电子血压计与台式水银血压计测量儿童青少年血压的比对研究

目的比较分析电子血压计(示波法)与台式水银血压计(听诊法)对儿童青少年血压的测量结果,对电子血压计测量儿童青少年血压的准确性进行评价。方法 2010年分层整群抽取北京市城、郊3～17岁儿童青少年,各年龄组至少100人,男女各半。问卷调查生活行为信息,测量身高、体质量、腰围,使用电子血压计(欧姆龙HEM-759P)与台式水银血压计分别测量血压两次,交替进行,记录血压及脉搏。比较两法测量结果,Bland-Altman法比较两法测量一致性。结果总计1695名3～17岁儿童青少年参加调查,各年龄组人数基本相同,男女比例0.99。各年龄组电子血压计与台式水银血压计测量结果互有高低,电子血压计测量值高于台式水银血压计居多。两法测量收缩压差值绝对值≤5,≤10和≤15mm Hg所占比例分别为54.2%,82.9%和100%;以台式水银血压计Korotcoff第Ⅳ音(K4)评价舒张压时,两法测量舒张压差值绝对值≤5,≤10和≤15mmHg所占比例分别为42.3%,70.4%和87.2%,以台式水银血压计Korotcoff第Ⅴ音(K5)评价舒张压时,3组比例分别为46.1%,70.6%和84.8%。调整性别、年龄,两法测量收缩压间、电子血压计舒张压与台式水银血压计K4间、电子血压计舒张压与台式水银血压计K5间的偏相关系数分别为0.716、0.448和0.353(P<0.01)。Bland-Altman分析显示两法收缩压差值95%一致性界限为-13.5～19.6mmHg,电子血压计舒张压与台式水银血压计K4差值95%一致性界限为-22.5～15.1mm Hg,电子血压计舒张压与台式水银血压计K5差值95%一致性界限为-20.3～28.4mm Hg。结论电子血压计测量结果高于台式水银血压计,测量结果比较稳定,两方法测量结果一致性好,电子血压计可用于儿童青少年人群血压的现场调查。     

不同电子血压计测量肥胖人群血压的准确性

目的比较脉搏波电子血压计和示波法电子血压计在肥胖人群中测量血压的准确性。方法于2015年9月在山东省莱芜市选择年龄≥18岁且体质量指数≥30kg/m~2的男性和女性为研究对象。对每个研究对象利用四通管道同时连接台式水银血压计和电子血压计进行血压测量。以台式水银血压计的测量值作为金标准,采用组内相关系数(ICC)、Bland-Altman分析和允许总误差(ATE)/最大误差限(LER)区域比较2种电子血压计的测量结果。结果共纳入研究对象118人。脉搏波电子血压计与台式水银血压计测量收缩压和舒张压的ICC值分别为0.99(95%CI0.99~1.00)和0.96(95%CI0.90~0.98),示波法电子血压计与台式水银血压计相应的ICC值分别为0.98(95%CI0.97~0.99)和0.90(95%CI0.44~0.96)。一致性检验显示,2种电子血压计测量的收缩压的差值均值均接近0值参考线;舒张压的差值均值均位于0值参考线下方,其中示波法电子血压计距离0值参考线更远(-5.7比-2.6mmHg,P0.05)。ATE/LER区域分析结果显示,2种电子血压计测量的收缩压均有95%的测量值落在ATE区域;脉搏波电子血压计的舒张压测量值落在中间区域和LER区域的比例分别为4.2%和0%,示波法电子血压计相应的比例为19.5%和0.8%。结论脉搏波电子血压计和示波法电子血压计在对肥胖人群进行收缩压测量时均表现出较高的准确性,但在舒张压测量上表现出不同程度的低估,示波法电子血压计的低估现象尤为明显。     

