连续无创血压(CNAP)与传统无创血压(NIAP)在剖宫产脊椎麻醉后血压监测中的比较

目的 研究与传统无创血压（non-invasive arterial pressure，NIAP）监测相比，剖宫产脊椎麻醉（简称脊麻）时连续无创血压（continuous non-invasive arterial pressure，CNAP）监测是否有利于维持产妇血流动力学稳定。方法 选择ASA Ⅰ~Ⅱ级，择期在脊麻下行剖宫产手术的产妇40例，采用随机数字表法将产妇分为2组，CNAP组（CS组）和NIAP组（N组）。血压的管理采用相同的方案，N组根据NIAP测定的血压数据，CS组根据CNAP测得的数据。我们比较了CNAP与NIAP监测的准确性和精确性，使用Bland-Altman散点图对获得的数据进行统计学分析。并记录两组产妇脊麻后低血压出现时间、低血压的发生率和血流动力学稳定的时间。结果 根据2 270对数据，CNAP与NIAP在SBP、DBP和MAP平均偏倚（NIAP-CNAP）和标准差分别为（-4±14）mmHg、（-9±14）mmHg和（-6±13）mmHg。脊麻后两组严重低血压发生率CS组明显低于N组（11.1% vs.28.9%，P=0.035），CS组血流动力学的稳定时间明显长于N组（93.5% vs.83.7%，P=0.01）。结论 与NIAP监测相比，剖宫产脊麻时CNAP监测有利于维持产妇血流动力学的稳定。

Impact of continuous non-invasive arterial pressure(CNAP)and non-invasive arterial pressure(NIAP)monitoring on hemodynamic fluctuation during spinal anaesthesia for cesarean section

Objective To assess the ability of a continuous non-invasive arterial pressure (CNAP) monitoring system to reduce intra-anesthetic hemodynamic fluctuation during caesarean section compared with non-invasive intermittent arterial pressure (NIAP) measurement. Methods Fourty healthy women scheduled for planned cesarean delivery under spinal anesthesia were recruited for this study.They were divided into two groups:continuous non-invasive arterial pressure device (Group CS,n=20) and intermittent oscillometric arterial pressure measurement (Group N,n=20),by using a computer-generated random number table.Blood pressure (BP) management was performed using the same protocol,with BP measured by intermittent BP cuff (i.e.,NIAP measurement) in Group N or by CNAP monitoring in Group CS.We assessed the accuracy and precision of the CNAP and NIAP measurement using Bland-Altman.Additionally,the time of hypotension after spinal anesthesia,the incidence of hypotension and the duration of hemodynamic stability were recorded. Results From 2 270 arterial pressure readings,biases (SD) for NIAP-CNAP for systolic blood pressure (SBP),diastolic blood pressure (DBP) and mean blood pressure(MBP) for all patients were(-4±14 mmHg),(-9±14 mmHg) and (-6±13 mmHg),respectively.Severe hypertension occurred less frequently in Group CS than in Group N after spinal anesthesia (11.1% vs.28.9%,P=0.035).The duration of hemodynamic stability (systolic BP 80%-110% of baseline) intraoperatively was longer in the Group CS than in the Group N (93.5% vs.83.7%,P=0.01). Conclusion CNAP monitoring may improve hemodynamic stability in the parturients during spinal anaesthesia compared with NIAP measurement.