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先心病患儿示波法与桡动脉置管法测量上肢血压的一致性
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DOI:
作者:
彭哲哲,孙瑛
PENG Zhe-zhe,SUN Ying
作者单位:
上海交通大学附属上海儿童医学中心麻醉科
Department of Anesthesiology,Shanghai Children's Mediacal Center,Shanghai Jiaotong University.
关键词:
示波法;无创血压;有创血压;先天性心脏病;儿童;一致性
oscillometric; noninvasive blood pressure; invasive blood pressure; congenital heart disease; children; agreement
摘要:
目的 在单纯室间隔缺损(VSD)或单纯房间隔缺损(ASD)儿童,采用示波法和有创桡动脉置管法同时测量上肢血压,分析其一致性。方法 选择单纯VSD或单纯ASD纠治术患儿35例,诱导完成后建立桡动脉有创监测通路连接监护仪行有创血压监测,同时,根据对侧上臂中点周径结合设备使用指南挑选袖带尺寸以便无创监测。选择气管插管后、手术开始前血流动力学稳定的任意时间段监测,设定无创血压测量间隔时间3min,重复测量5次,有创血压读数在每次无创测量袖带开始放气后,测量值显示前任意时刻读取。 结果 两种方法测定的收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)Pearson相关系数分别为0.798、0.774与0.880。Bland-Altman法分析显示,两种方法测量SBP、DBP和MAP的平均偏倚(Mean bias)与95%一致性界限(95%LOA)分别为-7.623(-24.996,9.750)mmHg、-2.880(-14.752, 8.992)mmHg和-1.606mmHg(-12.096,8.884)mmHg。 结论 在循环系统稳定的条件下,使用示波法测量单纯性VSD或单纯性ASD儿童上臂血压,MAP与DBP的测量一致性较好,而SBP尽管以统计学标准判断一致性良好,但是在实际应用中临床接受度有限。
Objective To evaluate the agreement of blood pressure measurement between oscillometric method and invasive radial artery cannulation (RAC) in children with simple ventricular septal defect (VSD) or simple atrial septal defect (ASD). Methods Thirty-five patients with simple VSD or simple ASD undergoing selective correction operation were included. oscillometric method measurement took place at contralateral arm once radial artery cannulation success after induction. The cuff was chosen followed recommendation by manufacture according to participants’ contralateral mid-limb circumference. A stable hemodynamic condition period was chosen to establish measurement. Five intermittent pairs of non-invasive blood pressure (NIBP) and invasive blood pressure (IABP) readings were recorded, IABP was read at a glance during cuff deflation before NIBP displayed. Measurement interval was set at three minutes. Results Pearson coefficients for SBP, DBP and MAP between osillometric method and invasive blood pressure measurement were 0.798, 0.774 and 0.880, respectively. The mean difference and 95% limits of agreement between NIBP and IABP measurements was -7.623mmHg (-24.996, 9.750) for SBP, -2.880mmHg (-14.752, 8.992) for DBP, and -1.606 mmHg (-12.096, 8.884) for MAP. Conclusions In a haemodynamically stable phase, the oscillometric method had good agreement in MAP and DBP measurements compared with invasive blood pressure measurement. As for SBP, although the agreement between two methods was acceptably judged by statistic criterion, its mean difference was clinically unacceptable.
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