臂围调查与血压计袖带大小的合理选择

目的调查北京地区成人高血压病患者右上臂臂围的数值,为临床工作中合理选择血压测量袖带提供一定的指导。方法用横断面研究,连续入选了424名成人高血压病患者(其中男性占61.6%),经右上臂的中点测量所有病例的臂围。根据臂围的数值将患者首先分为3组:1组臂围在22~26cm之间(小个成人),2组臂围在27~34cm(标准成人),3组臂围>34cm(大个成人)。再将患者分为两组:A组臂围<32cm,B组臂围≥32cm。结果在全部入选高血压病患者中,臂围均值为(29.6±2.6)cm。82.8%的患者右臂臂围在27~34cm之间,只有8.96%的患者臂围在22~26cm之间。无论男性和女性患者,其臂围和体质量指数(BMI)与腰围(WC)都呈显著相关性(BMI:r=0.810,WC:r=0.725,P均<0.01)。与A组比较,B组患者的血清肌酐、尿酸和三酰甘油都显著高于A组,而高密度脂蛋白胆固醇却显著低于A组。结论在当前临床实践中,需尽早采用气囊尺寸为13cm×30cm的袖带进行血压测量。另外,臂围增加可能与本地区高血压病患者代谢指标的紊乱相关。     

臂围调查与血压计袖带大小的合理选择

目的 调查北京地区成人高血压病患者右上臂臂围的数值,为临床工作中合理选择血压测量袖带提供一定的指导.方法 用横断面研究,连续入选了424名成人高血压病患者(其中男性占61.6%),经右上臂的中点测量所有病例的臂围.根据臂围的数值将患者首先分为3组:1组臂围在22～26 am之间(小个成人),2组臂围在27～34 cm(标准成人),3组臂围＞34 cm(大个成人).再将患者分为两组:A组臂围＜32 cm,B组臂围≥32 cm.结果 在全部入选高血压病患者中,臂围均值为(29.6±2.6)cm.82.8%的患者右臂臂围在27～34cm之间,只有8.96%的患者臂围在22～26 cm之间.无论男性和女性患者,其臂围和体质量指数(BMI)与腰围(WC)都呈显著相关性(BMI:r=0.810,WC:r=0.725,P均＜0.01).与A组比较,B组患者的血清肌酐、尿酸和三酰甘油都显著高于A组,而高密度脂蛋白胆固醇却显著低于A组.结论 在当前临床实践中,需尽早采用气囊尺寸为13 cm×30 cm的袖带进行血压测量.另外,臂围增加可能与本地区高血压病患者代谢指标的紊乱相关.     

血压测量

血压测量是重要临床诊断技术之一,已经历数百年的发展.其测量方式有诊室血压测量、家庭自测、动态血压监测;测量方法有直接测量和间接测量,间接测量又分听诊法、示波法等,各有一定适用范围,以水银柱血压计袖带听诊法应用最为广泛.袖带臂围匹配对血压测值有一定的影响,小袖带测值要高,而大袖带的测值要低.在临床工作中应注意袖带与臂围匹配,诊室应配备各种型号的袖带,适合各类人群的需要,以减少高血压的误诊和漏诊.     

宽袖带与常规宽度袖带臂式电子血压计测量血压结果的对比分析

目的 探索宽袖带(宽度为18 cm)与常规宽度袖带(宽度为13 cm)臂式电子血压计在测量血压值的差异.方法 选择2018年5-11月于河北医科大学第二医院心内科住院患者1 155例,其中男性占47％,年龄(59.7±13.2)岁.根据臂围大小将患者分为4组:第1组臂围范围为15～21 cm,第2组为22～26 cm,...     

血压测量

血压测量是重要临床诊断技术之一,已经历数百年的发展。其测量方式有诊室血压测量、家庭自测、动态血压监测;测量方法有直接测量和间接测量,间接测量又分听诊法、示波法等,各有一定适用范围,以水银柱血压计袖带听诊法应用最为广泛。袖带臂围匹配对血压测值有一定的影响,小袖带测值要高,而大袖带的测值要低。在临床工作中应注意袖带与臂围匹配,诊室应配备各种型号的袖带,适合各类人群的需要,以减少高血压的误诊和漏诊。     