心房颤动患者血压测量方法的选择——基于主动脉腔内血压的研究与探讨

目的探讨几种血压测量方法在心房颤动患者血压测量中的准确性。方法选择2015年1月至2017年5月在江西省南昌大学第二附属医院心血管内科就诊且诊断患有持续性心房颤动的208例住院患者作为研究对象,根据心房颤动的相关诊断标准选择研究对象,并以患者的主动脉腔内血压作为血压真实性和准确性的参考标准,分别用3种测量方法(台式水银血压计、上臂式电子血压计、腕式电子血压计)对心房颤动患者进行血压测量,每种血压计的测量间隔0.5h且均进行3次测量取平均值;血压测量间隔1~2min/次,有两次及以上收缩压/舒张压对应数值相差6mm Hg定义为测量结果不稳定。应用Bland-Altman方法对几种血压计测量结果的一致性进行分析。结果与主动脉腔内血压比较,3种血压计及对应方法所测数值的稳定性分别为:腕式电子血压计(74.5%)主动脉腔内血压测量(71.6%)台式水银血压计(49.5%)上臂式电子血压计(46.2%);与主动脉腔内血压相比,不同血压测量方法所得的收缩压与舒张压差异有统计学意义(台式水银血压计127.4/77.4、上臂式电子血压计130.6/78.4、腕式电子血压计127.4/80.3比主动脉腔内血压133.2/82.9mm Hg,均P0.05)。一致性检验分析结果提示3种无创测量方法所得的收缩压与舒张压差值均值均不同程度地偏移0值参考线,收缩压距离0值参考线情况为:上臂式电子血压计(2.58)台式水银血压计(4.53)腕式电子血压计(5.78mm Hg);舒张压距离0值参考线情况为:腕式电子血压计(2.57)上臂式电子血压计(5.47)台式水银血压计(5.75mm Hg);均P0.05。结论上臂式电子血压计在心房颤动患者的收缩压测量方面更接近主动脉腔内血压,腕式电子血压计在心房颤动患者的舒张压测量方面更接近主动脉腔内血压。     

海尔BP3BG1-A全自动上臂电子血压计准确性的临床评价

目的:按照《欧洲高血压协会国际质量控制方案2010修正版（ESH-IP 2010）》,评估海尔BP3BG1-A全自动上臂电子血压计临床应用的准确性。方法: 测量者采用水银血压计和受试血压计先后测量33名被试者同一左侧上臂收缩压和舒张压。根据ESH-IP 2010,每位被试者测量3对血压,共收集99例次受试血压计与水银血压计的测值。结果: 受试血压计测得73次（74%）收缩压与水银血压计测值差在5 mmHg以内,98次（99%）在10 mmHg以内,99次（100%）在15 mmHg以内;86次（87%）舒张压与水银血压计测值差5 mmHg以内,98次（99%）差10 mmHg。受试血压计测得收缩压与水银血压计测值差为（3.1±3.7） mmHg;舒张压测值差为（-0.9±3.7） mmHg。采用受试血压计与水银血压计的测值2~3次的差别都在5 mmHg以内的受试者数目分别为26名（79%）和29名（88%）。结论: 受试血压计对临床成人患者血压测量的准确性达到《 ESH-IP 2010》的验证标准。     

电子血压计与汞柱血压计测量结果比较

目的测试电子血压计测量的准确性，寻求电子血压计最有效的测量模式。方法采用分层随机抽样法抽得门诊及住院病人共1500人，固定专人分别用电子血压计固定模式测量法、非固定模式测量法与汞柱血压计测量右上肢肱动脉的血压。结果用电子血压计固定模式测量法与汞柱血压计所测上肢的血压值差异无统计学意义；而电子血压计非固定模式测量法与汞柱血压计所测上肢的血压值差异有统计学意义，血压绝对值收缩压相差（7．5±1．06）mmHg，舒张压相差（9．4±1．06）mmHg。结论电子血压计测量的血压数值是准确的，可代替汞柱血压计测量血压。但由于电子血压计敏感度高，运用固定的测量模式才能确保血压数值的准确性。     

电子血压计测量血压的重复性研究

目的:在一般人群中评价电子血压计测量血压的重复性.方法:选择492例研究对象,所有研究对象在标准状态下采用电子血压计测量血压3次,取3次测量值均数作为平均血压水平,采用重复测量资料的方差检验分析3次测量值之间差异有无统计学意义,同时根据年龄和脉压分层分析可能影响电子血压计测量血压重复性的影响因素.结果:收缩压、舒张压、平均动脉压和脉压的3次测量值间两两比较差异均有统计学意义,第1次测量值最高,第2次和第3次测量值依次降低.根据年龄分组后,在不同年龄组中的3次测量值仍是第1次最高,第2次和第3次测量值依次降低,差异有统计学意义.根据脉压分组后,在脉压<35 mmHg组,收缩压、舒张压、平均动脉压和脉压在3次测量间差异均无统计学意义.在脉压≥35 mmHg(1 mmHg=0.133 kPa)组,无论收缩压、舒张压还是平均动脉压,3次测量值间两两比较差异均有统计学意义,测量值随着测量次数逐渐降低.结论:电子血压计3次测量间两两比较的差异均有统计学意义,而脉压可能是影响电子血压计测量血压重复性的因素之一.     

