一种新型血压测量装置设计及其辨识方法的研究

根据水银血压计测量的柯氏音原理,设计了一种新的基于听诊法电子血压测量系统:利用嵌入在电子血压计装置内部的微小拾音器,通过连通器直接拾取来自袖带耦合到的柯氏音信号;血压参数辨识算法则根据柯氏音与脉搏波时相的一致性,采用柯氏音能量幅度积计算每个脉搏对应柯氏音的特征值,并利用柯氏音特征值类聚法进行归类以确定其时相位置并最终得到血压值.经比对实验和统计分析表明,该血压测量装置与标准水银血压测量方法具有良好的一致性和准确性.     

柯氏音信号拾取装置的研制

目的：设计血压柯氏音信号采集装置,用该装置实现基于柯氏音方法的血压测量。方法：通过传音器采集柯氏音信号,根据柯氏音信号出现和消失对应的袖带压力得到收缩压和舒张压,将该装置的血压测量结果与人工听诊法测量结果对比,验证结果的可信性。结果：2种方式得到的血压结果差别很小,用该装置测量血压结果是可信的。结论：用该装置可实现测量血压,进一步可以研究用该方法实现基于柯氏音原理的血压自动测量。     

关于水银式与电子式血压计临床测量血压值偏差的分析

在临床医疗护理中要大量地绘患者无创测量血压，无创血压测量的方法很多．诸如柯氏音法、测振法，超声法、双袖带法。恒定袖带法、逐拍跟踪法、张力测定法、恒定容积法等，临床实践中多采用柯氏音法、测振法。柯氏音法多应用于水银式或指针式普通血压计，测振法多应用于血压的电子自动测量，医护人员经常反映用普通的水银式或指针式血压计测量的血压与电子自动测量的血压值偏差很大。其实这里存在着一些误区。下面就这一问题笔者进行肤浅的探讨。     

等效听诊法无创自动测量血压计的提出

介绍两种无创自动测量血压计—听诊法（又称柯氏音法）血压计和示波法（又称振荡法）血压计的工作原理,指出导致测量准确度不理想的原因。通过仔细观察传统听诊器法水银血压计测量血压的过程,发现伴随着柯氏音响的同时,水银柱会抖动。可根据水银柱第一次抖动和最后一次抖动确定收缩压和舒张压的现象,认真分析提出了准确度能大幅提高的等效听诊法无创自动测量血压计。指出在现有示波法无创自动测量血压计的基础上,实现等效听诊法无创自动测量血压计,不仅完全可行,而且非常简易。     

推广电子压力计在血压测量的应用

目前血压测量主要使用的是台式血压计、血压表和电子血压计三种。血压表精度差;台式血压计会造成汞污染;电子血压计存在测量结果不准确的问题。为此,文章提出用电子压力计取代台式血压计中的汞柱压力计,既保留了医护人员习惯的传统＂柯氏音＂测量法,又彻底解决台式血压计汞污染和电子血压计测量结果不准确的问题,是一种精度高、稳定性好、经济环保的血压测量方式。     

三种不同测量原理血压计测量结果差异性研究

目的探讨柯氏音测压原理血压计、示波法血压计、脉搏波法血压计测量血压结果的差异性。方法随机选择2015年10月至11月,在我院住院的患者及医务工作人员共计106例,其中男50例,女56例。年龄20岁~87岁,平均54岁。高血压患者51例,平均65岁;非高血压患者55例,平均42岁。分别使用柯氏音测压原理血压计、示波法血压计、脉搏波法血压计按相同操作规程测量肱动脉血压,比较三者测量结果的差异。结果柯氏音测压原理血压计、示波法血压计、脉搏波法血压计三种血压计测得的血压值差异均无统计学意义(P0.05)。以柯氏音测压原理血压计测得的血压值为标准,对脉搏波法血压计与示波法血压计测量血压值的准确性进行频数与构成比的分析,在一定程度上得出脉搏波法血压计所测得血压值与柯氏音测压原理血压计相对接近,浮动的幅度较小,更为准确。结论在血压测量方面,脉搏波法血压计测得血压值较示波法血压计测得血压值与柯氏音测压原理血压计更接近,且脉搏波法血压计更安全环保、操作简单、便于携带,可以应用于临床。     

基于振动法和柯氏音法的无创血压测量值差异性研究

对无创血压测量仪测量值误差异性展开分析。用与各种血压测量技术进行比较的方法，着重分析了振动法无创血压测量和柯氏音听诊法。使用振动法无创伤血压测量监护仪和柯氏音听诊法对样本人群进行了血压测量，分析所得数据，结果表明，基于振动法和柯氏音法无创血压测量仪测量值差异小，准确性也比较好。同时，也展望了无创血压装置未来的发展方向。     

