmission (NMT) Monitoring,E-NMT,NMT 监测方式,测量肌肉对刺激的收缩反应 最常用尺神经,刺激,测量反应,NMT 监 测,刺激模式： TOF，DBS，ST，PTC ST 单次刺激 TOF 四个成串刺激 (临床最常用） PTC 强直刺激后计数 （监测深度神经阻滞） DBS 双强直刺激 刺激强度和时间可调 刺激反应在屏幕上独立显示 文字提示肌松状态,应用肌松药前 TOF%100 ；TOF值4,用药初期 TOF 下降，肌松药起效,TOF值降到2或2以下

2、时，即可进行插管。 外科手术通过控制TOF值，一般TOF值0， 来获得理想肌松效果。,手术结束后，当TOF值达到2或3时， 即可使用拮抗药，使病人恢复。,手术恢复期，当TOF达到90时， 可安全拔管。,肌松监测的临床应用,肌松状态的全程监测,肌松监测3个参数同屏全程显示,校准,气管插管,拔管,神经肌肉松弛起始,肌松恢复,TOF% 100 20 Count 4 0 PTC 10 0,浅,深,肌松程度,追加肌松药,肌松监测的临床价值,测定肌松药作用起效时间和气管插管时机选择 维持术中最佳肌松状态 神经肌肉阻滞的恢复判断和拔管时机选择 判断神经肌肉阻滞的类型 神经定位,麻醉科：,外科医生要求手术区域

3、肌肉松弛 几乎所有的外科手术必要条件 安 全: 避免患者活动造成的伤害 e.g. 神经科，眼科及颌面外科手术 气管插管 when note appears, inject a new bolus Adequate level in critical care depends on the patient; often in the Count range New: Recovery Note proceeds into a yellow alarm,Regional block,Regional anesthesia: Anesthetic agent is injected to a per

4、ipheral nerve to produce a block of responses in a certain anatomical area (the hand /plexus nerve) Nerve location tool for Regional block helps in finding the optimum site of the regional nerve to be blocked and helps to optimizes the bolus of the anesthetic to be injected. The correct location als

5、o protects the patient against mechanical nerve and vessel lesions.,Other technologies,GE Healthcare: a modular solution Philips/Agilent has licensed the acceleration measurement technology from Organon Teknika Stand-alone competitors: Peripheral nerve stimulators with no quantitative measurement TO

6、F Guard or TOF Watch (Organon Teknika): accelerography Paragraph (Vital Signs): piezoelectric MechanoMyography,Comparison to peripheral nerve stimulators,Only stimulation, no quantitative measurement requires user intervention inaccurate no documentation ( no trends!) Battery operated Few stimulatio

7、n modes Price: PNS module (or given free),Comparison to TOF Watch / TOF Guard,Measures the acceleration of the thumb Battery operated Separate vs. integrated an extra display to look at no documentation, no data integration Ease of use acceleration transducer vs. MechanoSensor D-O: recovery note Pri

8、ce: TOF Watch module,Accelerometry,An acceleration transducer in the tip of the finger The thumb must always move in the same direction, hand must be immobilized Attachment not as easy as with the MechanoSensor Less robust,The NMT Module Strengths,Ease of use MechanoSensor Automatic operation Recovery Note Integrated, all-in one Two sensor options All stimulation modes Regional block with nerve stimulation Documentation with other vital signs,