同一肢体正反放置袖带测量上臂肱动脉血压值的比较

目的比较同一肢体采用多参数心电监护仪,正放置袖带(袖带橡胶管朝手臂下方)与反放置袖带(袖带橡胶管朝手臂上方)测量上臂肱动脉血压值的变化。方法 2016年10-11月,便利抽样法选取长沙市某三级甲等医院神经外科重症监护室122例患者为研究对象。采用飞利浦intelliVue MP20-MP90多参数心电监护装置,在1d内分别于6个时间点进行同一肢体正、反放置袖带测量上臂肱动脉血压。以正放置袖带血压测量值为参照标准,比较反放置袖带血压测量值的诊断符合率以及相关性。结果多参数监护仪正、反放置袖带血压测量值,差异无统计学意义(P0.05)。反放置袖带血压测量值与参照标准有高度相关性(均P0.001)。结论采用多参数心电监护仪反放置袖带测量血压不仅能降低压迫袖带橡胶管造成的漏测,同时提高患者舒适度,对患者翻身活动影响小,对于需长期监测血压的患者具有较高的临床应用价值。     

袖带内幅与臂围的比率引起血压值误差的研究

目的:研究袖带内幅与臂围的比率引起血压值误差的规律性。方法:应用不同内幅的袖带测定血压,以袖带内幅与臂围的比率为40％所测得的血压作为基准,与之相比较,求出臂围的20％～90％的袖带幅度所测得的血压误差的平均值,并找出其规律性。结果:臂围30％幅度的袖带测定的收缩压误差值为4.7 mmHg,舒张压误差值为3.5 mmHg;臂围50％幅度的袖带测定的收缩压误差值为-4.1 mmHg,舒张压误差值为-1.4 mmHg;臂围60％幅度的袖带测定的收缩压误差值为-8.9 mmHg,舒张压误差值为-4.9 mmHg。结论:袖带内幅与臂围的比率和血压误差值之间存在线性关系,回归方程:Y=28.32-0.69 x(收缩压),Y=19.12-0.48 x(舒张压)。     

桡动脉压与袖带压差异的临床研究

笔者在临床实践中发现患者的直接动脉压与常规的袖带压值之间存在一定差异，并不相吻合。而我们平日所谈的血压大多是指袖带压值。但我们在手术当中许多病人特别是对于一些高龄及危重病人常常需要直接动脉压的监测。这样以来，术前的血压值对于术中血压的观测与处理及术中的血压值对术后病人的处理将产生一定的影响。所以笔者认为搞清它们之间的关系很重要。笔者随机抽取30例开胸病人并对其血压进行测量观察，结果报告如下：     

影响测量血压的有关因素

影响测量血压的有关因素大连计划生育科研所林荃１．袖带宽窄对测量血压的影响：从测量血压的袖带来看是有一定规格的，要求袖带的宽度比被测肢体直径宽２０％，袖带过宽则血压偏低，因袖带过宽则有较长的一段血管被压，血流阻力增加，在血流尚未到达袖带下缘时，脉搏即可...     

不同规格袖带对血压测量值的影响

[目的]通过按臂围大小采用不同规格的袖带（气囊长度和宽度不同）对人群进行血压测量，以比较袖带过长、过短以及过窄对成人血压测量值造成的影响。[方法]采用横断面研究，连续入选520例门诊病人，根据臂围数值选用不同型号的血压测量袖带进行血压测量。[结果]袖带过长，可能低估病人的血压值（P〈0．05）；袖带过短或过窄，可能高估病人的血压值（P〈0．05）。[结论]在血压测量中，袖带过长、过短或过窄均影响病人血压测量值，建议尽可能根据臂围尺寸选择合适的血压测量袖带，以期获得准确的血压数值。     

两种血压计袖带测量下肢血压对比研究

目的研究两种不同血压计袖带的气囊长度、宽度对下肢血压测量值的影响,探讨下肢血压准确的测量方法。方法对69名患者分别采用普通血压计袖带气囊、新型下肢袖带气囊测量下肢血压,普通血压计袖带气囊测量肱动脉血压,进行自身对照研究。结果普通血压计袖带气囊与新型下肢袖带气囊测量下肢血压相比,收缩压经t检验,t=4.44,P<0.001,舒张压经t检验,t=3.01,P<0.01,具有统计学意义;新型袖带气囊测量体表下肢与普通袖带气囊测量上肢血压相比,收缩压经t检验,t=-7.09,P<0.001,舒张压经t检验,t=-7.24,P<0.001,也具有统计学意义。结论普通血压计袖带气囊测量下肢血压比新型袖带气囊测量的下肢血压偏高,而新型下肢袖带气囊测量较准确。新型袖带气囊测量的下肢血压高于普通袖带气囊测量的上肢血压,符合生理特点,与测量工具无关。     