成人臂围调查及袖带臂围匹配对血压测值的影响

目的 调查南昌市一个社区人群臂围,并观察袖带臂围匹配与否对袖带法血压测值的影响.方法 由两位经过专门培训的医务人员,用12 cm×22 cm袖带测量25～90岁社区居民2041名血压、右上臂的臂围、身高、体质量、体质量指数(BMI).按年龄分为≤35岁组(≤35)、36～45岁组(35～)、46～55岁组(45～)、56～65岁组(55～)、＞65岁组(＞65).208名冠脉造影患者同步测量主动脉根部(直接)和袖带法肱动脉(间接)血压,计算两者的差值(直-间血压差).结果 1)该社区成人臂围为17～37 cm 2)袖带臂围不匹配(＞26 cm)组的收缩压和舒张压测值分别比匹配(≤26 cm)组高6 mm Hg和4 mm Hg;不匹配组的直-间收缩压差比匹配组小2.7 mm Hg.结论 1)小号袖带对49.0%的南昌地区人群过小;2)使用小号袖带可能高估臂围＞26 cm人群的收缩压.     

听诊器胸件塞进袖带测量血压对测量结果的影响

目的 探讨听诊器胸件塞进袖带测量血压对测量结果的影响.方法 对徐州市云龙区民强、民建小区138位市民分别采用听诊器胸件塞进袖带内（不规范操作,袖带内组）与置于袖带外（规范操作,袖带外组）两种方式测量血压,对测量结果进行比较.结果 袖带内组收缩压为（118.515±18.245） mmHg,舒张压为（78.630±10.585） mmHg,袖带外组分别为（117.297±17.761）、（77.725±10.362） mmHg,两组比较,P均＜0.05.结论 听诊器胸件塞进袖带测量血压会导致青壮年血压测值偏高.临床测量血压应规范操作.     

脉搏波传导时间法与袖带血压测定值的对比研究

目的 脉搏波传导时间法与袖带血压（示波法）测定值的对比研究。方法 入选2023年4月至9月在北京大学人民医院进行了直立倾斜试验的患者共92例（其中男49例,女43例）,在直立倾斜试验中第1分钟和第15分钟进行血压测定,并同时采用脉搏波传导时间法进行血压连续测定。以袖带血压（示波法）测定值为参考血压,对血压连续测定值进行相关性、一致性分析和差值分析。结果 在各个时点下,两法测定的收缩压相关系数分别为0.897和0.832,舒张压相关系数分别为0.757和0.409,提示两法存在相关性。使用配对t检验进行δ差值分析发现,两个时点的收缩压δ差均值及第2个时点的舒张压δ差均值均小于1mm Hg,说明两法血压测定值比较接近,差值无统计学意义。Bland-Altman图结果显示,有95%数据在可信区间内,显示两种方法测定结果具有一定程度的一致性。对两法血压测定值的差值小于6mm Hg视为无差别,在第1个时点下,采用脉搏波传导时间法测定的收缩压值和舒张压值,分别是72%和78%。在第2个时间点下,分别是60%和72%。结论 脉搏波传导时间法与袖带血压（示波法）测定值具有良好的相关性及一致性。     

有创血压和袖带听诊血压相关性及一致性分析

近年随着危重病学的发展及各种先进医疗仪器的临床应用,有创血压(Arterial Blood Pressure,ABP)监测已在各大医院ICU和麻醉科陆续开展。而袖带听诊血压(BP)作为传统的测量血压方式有着简单、无痛苦、安全等优点,仍被广泛应用。理论上讲,有创血压比较准确、可靠,较无创血压接近于正常值[1]。为     

脉搏波无创血压测量技术与有创血压测量技术临床对比及应用前景

目的对比脉搏波无创血压测量技术与有创血压测量技术的临床效果及其应用前景。方法选择冠脉造影患者120例,随机数字法分为对照组与观察组各60例,对照组经周围动脉将导管送至腋动脉,有创测量其中心动脉压;观察组利用四管通道连接脉搏波无创血压计,测量左、右侧肱动脉无创血压,记录两组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及脉压(PP),比较两组血压值,并采用相关系数(ICC)与Bland-Altman分析两组血压值的相关性。结果两组SBP、DBP、MAP、PP差异均无统计学意义(均P>0. 05);两组SBP与DBP的ICC值分别为0. 98(95%CI 0. 97～1. 00)和0. 96(95%CI 0. 90～0. 98);Bland-Altman分析发现SBP和DBP的差值均值均接近0值参考线。结论脉搏波无创血压测量技术能准确反映患者血压状况,更加安全、简便。     

Comparison of exercise blood pressure measured by technician and an automated system

We evaluated the automated system Blood Pressure Measuring System (BPMS) developed by NASA on 277 adult males who elected to have a treadmill test as part of their annual physical. The BPMS uses acoustic transduction with a computer-assisted ECG gating to detect nonsynchronous noise. The BPMS readings were compared to pressures simultaneously measured by trained technicians. For all stages of work, BPMS readings were higher for systolic and lower for diastolic than technician readings. At peak stages of work, BPMS systolic pressures were about 20 mmHg higher than technician readings. Within each 3-min workstage, BPMS readings were found to be more inconsistent than technician readings. The standard errors of measurement for BPMS were from two to three times higher than technician values. These data showed automated blood pressure readings were significantly different than technician values and subject to more random fluctuations. These findings demonstrate the need to view exercise blood pressure measured by automated systems with caution.     