家庭3G无线传输电子血压计与门诊台式水银血压计测量结果的相符性

目的为评价电子血压计居家测量的可靠性,开展家庭电子血压计(HBPT)和社区门诊台式水银血压计(OBPM)测量结果的相符性研究。方法 2015年9-12月,随机抽取10个行政村,在自愿的基础上按照新登记高血压患者顺序选择研究对象;研究对象获得电子血压计当天(第1天)和第7天同日进行OBPM和HBPT测量;所得数据先进行差值统计学比较,在此基础上进行方法一致性分析。结果有效观察对象294人,第1天和第7天OBPM血压值分别为(133.9±14.1)/(82.3±9.7)、(130.0±11.6)/(79.6±8.4)mm Hg,HBPT分别为(133.8±16.2)/(81.7±10.7)、(130.3±14.4)/(79.4±9.9)mm Hg,差异无统计学意义(P=0.809、0.156、0.637、0.742);第1天和第7天OBPM、HBPT患者达标率分别为62.9%、45.2%、77.2%、62.9%,差异有统计学意义(均P0.001);Bland-Altman PLOT计数收缩压6.10%(36/588)和舒张压5.95%(35/588)超出95%极限范围。结论将创新型具有3G数据传输功能的电子血压计引入HBPT,所获血压值信息与OBPM相符,能够替代OBPM的血压监测管理;且3G无线传输电子血压计具有操作简便、测量信息电子化等优势,值得在家庭中推广使用,但评估达标率需慎重。     

HEM-6000手腕式血压计的可靠性

目的采用美国医疗器械检测协会(AAMI)标准,对HEM-6000手腕式血压计的血压测量精确度进行临床验证研究。方法入选对象为18岁以上成年人,共91人。腕部测压结果与听诊法比较。每位受试者用2种方法同时各进行3次坐位血压测量,对91人的273对血压测量值用以下2种方法进行统计分析:(1)先计算出2种测压方法得到的血压测量值误差,再求得误差的平均值和标准偏差。(2)先计算出每位受试者用2种测压方法得到的血压平均值的差值,再求得该差值的平均值和标准偏差。结果根据方法1得到的收缩压(SBP)和舒张压(DBP)的测量误差分别为(0.5±7.1)mm Hg和(-1.6±6.1)mm Hg;根据方法2得到的结果分别(0.5±6.1)mm Hg和(-1.6±5.3)mm Hg。血压值的水平及手腕周长对测量误差无影响。结论HEM-6000手腕式血压计通过AAMI检验标准,可推荐患者用于家庭自我测压。     

HEM-6000手腕式血压计的可靠性

目的 采用美国医疗器械检测协会(AAMI)标准,对HEM-6000手腕式血压计的血压测量精确度进行临床验证研究.方法 入选对象为18岁以上成年人,共91人.腕部测压结果与听诊法比较.每位受试者用2种方法同时各进行3次坐位血压测量,对91人的273对血压测量值用以下2种方法进行统计分析:(1)先计算出2种测压方法得到的血压测量值误差,再求得误差的平均值和标准偏差.(2)先计算出每位受试者用2种测压方法得到的血压平均值的差值,再求得该差值的平均值和标准偏差.结果 根据方法1得到的收缩压(SBP)和舒张压(DBP)的测量误差分别为(0.5±7.1)mm Hg和(-1.6±6.1)mm Hg;根据方法2得到的结果分别(0.5±6.1)mm Hg和(-1.6±5.3)mm Hg.血压值的水平及手腕周长对测量误差无影响.结论 HEM-6000手腕式血压计通过AAMI检验标准,可推荐患者用于家庭自我测压.     

常用家庭电子血压计示值重复性和准确度的研究

目的:对常用家庭电子血压计示值重复性和准确度进行再评估.方法:选择中国人民解放军空军特色医学中心高血压和心内科门诊患者140例,以水银血压计测量3次的血压平均值为真实血压水平,依据《JJG692-2010无创自动测量血压计检定规程》和听诊法对患者使用的140台家庭电子血压计进行示值重复性和准确度再评估.结果:140台家...     