基于示波法和柯氏音法的双踪电子血压测量系统

目的：为了深入研究示波法血压测量技术，获取基于个体特征的血压测量方法，我们设计了基于示波法和电子柯氏音法的血压测量平台，同步采集袖带放气过程中的振荡波和电子柯氏音。方法：使用固体振动传感器获取声音振动信号，使用压力传感器经过信号调理后获得袖带压力和振荡波信号，使用14bits数据采集卡USB6009同步采集上述信号。结果：对压力传感电路以及电子柯氏音电路经过定标后，开展了初步的预试验，试验结果表明该血压测量平台能够有效的获取袖带充放气过程的振动波以及电子柯氏音。     

一种基于移动家庭医生平台的医患共享式电子血压计的准确性评估

目的:评估一款基于物联网移动家庭医生平台的医患共享式电子血压计的准确性。方法:采用Excel随机数表法抽取100例住院患者,分别应用医患共享式电子血压计与台式水银血压计检测其入院时血压,并进行对照比较,采用英国高血压协会(BHS)标准对比分析两种血压计测量结果的差异性。结果:两种血压计所测得的收缩压和舒张压的差异均无统计学意义;经BHS标准分析,两种血压计测得的收缩压和舒张压的差值在≤5 mmHg、≤10 mmHg、≤15 mmHg范围内的例数占总例数的百分比分别为70%、91%、98%和76%、94%、100%,评分等级为A,均达到BHS标准规定的医用电子血压计的等级要求,其中有2次测量的收缩压差值>15 mmHg。结论:基于物联网的医患共享式电子血压计的准确率达到了相关国际论证的精度标准,可用于普通人或患者的远程家庭医生平台模式的血压测量。     

血压计的使用及注意事项

测量血压是护理工作中最基础的工作之一。保证测量数据的准确是很重要的,人工测量和自动测量用的血压计所操作的方法是一样的。自动测量选用柯氏音法和振荡法(示波法)。人工测量的血压计是水银柱血压计和气压表式血压计。在具体操作中应采取相应措施保证测量的准确。     

臂式电子血压计与汞柱式血压计测量结果对比观察

目的:为了探讨臂式电子血压计与汞柱式血压计血压测量结果的准确性,为临床血压测量提供指导。方法:从本院门诊患者中随机选取153例作为被测对象,分别对其采用臂式电子血压计和水银血压计进行血压测量,并分别将血压测量结果记为研究组和对照组,观察两组血压测量结果之间的差异。结果:研究组和对照组收缩压分别为(112.79±15.48)mmHg和(112.35±15.16)mmHg,组间差异不显著(P>0.05);研究组和对照组舒张压分别为(71.12±9.85)mmHg和(70.36±9.47)mmHg,组间差异不显著(P>0.05)。结论:臂式电子血压计血压测量结果整体高于汞柱式血压计,但是两者之间差异不显著,由于臂式电子血压计测量操作更加简单方便,易于携带。     

自动血压计测量值一致性评估方法的应用

目的：通过对自动血压计和标准汞柱式血压计测量值的对照分析,探讨2种测量方法定量测量结果一致性评估方法在自动血压计测量准确性方面的应用。方法：采用组内相关系数评价重复测量的信度,利用Bland—Ahman分析方法评估自动血压计和标准汞柱式血压计测量值的一致性。同时,比较欧洲高血压协会（European Society of Hypertension,ESH）关于血压计评估国际标准的评测结果。结果：该次被测的自动血压计未通过ESH的评估方案。汞柱式血压计收缩压测量值的组内相关系数为0．937,舒张压为0．849;被测血压计收缩压测量值的组内相关系数为0．944,舒张压为0．929。收缩压测量值差值的95％一致性界限为-10.20～16．94mmHg（1mmHg=133．322Pa）．舒张压为-6．25～11．69mmHg。结论：正常状态下,Bland—Ahman分析和ESH评估方案的判断结果是相同的。     

Comparison of three devices for measuring blood pressure

Blood pressure measurement with two automatic devices, Dinamap 845 and Sentry, was compared with the standard mercury sphygmomanometer, by means of a 3-period crossover experiment. Both automatic devices read diastolic pressure considerably lower than the mercury sphygmomanometer (about 7 mmHg on average); agreement was better for systolic pressure. Device differences in individual patients were often much higher. To assess the patient's emotional pressor response during manual measurement, Dinamap was used to monitor blood pressure before, during and after measurement with the mercury sphygmomanometer. No rise in pressure was found. It is concluded that the three devices can often give different values, and that the physician's involvement cannot explain these differences.     