心房颤动患者Korotkoff音法测压与动脉有创测压之间的比较

目的:探讨心房颤动(Af)患者用Korotkoff音法测量血压与动脉有创测量血压之间的差异性,并对Korotkoff音法的局限性及方法改良进行探讨。方法:用传统的Korotkoff音法及动脉有创法对95例疑诊冠心病伴有Af的患者在行冠状动脉造影时进行血压测定,根据脉搏短绌程度对病例进行分组。同时,对窦性心律患者中接受冠状动脉造影的50例患者进行有创测压和Korotkoff音法测压。结果:对于伴Af患者,传统Korotkoff 音法测量出的收缩压及舒张压均低于有创测量的动脉血压(均P<0.01),Af时明显的脉搏短绌可使误差明显增大。而窦性心律患者Korotkoff音法测得的血压水平虽然低于有创压,但两者之间差异无统计学意义(P> 0.05)。结论:传统Korotkoff音法不适于Af,尤其是快心室率的Af患者的血压测量,测出的血压不能代表Af时的血压水平,对于Af患者应该对测量方法进行适当的调整,建立新的测量方法。     

Neck circumference and blood pressure among children: a systematic review and meta-analysis

Emerging evidence suggested that large neck circumference (NC) in children and adolescents may be an indicator of increased blood pressure. We sought to conduct a systematic review and meta-analysis regarding the association between NC and blood pressure in children. Pertinent studies were identified by searching PubMed and Scopus databases, up to January 2018. Studies which reported the correlation coefficient between NC, systolic blood pressure and diastolic blood pressure in children (aged <18 years) were selected. Fifteen studies met eligibility criteria for the quantitative synthesis. Overall, NC was significantly correlated with systolic blood pressure (effect size (z) = 0.39; 95% confidence interval [CI] = 0.29–0.49; P < .001; meta r = 0.371; r² = 0.13) and diastolic blood pressure (effect size (z) = 0.25; 95% CI = 0.19–0.32; P < .001; meta r = 0.0.245; r² = 0.06). NC had a positive relationship with the risk of hypertension (odds ratio [OR] = 1.35; 95% CI: 1.05–1.75). Furthermore, studies conducted in Western regions (OR = 1.55; 95% CI: 1.12–2.14) reported higher risk of hypertension in association with NC than those conducted in the Eastern regions (OR = 1.14; 95% CI: 1.03–1.25).NC seems to be a novel anthropometric measurement in children and adolescents. It can be a good predictor of elevated blood pressure, especially in the Western population.     

Principles and techniques of blood pressure measurement

Although the mercury sphygmomanometer is widely regarded as the gold standard for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings. To date, mercury devices have largely been phased out in United States hospitals. This situation has led to the proliferation of nonmercury devices and has changed (probably forever) the preferable modality of blood pressure measurement in clinic and hospital settings. In this article, the basic techniques of blood pressure measurement and the technical issues associated with measurements in clinical practice are discussed. The devices currently available for hospital and clinic measurements and their important sources of error are presented. Practical advice is given on how the different devices and measurement techniques should be used. Blood pressure measurements in different circumstances and in special populations such as infants, children, pregnant women, elderly persons, and obese subjects are discussed.     

Relationship between blood pressure obtained from the upper arm with a cuff-type sphygmomanometer and central blood pressure measured with a catheter-tipped micromanometer

Recently, the importance of central blood pressure for cardiovascular risk stratification has been emphasized. Accordingly, the differences in peak systolic and bottom diastolic pressures between the ascending aorta and the brachial artery should be clarified. Study subjects consisted of 82 consecutive patients with suspected coronary artery disease who underwent cardiac catheterization, and in whom ascending aortic pressure waveform was obtained using a catheter-tipped micromanometer, and at the same time systolic and diastolic pressures were measured (single measurement) from the right upper arm with a cuff-type sphygmomanometer based on the oscillometric technique. No significant systematic difference (bias) was found between the peak pressure obtained in the ascending aorta and the systolic pressure from the right upper arm (133.6 ± 25.1 vs 131.8 ± 21.5 mmHg, not significant). Bland–Altman analysis showed only a small bias of +1.8 mmHg, and the limits of agreement were 25.4 mmHg and −21.8 mmHg. In contrast, the bottom pressure in the ascending aorta was significantly lower compared with the diastolic pressure from the upper arm (68.5 ± 10.7 vs 73.0 ± 12.4 mmHg, P < 0.0001). Bland–Altman analysis showed a small but significant bias of −4.5 mmHg, and the limits of agreement were 14.1 mmHg and −23.1 mmHg. The observed biases seemed to remain within practical range. However, random variation in the two measurements was rather large. This is considered to be caused by the random error in the single measurement with the cuff-type sphygmomanometer.     