根据新生儿体重选择血压袖带的探讨

目的探讨根据新生儿体重选择适宜型号的血压袖带的可行性。方法抽取某院NICU和产休病房的新生儿共80例，测量其体重与臂围，进行回归分析，并求其回归方程。结果新生儿体重与臂围之间存在线性回归关系，得出由体重（W）测量值计算臂围（C）的直线回归方程C=3．641＋2，该回归方程有统计学意义（P〈0．01）。结论在新生儿血压测量过程中，体重〈2．0kg的新生儿可选择小号袖带；体重在2．0～3．0kg范围内的可选择中号袖带；体重〉3．0kg的可选择大号袖带，此方法与测量臂围选择袖带的一致性好，且更加简便易行。     

血压计袖带污染的调查及防护

目的了解医院血压计袖带细菌污染情况，探讨测量血压时设置防护屏障的必要性和可能性。方法对60只血压计袖带的细菌污染情况进行调查，并对100例测量血压时设置防护屏障做了研究。结果血压计袖带污染情况严重，有无防护屏障对血压值的影响差异无显著性（P〉0．05），同时防护屏障阻挡病菌效果好。结论选用单层塑料薄膜可作为测血压屏障物有效阻挡病菌的穿透，具有简单易行、实用有效等优点。     

保鲜袋作为一次性血压计袖带套在血压监测中的应用

目的探讨采用保鲜袋作为血压计袖带套监测血压对血压测量值的影响。方法选取100例患者分别2d采用保鲜袋作为血压计袖带套测量血压并同时使用传统血压计袖带测量血压,采用自身对照法测量血压共400次,比较两种方法测得血压值结果。结果第1种方法先采用保鲜袋作为血压计袖带套测量100例患者血压收缩压、舒张压值分别为（120．92±19．35）,（72．12±15．10）mmHg与后使用传统血压计袖带测量血压收缩压、舒张压值（121．50±18．00）,（70．37±14．00）mmHg比较,差异均无统计学意义（t分别为0．73,0．32;P〉0．05）;第2种方法先用传统方法测量血压100例患者血压收缩压、舒张压值分别为（122．044-15．21）,（74．52±9．96）mmHg与后使用保鲜袋作为血压计袖带套垫测量血压收缩压、舒张压值（122．06±15．26）,（73．86±10．37）mmHg比较,差异均无统计学意义（t分别为0．03,0．06;P〉0．05）。结论采用保鲜袋作为一次性血压计袖带套监测血压,操作简便,符合感染管理要求,不影响血压数值的准确性。     

ICU患者持续外周血压监测袖带压疮的预防方法探讨

目的观察普通卫生纸在预防袖带压疮中的效果。方法将100例持续外周血压监测的患者随机分为对照组和观察组各50例。对照组每2h松开袖带缓解压力,定时清洁局部皮肤;观察组采用普通卫生纸将患者测量部位缠绕2周,再将测量袖带缠绕在卫生纸外围进行持续测量。结果观察组皮肤完好无损,无1例发生袖带压疮。结论普通卫生纸能有效预防持续外周血压监测患者的袖带压疮。     

Cuff width influence on blood pressure measurement during the pregnant-puerperal cycle

BACKGROUND: The correct evaluation of blood pressure (BP) during pregnancy is a crucial factor in the prevention of eclampsia. Following American Heart Association (AHA) guidelines to employ a correct cuff width (CCW), 20% larger than arm diameter, we demonstrate that the standard cuff width (SCW), 12 cm wide, is too large for lean women causing underestimation of BP. AIMS: To identify the arm circumference (AC) in pregnant women and the corresponding cuff width; to compare BP records from CCW vs. SCW; and to identify under- and overestimation of BP in SCW reading. DESIGN: A follow up study of BP was performed in 104 pregnant women using two cuffs widths (CCW vs. standard one). The investigation was carried out during all antenatal appointments and postpartum stage in two maternity hospitals. In every appointment BP was registered three times with each type of cuff; and the means of those three readings were compared. METHODS: The CCW for each woman was selected according to AHA recommendation for cuff width size (20% larger than arm diameter), which was based on the classical European and North-American studies. Results. Arm circumference varied from 20 to 38 cm requiring a cuff width from 8 to 14 cm. The CCW most employed was 10 cm wide. The SCW (12 cm) was employed as CCW in only 13.4% of the subjects. Statistical difference was found on BP means when comparing both cuffs (P < 0.05), reaching 23 mmHg in systolic values and 20 in diastolic ones. Such differences showed a serious underestimation when SCW was employed in 80.8% of the subjects and overestimation in 5.8% of obese subjects. CONCLUSION: Our findings showed that the SCW underestimates BP of pregnant women. Our hypothesis is that such underestimation may lead to the misdiagnosis of pre-eclampsia, particularly in lean pregnant women.     

