动脉血压监测患儿的安全管理

[目的]探讨护理安全管理对减少有创血压监测并发症的影响。[方法]将2012年1月—6月没有开展安全护理模式的50例患儿设为对照组,2012年7月—12月开展安全护理模式的50例患儿设为观察组,比较两组患儿常见并发症的发生率。[结果]观察组并发症发生率明显低于对照组,两组比较差异有统计学意义(P0.05)。[结论]对有创血压监测的患儿采取安全管理护理,明显降低了并发症的发生率。     

有创直接动脉血压监测

血压的监测分为无创血压监测和有创血压监测。我院手术室于2007年3月开展有创直接动压血压监测。     

有创动脉血压监测在手术麻醉中的应用

目的:对有创动脉血压监测在手术麻醉中的应用效果进行观察,以提高临床手术治疗的成功率。方法:将196例需要在术中进行麻醉治疗的患随机分成观察组与对照组各98例。对照组采用常规手术麻醉方法,观察组在手术麻醉过程中行有创动脉血压监测。比较两组的手术成功率、病死率、并发症发生率。结果:与对照组相比,观察组手术成功率更高,并发症发生率和病死率更低(P<0.05)。结论:有创动脉血压监测在手术麻醉中的应用有较大的作用,可以降低手术风险,为医生提供正确情况,使手术成功率大大提高。     

有创动脉血压监测在危重患儿抢救中的护理体会

总结了27例使用有创动脉血压监测患儿的护理经验,主要护理措施包括严防动脉内血栓形成,防止远端肢体缺血,防止感染,保持测压管通畅等,认为有创动脉血压监测具有直观、准确、及时、能动态反应危重患儿血压变化的优点,它可以及时准确地监测患者血压变化并给予相应的治疗和护理,极大地提高了危重患者的抢救成功率。     

动脉血压监测及其影响因素

动脉血压 (ABP)是一项重要的血流动力学指标 ,正确监测很重要。重点介绍ABP的生理及影响 ABP的生理及病理生理学因素 ,ABP的监测原则 ,ABP波形及其临床解释。     

护理风险管理对有创血压监测危重患儿的影响

[目的]探讨护理风险管理对有创血压监测危重患儿的影响.[方法]2015年1月-2015年12月选取80例行有创血压监测危重患儿为观察组,2014年1月-2014年12月选取80例行有创血压监测的危重患儿为对照组.对照组患儿给予常规护理,观察组患儿在对照组的基础上实施护理风险管理,比较两组患儿穿刺依从率、一次性穿刺成功率、患儿家属满意率、置管时间、并发症发生情况.[结果]观察组患儿穿刺依从率、一次性穿刺成功率、患儿家属满意率显著高于对照组(P＜0.05),导管留置时间长于对照组(P＜0.05);观察组患儿血栓、堵管、血肿、渗血、血流感染等并发症发生率低于对照组(P＜0.05).[结论]对有创血压监测危重患儿应用护理风险管理能有效减少患儿穿刺风险及并发症,提高患儿穿刺成功率及延长置管时间,确保穿刺更加安全有效.     