Effect of cuff positioning on the accuracy of blood pressure measurement with automated electronic blood pressure monitors

It is recommended that the cuff should be wrapped around the upper arm with the midline of the bladder placed over the brachial artery during blood pressure (BP) measurement. However, in practice, the cuff of sphygmomanometers is often incorrectly placed. The authors aimed to assess the effect on the accuracy of BP measurement as to the placement of the cuff bladder by using oscillometric devices. Participants aged 18 years or older were enrolled. The center of the cuff bladder was placed directly over the brachial artery as the standard position (correct position), which was rotated by 90°medially (medial position), 90°laterally (lateral position), and rotated by 180°(contralateral position), respectively. The main outcomes were non‐invasive brachial BP in the four cuff positions, brachial artery pulse wave velocity, ankle‐brachial index, and invasive radial BP. Of 799 participants, 56.4% were men (60.37 ± 12.73 years), and of the 104 intensive care unit participants, 60.57% were men (57.78 ± 15.89 years). There were no significant differences in non‐invasive brachial BP among the four cuff positions (P > .1), and the mean BP differences between incorrect and standard cuff positions were within 1.0 mm Hg. BP of the incorrect positions was positively correlated with standard position (P < .001, r > .88) and showed good consistency. There was no effect on the accuracy of BP measurement as to the location of the midline of the cuff bladder by using oscillometric devices with a conventional cuff.     

Evaluation of sustained blood pressure elevation in children

ObjectivesTo document the prevalence and etiology of sustained blood pressure elevation in children.Methods & resultsIt is a school-based prospective cross-sectional study involving healthy school children in age group of 5–15 years (both sexes). Children with any acute or chronic illnesses and the intersexes were excluded from the study group. Total number of hypertensive children were 37. Of these 37 cases, 23 hypertensive cases were boys and 14 were girls. All these hypertensive children maintained their blood pressure above +2SD for the corresponding age and sex. Male and female ratio of hypertensive cases was 62:38. All were primary hypertensives as per working definition. Majority belonged to Class II socio-economic status.ConclusionHypertension in children is very rare with a prevalence of 0.38% and majority had primary hypertension.     

Evaluation of a new ambulatory blood pressure device

We assessed the OSCILL-IT ambulatory blood pressure (BP) recorder (FIGI srl, Rome, Italy) according to the performance criteria set out by the British Hypertension Society (BHS) protocol. The OSCILL-IT is a portable, noninvasive recorder that uses a process that correlates systolic, mean, and diastolic areas, identified on the oscillations, to the cuff absolute pressure. According to the recommendations of BHS, a large heterogeneous population (100 subjects: 52 men aged from 19 to 79—median 44 and 48 women from 19 to 74—median 54) was recruited in order to assess accuracy and to analyze, in addition, the effects of observer agreement and BP level on the observer–device differences. With reference to BP level, we suggest also a new graphic approach. Four sets of sequential, same arm, comparative BP measurements were obtained, performed by the OSCILL-IT recorder and two skilled clinicians using a mercury column, for each subject. We used a linear combination for the statistical evaluations. We confirmed the observer agreement through the frequency distribution of BP as a function of the observer and through the differences between observers. We compared OSCILL-IT with sphygmomanometric readings: the differences were not significant. A visual inspection, with the addition of regression lines, showed that there were no variations in differences at the changing of BP level. The difference between observers and OSCILL-IT was 0.2 ± 5.3 mm Hg and 0.2 ± 5.8 mm Hg both for systolic BP (SBP) and diastolic BP (DBP). The level of agreement, according to BHS criteria, showed that 64% of all systolic and 70% of all diastolic readings obtained by the OSCILL-IT were within 5 mm Hg of the sphygmomanometric determinations. Therefore, the grade is C for SBP, even if 93% of SBP and 95% of DBP obtained by the OSCILL-IT were within 10 mm Hg of the sphygmomanometric determinations. These analyses demonstrate that the OSCILL-IT satisfies the accuracy parameters and the additional linear regression yields graphics more immediate.