吸痰时咳嗽强度对气囊压力不达标的预测价值

目的 探讨吸痰时咳嗽强度对气囊压力不达标的预测价值,旨在为个性化校正气囊压力提供参考.方法 2020年6月至2021年2月,便利选取某院50例建立人工气道的患者,采用半定量咳嗽强度评分法(semi-quantitative cough strength score,SC-SS)评估吸痰时咳嗽强度,分析咳嗽强度与气囊压力...     

人工气道气囊内压力与误吸量相关性动物实验研究

目的探讨人工气道气囊内压力与误吸的相关性。方法Sheridan气管导管气囊上缘伴行7.0 Fr吸痰管,健康杂种犬麻醉后置入内径7.0 mm的气管导管,给人工气道气囊充气,选择不同水平囊内压,在气囊上声门下通过伴行的吸痰管注入10 mL生理盐水,保留5 min,收集剩余液体量,漏出液体量即误吸量,观察比较各囊内压力下误吸量。结果囊内压力在29 mmHg时误吸量为0 mL,与囊内压力在26 mmHg误吸量为(0.48±0.48)mL相比有显著差异P<0.05。当囊内压力在15mmHg时误吸量为(1.3±1.57)mL,18 mmHg时误吸量为(0.8±1.0)mL,22 mmHg时误吸量为(0.75±0.8)mL,与囊内压力在26 mmHg比较均无显著差异。囊内压力在11 mmHg时已出现漏气。结论囊内压力在15~26 mmHg时误吸量无显著差异,临床工作中可结合其他因素选择此范围内的压力。     

Comparative effects of cuff size and tightness of fit on accuracy of blood pressure measurements

To determine the effect of snugness of cuff wrap on the accuracy of blood pressure (BP) measurements, we performed two studies on 6 healthy volunteers. In both studies, control values were obtained from the right upper arm with cuffs of appropriate size and snug fit. Study 1 had two phases. In the first, cuffs of appropriate size were wrapped snugly around the upper left arm of seated subjects. The effects of two other degrees of cuff snugness on the measurement of BP were evaluated by placing a filled 250-mL intravenous fluid bag between the cuff and arm over the triceps, measuring BP, then draining the same bag of half its contents and then all of its contents without rewrapping the cuff (loose, very loose fit), each time measuring BP. The second phase of study 1 was identical in procedure, except that the cuffs used on the left arm were one size too small. In study 2, the experimental cuffs were placed just above the right ankle. To alter the signal-to-noise ratio, BP was raised or lowered: the standing position elevated mean BP by an average of 90 mm Hg, and elevation of the legs decreased mean BP by an average of 43 mm Hg. In study 1, we found that appropriately sized cuffs, whether wrapped tightly or loosely, gave correct BP readings. Cuffs snugly wrapped, but too small for the subject, gave high BP readings, on the average by approximately 10 mm Hg. Loose wrapping of small cuffs gave variable results in individual subjects that exaggerated systolic BP from 2 to 80 mm Hg. In study 2, elevating the legs or standing decreased or increased BP consistently. Loose wrapping of appropriately sized cuffs around the ankles of the subjects had no additional significant effect on BP.     

Modality-specific facilitation and adaptation to painful tonic stimulation in humans.

The study assessed the influence of stimulus modality on adaptation or facilitation of pain during tonic cold and tourniquet pressure stimulation. Experimental set-up for the cold stimulation consisted of a thermo-tank with water, cooled to 3 degrees C, circulation pump, electronic thermometer and an electronic 10 cm visual analogue scale (VAS). Experimental set-up for the tonic pressure stimulation consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor, and an electronic VAS. The first experiment assessed temporal profiles of pain intensity and skin temperature during immersion of the non-dominant hand and lower arm into cold water for 3 min or until the pain tolerance limit was reached. The second experiment assessed temporal profile of cuff pain intensity during constant compressions for 10 min beginning at pain intensities of 2, 4, and 6 cm on the VAS ("VAS 2", "VAS 4" and "VAS 6" sessions). Subjects enduring cold stimulation for less than 3 min were defined as non-adapting to cold and vice versa. The intensity of cold pain in non-adapting subjects increased significantly faster than in adapting subjects and reached significantly higher magnitude. The course of pain intensity during constant compression, estimated by a linear regression line, was increasing or decreasing, representing facilitation or adaptation of pain, respectively. The typical profile of adaptation consisted of an "overshoot" in pain intensity, followed by a decrease in pain intensity. There was significant correlation in VAS slopes between sessions separated by 2-5 days, suggesting consistent pattern in pain responses to tonic pressure stimulation. Adaptation or facilitation rates and the overshoot magnitude were dependent on the initial pain intensity (2, 4, or 6 cm on the VAS). The facilitation rate was highest and the adaptation rate was lowest during the "VAS 2" session, while the facilitation rate was lowest and the adaptation rate was highest during the "VAS 6" session. The overshoot magnitude was lowest during "VAS 6" session. Adapting and non-adapting/facilitating responses to cold and to pressure during "VAS 6" session were not correlated, suggesting that pain course and therefore stimulus tolerance during tonic stimulation are modality-specific. The results of the study suggest that tolerance of tonic painful pressure and cold stimulations is specific to stimulus modality and may represent separate nociceptive mechanisms.     