动脉血压监测及其影响因素

动脉血压(ABP)是一项重要的血流动力学指标，正确监测很重要。重点介绍ABP的生理及影响ABP的生理及病理生理学因素，ABP的监测原则，ABP波形及其临床解释。     

两种路径行动脉血压监测出血性并发症的比较

近年来全麻手术中经桡动脉行动脉血压监测已成为一种趋势,该路径具有病人疼痛小,并发症少的优点,而肱动脉往往不是动脉测压的首选路径,临床上大部分病人均可经桡动脉成功穿刺而完成动脉血压监测。少部分病人可能存在解剖异常的原因而不得不采用肱动脉路径。肱动脉因解剖位置浅表,搏动明显而穿刺容易,但临床上局部压迫止血的经验相对较少。本文回顾了近年来经上肢两种血管途径进行动脉血压监测的病例,比较经两种路径在血压监测后的出血性并发症的发生率。1材料与方法1.1一般资料2003年1月～2006年6月我院的外科手术中,215例进行了动脉血压监测,其中经桡动脉路径160例,经肱动脉路径55例。检查与治疗过程中一般首选桡动脉途径,如穿刺困难时改用肱动脉途径。所有病人均于术后即刻拔除动脉测压导管,并采用弹力绷带加压包扎进行止血,包扎止血时间均在24h以上。采用肱动脉路径的原因:因桡动脉搏动减弱而穿刺失败22例,穿刺导致动脉痉挛18例,桡动脉迂曲致导丝不能通过者8例,因动脉硬化致桡动脉搏动缺失7例。1.2评价指标研究采集了2组病人的临床资料,出血性并发症的发生例数,以及手术操作时间。1.3统计学处理2组病人的统计学资料比较采用F检验。检验水...     

体位对无创血压监测的影响

血压是重要的生命体征，血压的测量必须准确。测量血压时一般要求袖带与心脏处于同一水平，即坐位时平锁骨中线第四肋问水平，仰卧位时平腋中线水平，但进行长时间无创血压监测时很难做到让患者持续性坐位或仰卧位。侧卧位与仰卧位时测量血压有否不同，影响有多大，国内外鲜见报道。笔者通过比较仰卧位与左、右侧卧位无创血压测量的结果，探讨它们之间有否差异。     

Umbilical catheters and arterial blood pressure monitoring

The natural frequencies, damping coefficients, and accuracies of umbilical artery catheters were determined. The damping coefficients for the 3.5, 5.0, and 8.0 French catheters were 0.40 ± 0.04 (mean ± SD), 0.42 ± 0.05, and 0.19 ± 0.02, respectively. The natural frequencies were 24.2 ± 3.2 Hz (mean ± SD), 18.4 ± 3.5 Hz, and 26.8 ± 2.9 Hz, respectively. Measurements obtained with 3.5 and 8.0 French catheters were within 6% of the reference pressure at all pressures and rates tested. With the 5.0 French catheter, however, error greater than 10% from the reference pressure occurred when the rate was 200 pulses per minute or greater and the applied maximum pressure was 100 mm Hg or more.     

Hypertension management in patients receiving hemodialysis: the benefits of home blood pressure monitoring

Patients with end stage renal disease on hemodialysis are at risk for cardiovascular events and increased mortality. Hypertension contributes to these risks and can be difficult to assess due to unreliable blood pressure (BP) measurements at dialysis centers. A clinical practice grant from the American Nephrology Nurses'Association allowed for the purchase of 35 home BP monitors to study the use of these monitors to provide additional information for BP management. Findings indicated that home BP monitoring can be an effective tool in hypertension management.     

Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study

Introduction  

Invasive arterial blood pressure monitoring is a common practice in intensive care units (ICUs). Accuracy of invasive blood pressure monitoring is crucial in evaluating the cardiocirculatory system and adjusting drug therapy for hemodynamic support. However, the best site for catheter insertion is controversial. Lack of definitive information in critically ill patients makes it difficult to establish guidelines for daily practice in intensive care. We hypothesize that peripheral and central mean arterial blood pressures are interchangeable in critically ill patients.     

影响有创动脉血压监测的相关因素

在危重症监护病房(ICU),存在各种因素影响监测结果,如测量的部位、测量方式、压力传感器的高低、延长管的长度、延长管的弹性、与受测者的相关因素、体位的改变以及与测量者的经验等.本文重点综述有创动脉血压(IABP)监测有关方面的内容,探讨危重患者IABP监测的影响因素,以引起医护人员在临床工作中对动脉血压测量准确性的重视.     