The random-zero versus the standard mercury sphygmomanometer: a systematic blood pressure difference

The random-zero and standard mercury sphygmomanometers are used frequently, and sometimes interchangeably, in epidemiologic studies. To determine whether there is a systematic difference between them, the authors measured systolic, fourth-phase, and fifth-phase diastolic blood pressures using both sphygmomanometers simultaneously in a series of six experiments. For most experiments, the system for simultaneous blood pressure measurements employed one cuff connected to both sphygmomanometers, which were carefully calibrated and read by two trained technicians using a double stethoscope. Order of use of the random-zero sphygmomanometer was randomly assigned, and technicians were blind to each others readings. At deflation rates of 2 mmHg/second, readings of the random-zero sphygmomanometer were systematically lower than those of the standard mercury sphygmomanometer: -0.9 mmHg for systolic, -1.8 mmHg for fourth-phase, and -1.8 mmHg for fifth-phase diastolic blood pressures (all differences, p less than 0.001). The difference persisted after adjustment for subject age, sex, heart rate, blood pressure level, observer, and room temperature, and was present for varying deflation rates. However, by draining the residual mercury from a random-zero sphygmomanometer and using the instrument as if it were a standard mercury sphygmomanometer, much of the difference between the two was eliminated. This suggests that the mechanism for the difference relates to the increased height of mercury in the random-zero manometer tube. The authors conclude that the random-zero and standard mercury sphygmomanometers should not be used interchangeably in epidemiologic studies.     

一种基于脉搏波的无创连续血压测量方法

提出一种基于脉搏波的无创连续血压测量方法。该方法通过提取人体肱动脉脉搏波的特征参数,根据逐步回归分析建立的血压特征方程估计人体每搏的血压,实现无创连续血压测量。实验结果表明,采用此方法测得的血压与水银血压计测得的血压具有很好的一致性,收缩压与舒张压的平均差值都小于3mmHg,标准误差都小于5mmHg。     

汞柱式血压计与电子血压计测量结果异常研究

目的：分析汞柱式血压计与电子血压计测量结果差异。方法：利用血压计标准器对汞柱式血压计进行检定,把检定合格的汞柱式血压计同电子血压计一起,在相同条件下对不同患者进行测量,计算出汞柱式血压计与电子血压计血压测量的差值。结果：10名被测量患者中有7名患者血压值在最大允许误差范围内,赋予差值的电子血压计可信度为70%。结论：在使用电子血压计时,一定要按说明要求,规范操作,减少人为因素引起的差异。     

动态血压记录仪测量准确性的实验研究

本研究以公认测量血压比较准确的汞柱式血压计听诊为标准,通过比较英国ＯｘｆｏｒｄＭｅｄｉｌｏｇ动态血压监测记录仪测得的血压值,观察了该记录仪测量血压的准确性。在测量中以三通管将汞柱式血压计与英国Ｏｘｆｏｒｄ Ｍｅｄｉｌｏｇ动态血压监测记录仪相连,在记录仪测量血压的同时进行听诊。又在人为设计胆识箕测量准确性的状态下,进行了测量对比。结果表明,该记录仪准确交好,尤以测量收缩压更国准确。各状态下,仅在记录     

Oscillometric finger blood pressure versus brachial auscultative blood pressure recording

In this study, a recently marketed proprietary finger blood pressure monitor, the Marshall, Astro F-88, was compared with the standard auscultative brachial mercury sphygmomanometer on 125 subjects. Measurements were undertaken according to the standards set by the American Heart Association. Sensitivity of the finger blood pressure measurement was 76% for systolic and 75% for diastolic blood pressure in diagnosis of high blood pressure (systolic greater than 140 mm Hg and diastolic greater than 90 mm Hg). Specificity was 86% for systolic and 82% for diastolic blood pressure. Positive predictive values were 58% for systolic and 38% for diastolic blood pressure in the study population in which prevalence of hypertension was 12%. The correlation coefficient (Pearson) for systolic values between devices was 0.76 (P less than .0001) and 0.57 (P less than .0001) for diastolic pressure. Values obtained by the finger monitor were found to be higher than those obtained by the mercury sphygmomanometer. Mean differences and standard deviations (paired t test) for systolic and diastolic pressures between the two devices were 2.3 +/- 14.9 mm Hg (P less than .08) and 2.9 +/- 14.5 mm Hg (P less than .02), respectively. These values are not in accordance with the proposed national standards because only 48% of the systolic and 37% of the diastolic blood pressure measurements were within 5 mm Hg of the mercury sphygmomanometer measurements. Therefore, although these differences may well be due to different techniques of monitoring employed by the devices, this device is not recommended for evaluation of blood pressure.