Computer-controlled pneumatic pressure algometry--a new technique for quantitative sensory testing.

Hand-held pressure algometry usually assesses pressure-pain detection thresholds and provides little information on pressure-pain stimulus-response function. In this article, a cuff pressure algometry for advanced pressure-pain function evaluation is proposed.The experimental set-up consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor and an electronic visual analogue scale (VAS) for constant pain intensity rating. Twelve healthy volunteers were included in the study. In the first part, hand-held algometry and cuff algometry were performed over the gastrocnemius muscle with constant compression rate. In the second part, the cuff algometry was performed with different compression rates to evaluate the influence of the compression rate on pain thresholds and other psychophysical data. Pressure-pain detection threshold (PDT), pain tolerance threshold (PTT), pain intensity, PDT-PTT time and other psychophysical variables were evaluated.Pressure-pain detection thresholds recorded over the gastrocnemius muscle with a hand-held and with a cuff algometer, were 482 +/- 19 kPa and 26 +/- 1.6 kPa, respectively. Pressure and pain intensities were correlated during cuff algometry. During increasing cuff compression, the subjective pain tolerance limit on VAS was 5.6 +/- 0.95 cm. There was a direct correlation between the number of compressions, the compression rate and pain thresholds.The cuff algometry technique is appropriate for pressure-pain stimulus-response studies. Cuff algometry allowed quantification of psychophysical response to the change of stimulus configuration.     

对机械通气患者气管套管气囊压力的临床观察

目的判断机械通气患者气管套管气囊压力和注气量是否合适。方法对30例机械通气老年患者的气管套管气囊压力和注气量的实际值和理想值进行精确测量。结果53.3％的患者气囊实际压力和注气量过高，大于理想值。其中气囊实际注气量大于理想注气量3～5ml，气囊压力超过理想压力2～26cmH2O(0．2～2．6kPa)。结论临床大部分气管套管气囊压力和注气量偏高，应对机械通气患者的气管套管压力和注气量定期进行精确测量和调整，以减少气管套管对气管粘膜的损伤。     

Discrepancy of blood pressure between the brachial artery and radial artery

BACKGROUND:

In this study, we attempted to find the relations between blood pressure (BP) measured on the brachial artery (bBP) and BP assessed on the radial artery (rBP) in the right arm.

METHODS:

Three hundred and fifteen patients were enrolled in this study. Those who had peripheral vascular disease, wounds of arm skin or subcutaneous tissue infection were excluded. After a 15-minute equilibration and stabilization period after inducation of anesthesia, three bBP and rBP records were obtained sequentially using an oscillometric device with an adult cuff and infant cuff, respectively. Order for each BP was randomized.

RESULTS:

The bBP was significantly lower than the rBP (P<0.05). The difference between the two values varied from 13 to 18 mmHg in systolic BP (SBP), diastolic BP (DBP) and mean blood pressure (MAP) respectively. And the rBP was positively correlated with the bBP (r=0.872, 0.754, 0.765; P<0.001, <0.001, <0.001; SBP, DBP, MAP, respectively).

CONCLUSION:

The bBP value can be evaluated by the noninvasive measurements of rBP using an appropriate cuff in clinical practice.KEY WORDS: Blood pressure, Brachial artery, Radial artery, Correlation, Linear regression     

机械通气病人气管导管套囊压力监测值的差异性研究

[目的]探讨3种气管导管套囊压力监测方法的差异性[方法]对32例入住ICU的机械通气病人分别采用常规手指捏感法、最小闭合容量法、专用套囊测压表法各测气管导管囊内压1次,进行注气量及囊内压关系的比较。[结果]手指捏感法测压值较压力表法及最小闭合容量法明显偏高(P均<0.05),专用套囊测压表与最小闭合容量测压值比较,差异无统计学意义(P>0.05)。[结论]手指捏感法所测压力值偏高,专用套囊测压表法与最小闭合容量法可以相互取代,测压表法操作简便,测压准确可靠。