The pharmacist and the management of arterial hypertension: the role of blood pressure monitoring and telemonitoring

Randomized controlled trials have documented that a team of health care professionals which includes a physician, a nurse and a community pharmacist may improve the benefit and adherence of anti-hypertensive therapy. If such a health care model relies on blood pressure telemonitoring, it can promote a stronger relationship between health care professionals and patients, and further improve BP control of hypertension. The major benefit of this collaborative approach is to center the patient’s management in a tailored way, providing comprehensive and preventive care based on health information technologies. In this review, the authors summarize recent clinical studies that evaluate the role of the community pharmacist in BP measurements, and in hypertension screening and control. The authors also describe the advantages of using blood pressure telemonitoring in home and ambulatory settings to evaluate potential alternatives to primary care in hypertension management.     

危重症监护室护士血压监测认知水平的调查研究

目的调查江苏省危重症监护室护士血压监测认知水平现状,分析现状原因。方法采用自行研制的调查表调查江苏省6所三级甲等医院13个危重症监护室165名护士血压监测认知情况并进行分析。结果危重症监护室护士血压监测认知得分为13.3~56.7(33.8±9.2)分。危重症专科护士认知得分(34.4±9.0)高于普通护士(30.0±9.6)(t=2.103,P=0.037)。结论尽管危重症监护室护士经常参与重症患者血压监测,但其认知水平亟需提高,在危重症专科护士培养中应加强相关知识培训。     

24-hour ambulatory blood pressure monitoring in male children receiving stimulant therapy

OBJECTIVE: To determine whether cardiac indices are altered as assessed by 24-hour ambulatory blood pressure monitoring (ABPM) in male children receiving either chronic methylphenidate or dextroamphetamine/levoamphetamine (Adderall) therapy. METHODS: Boys 7-11 years old who were receiving methylphenidate or Adderall for a minimum of 2 months were asked to participate. Subjects wore ambulatory blood pressure monitors for 24-hour periods both off and on stimulant therapy. RESULTS: Subjects (n = 17; 8 methylphenidate, 9 Adderall) were well matched. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate differed between off and on stimulant therapy (p < 0.05). DBP load calculated from ABPM reference data was increased significantly (9.0% +/- 5.6% on and 4.8% +/- 4.5% off therapy; p < 0.05) while subjects were taking Adderall. There was a trend toward a greater elevation in blood pressure load during awake hours and a more pronounced decrease during the asleep hours for periods on compared with off-stimulant therapy. This trend resulted in significant (p < 0.05) nocturnal dipping on-stimulant phases compared with off-stimulant therapy for both SBP and DBP (Adderall) and SBP (methylphenidate). Two subjects (1 Adderall, 1 methylphenidate) met the criteria to be considered hypertensive based both on mean awake and 24-hour blood pressure load assessments during their on-treatment period. One additional subject receiving Adderall therapy met the criteria to be considered hypertensive based on blood pressure load criteria while off therapy only. Positive correlation coefficients (p < 0.05) were found when comparing stimulant dose (mg/kg) with the percent change of mean SBP, DBP, and heart rate between off and on therapy (r = 0.56, 0.61, and 0.58, respectively). CONCLUSIONS: These preliminary data suggest that blood pressure and heart rate appear to be altered in male patients while receiving stimulant therapy for attention-deficit hyperactivity disorder. Blood pressure and heart rate screening and monitoring during stimulant therapy to determine whether alterations become clinically significant is encouraged.     