New clinical validation method for automated sphygmomanometer: a proposal by Japan ISO-WG for sphygmomanometer standard

INTRODUCTION: Owing to fast or stepwise cuff deflation, or measuring at places other than the upper arm, the clinical accuracy of most recent automated sphygmomanometers (auto-BPMs) cannot be validated by one-arm simultaneous comparison, which would be the only accurate validation method based on auscultation. Two main alternative methods are provided by current standards, that is, two-arm simultaneous comparison (method 1) and one-arm sequential comparison (method 2); however, the accuracy of these validation methods might not be sufficient to compensate for the suspicious accuracy in lateral blood pressure (BP) differences (LD) and/or BP variations (BPV) between the device and reference readings. Thus, the Japan ISO-WG for sphygmomanometer standards has been studying a new method that might improve validation accuracy (method 3). The purpose of this study is to determine the appropriateness of method 3 by comparing immunity to LD and BPV with those of the current validation methods (methods 1 and 2). METHOD: The validation accuracy of the above three methods was assessed in human participants [N=120, 45+/-15.3 years (mean+/-SD)]. An oscillometric automated monitor, Omron HEM-762, was used as the tested device. RESULTS: When compared with the others, methods 1 and 3 showed a smaller intra-individual standard deviation of device error (SD1), suggesting their higher reproducibility of validation. The SD1 by method 2 (P=0.004) significantly correlated with the participant's BP, supporting our hypothesis that the increased SD of device error by method 2 is at least partially caused by essential BPV. Method 3 showed a significantly (P=0.0044) smaller interparticipant SD of device error (SD2), suggesting its higher interparticipant consistency of validation. CONCLUSION: Among the methods of validation of the clinical accuracy of auto-BPMs, method 3, which showed the highest reproducibility and highest interparticipant consistency, can be proposed as being the most appropriate.     

Obesity,hypertension and home sphygmomanometer cuffs

BackgroundSince the increasing prevalence of obesity leads to a larger mean arm circumferences in the hypertensive population and appropriate cuff size is essential for accurate measurement of blood pressure, overweight and obese patients often require automated home sphygmomanometers with large- or extra large-sized cuffs. The aims of this study were to evaluate the information about cuff size on automated upper arm home sphygmomanometer packing boxes and compare the findings with wrist device boxes.MethodsOne hundred twelve different device boxes (49 automated upper arm, 5 semi-automatic, and 58 wrist) produced by 40 manufacturers were investigated.ResultsThree different types of information were observed (written, graphical, or a combination of both). There was not any information about cuff size on 49 (44%) device boxes. Most of the information expressed on the boxes was not attractive or informative for the patients.ConclusionThis study showed that the information regarding cuff size on most of the device boxes was obtuse and the patients are not warned sufficiently about appropriate cuff size. Physicians and health care providers should inform and train their patients about appropriate cuff size.     

The case for a hybrid sphygmomanometer.

Mercury sphygomanometers are being banned in many countries, but what will replace them for the routine management of clinic blood pressure is unresolved. The accuracy of the two most widely used alternatives, aneroid and oscillometric devices, is questionable. A proposed alternative is a hybrid sphygomomanometer which is based on the mercury technique, but replaces the mercury column with an electronic transducer and display. It also has the potential to eliminate terminal digit preference.     

Clinical experience with use of ultrasound sphygmomanometer.

The performance of an ultrasound sphygmomanometer (Arteriosonde 1217) has been compared with that of the London School of Hygiene and Tropical Medicine and Hawksley sphygmomanometers. The Arteriosonde gave closely similar values of systolic blood pressure of the other instruments but diastolic blood pressure lay midway between phase 4 and phase 5 of the Korotkoff sounds. Observers using the Arteriosonde showed a significant preference for even terminal digits.     

Validation of an oscillometric electronic sphygmomanometer in an obstetric population

Use of an automated electronic sphygmomanometer will allow us to minimize the errors inherent in mercury sphygmomanometry. We conducted this validation according to the 1990 protocol of the British Hypertensive Society. We recruited 87 subjects from the antenatal population of Kandang Kerbau Hospital and took three sequential readings using simultaneously both manual and electronic sphygmomanometry. A total of 261 readings from either method were thus collected and the results analyzed to compare the accuracy of electronically read blood pressure with that assessed manually. We found that 89.9% of the electronically read pressures differed from the manually read pressures by 5 mm Hg or less and 98.9% of the electronic readings differed from manual readings by 10 mm Hg or less; only 0.4% of readings had a difference of more than 15 mm Hg. The accuracy of the device was not affected either by the blood pressure or the arm circumference.