BACKGROUND The paucity of easy-to-use, reliable objective neuromuscular monitors is an obstacle to universal adoption of routine neuromuscular monitoring. Electromyography (EMG) has been proposed as the optimal neuromuscular monitoring technology since it addresses several acceleromyography limitations. This clinical study compared simultaneous neuromuscular responses recorded from induction of neuromuscular block until recovery using the acceleromyography-based TOF-Watch SX and EMG-based TetraGraph. METHODS Fifty consenting patients participated. The acceleromyography and EMG devices analyzed simultaneous contractions (acceleromyography) and muscle action potentials (EMG) from the adductor pollicis muscle by synchronization via fiber optic cable link. Bland-Altman analysis described the agreement between devices during distinct phases of neuromuscular block. The primary endpoint was agreement of acceleromyography- and EMG-derived normalized train-of-four ratios greater than or equal to 80%. Secondary endpoints were agreement in the recovery train-of-four ratio range less than 80% and agreement of baseline train-of-four ratios between the devices. RESULTS Acceleromyography showed normalized train-of-four ratio greater than or equal to 80% earlier than EMG. When acceleromyography showed train-of-four ratio greater than or equal to 80% (n = 2,929), the bias was 1.3 toward acceleromyography (limits of agreement, -14.0 to 16.6). When EMG showed train-of-four ratio greater than or equal to 80% (n = 2,284), the bias was -0.5 toward EMG (-14.7 to 13.6). In the acceleromyography range train-of-four ratio less than 80% (n = 2,802), the bias was 2.1 (-16.1 to 20.2), and in the EMG range train-of-four ratio less than 80% (n = 3,447), it was 2.6 (-14.4 to 19.6). Baseline train-of-four ratios were higher and more variable with acceleromyography than with EMG. CONCLUSIONS Bias was lower than in previous studies. Limits of agreement were wider than expected because acceleromyography readings varied more than EMG both at baseline and during recovery. The EMG-based monitor had higher precision and greater repeatability than acceleromyography. This difference between monitors was even greater when EMG data were compared to raw (nonnormalized) acceleromyography measurements. The EMG monitor is a better indicator of adequate recovery from neuromuscular block and readiness for safe tracheal extubation than the acceleromyography monitor. EDITOR’S PERSPECTIVE

中文翻译：

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来自基于加速肌电图和肌电图的神经肌肉监测器的同侧和同时反应比较。

背景技术缺乏易于使用、可靠的客观神经肌肉监测器是普遍采用常规神经肌肉监测的障碍。肌电图 (EMG) 已被提议作为最佳的神经肌肉监测技术，因为它解决了几个加速度计的局限性。该临床研究使用基于加速度计的 TOF-Watch SX 和基于 EMG 的 TetraGraph，比较了从诱导神经肌肉阻滞到恢复期间记录的同步神经肌肉反应。方法 五十名同意的患者参与。加速度计和 EMG 设备通过光纤电缆链接同步分析来自拇内收肌的同步收缩（加速度计）和肌肉动作电位 (EMG)。Bland-Altman 分析描述了神经肌肉阻滞不同阶段设备之间的一致性。主要终点是加速度计和 EMG 衍生的标准化四组比率的一致性大于或等于 80%。次要终点是四组恢复比率范围内的一致性小于 80%，以及设备之间的四组基线比率的一致性。结果 Acceleromyography 显示归一化的四列比率大于或等于 80% 早于 EMG。当加速度计显示四列比值大于或等于 80% (n = 2,929) 时，加速度计的偏差为 1.3（一致性限制，-14.0 到 16.6）。当 EMG 显示四组比率大于或等于 80% (n = 2,284) 时，对 EMG 的偏差为 -0.5（-14.7 到 13.6）。在加速度计范围四列比率小于 80% (n = 2,802) 中，偏差为 2.1（-16.1 到 20.2），在 EMG 范围四列比率小于 80% (n = 3,447) )，它是 2.6（-14.4 到 19.6）。与 EMG 相比，加速度计的基线四组比率更高且变化更大。结论 偏差低于以前的研究。一致性的范围比预期的要宽，因为在基线和恢复期间，加速度计读数的变化大于 EMG。基于 EMG 的监视器比加速度计具有更高的精度和更大的可重复性。当将 EMG 数据与原始（非标准化）加速度计测量值进行比较时，监视器之间的这种差异甚至更大。EMG 监测器是神经肌肉阻滞充分恢复和安全气管拔管准备就绪的更好指标，而不是加速肌电图监测器。编辑的观点