动态血压及其模拟家庭自测血压评价动态动脉硬化指数的方法学简化

目的探讨动态血压及其模拟家庭自测血压评价动态动脉硬化指数（ambulatory arterial stiffness index,AASI）的方法学简化。方法连续入选81例行24小时动态血压监测的患者。AASI的计算：首先根据血压监测所得舒张压与收缩压之间的关系计算出回归斜率,AASI定义为1减去该斜率。AASI2的计算：把动态血压监测数值按收缩压排序,从中选取收缩压的25%及75%分位数,计算出该两个收缩压对应的血压间关系的回归斜率。AASI2定义为1减去该斜率。家庭自测血压的模拟简化（AASI4）：应用24小时动态血压监测期间7：00、12：00、18：00、22：00 4个时间点的血压模拟家庭自测的4次血压。AASI4定义为1减去该4点舒张压与收缩压关系的斜率。Sym-AASI的计算：1-（1-AASI）/r,其中r为动态血压直线回归模型的相关系数。结果 AASI为0.51±0.16,AASI2为0.50（0.24,0.68）,两组比较差异无统计学意义（Z=-1.196,P〉0.05）,两者无相关性（r=0.186,P〉0.05）;AASI4为0.52（0.29,0.71）,与标准AASI差异无统计学意义（Z=-0.480,P〉0.05）,两者无相关性（r=0.123,P〉0.05）;标准的sym-AASI为0.26±0.16,4点sym-AASI4为0.29（0.08,0.47）,两组比较差异无统计学意义（Z=-0.005,P〉0.05）,且两者呈正相关关系（r=0.307,P〈0.01）。Bland-Altman及Mountain plot分析显示标准AASI与AASI2、AASI4不能替换使用,sym-AASI与sym-AASI4不能够替换使用。结论简化AASI2不能替代标准AASI,不能利用1日内家庭自测血压值来简化AASI的计算。     

Accuracy of oscillometric blood pressure measurement in critically ill neonates with reference to the arterial pressure wave shape

Objective To perform further evaluation of the oscillometric device for neonatal arterial blood pressure (ABP) measurement, using a catheter-manometer system (CMS) for accurate intraarterial measurement. We aimed to describe the influence of the radial artery wave shape on oscillometric ABP determination, as pressure, wave-shape influences the relationships between systolic arterial pressure (SAP),diastolic arterial pressure (DAP) and mean arterial pressure (MAP) in the wave. These relationships are part of the algorithms contributing to the final ABP determination in the oscillometric device.Design Intra-patient comparison of two blood pressure measurement systems.Setting Neonatal intensive care unit.Patients In 51 critically ill newborn infants, ABP was determined oscillometrically in the brachial artery and, simultaneously, invasively in the radial artery using a high-fidelity CMS. Clinical data of the infants were: gestational age: 29 (25–41) weeks; brithweight: 1200 (500–3675) g, postnatal age: 6 (2–46) h.Methods Statistical analysis was performed with the paired Student'st-test. Multiple regression analysis was used to determine the influence of birthweight and height of the blood pressure on the results.Measurements and main results In 51 infants, 255 paired values of SAP, DAP and MAP were recorded. In all recordings we determined the relationship between SAP, DAP and MAP, using the equation.MAP=%(SAP-DAP)+DAP. For SAP, DAP, MAP and , we computed mean differences (bias) and the limits of agreement (precision). Biases for SAP, DAP, MAP and were significantly different from zero (P<0.001) and the limits of agreement for SAP, DAP and MAP were wide: 18.8 mmHg, 17.2 mmHg and 15.2 mmHg respectively The relationship between invasive and noninvasive values is only partly (7–19%) influenced by the height of the blood pressure; low values of SAP, DAP and MAP tend to give overestimated oscillometric values. In the relationship between SAP, DAP and MAP, was found to be 47% invasively (as generally found in the radial artery in newborns) and 34% noninvasively (as generally found in the brachial/radial artery in adults).Conclusions Inaccuracy of the oscillometric device may be partly explained by the incorporation of an inappropriately fixed algorithm for final ABP determination in newborns. Care should be taken when interpreting the oscillometrically derived values in critically ill newborn infants.Abbreviations ABP Arterial blood pressure - SAP Systolic arterial pressure - MAP Mean arterial pressure - DAP Diastolic arterial pressure - PP Pulse pressure - MAP% Level of MAP in the wave in relation to SAP and DAP expressed as MAP% (MAP-DAP)/(SAP-DAP)×100% - CMS Catheter-manometer system - IRDS Idiopathic respiratory distress syndrome