监护仪不同袖带绑扎方法对血压测量及袖带破损的观察

目的观察监护仪不同袖带绑扎方法对血压测量及袖带破损的影响。方法用2台飞利浦MP20心电监护仪对450例急诊患者进行间隔5 min血压测量,第1次测量采用传统袖带绑扎方法,第2次测量采用袖带反扎法,观察并记录血压值和袖带破损情况。结果前后两次方法测量血压无变化,传统袖带绑扎方法测量450次,发生袖带破损4个,袖带反扎法测量450次,未发生袖带破损。结论监护仪袖带反扎法可以准确测量血压,同时能减少袖带破损。     

不同卧位双上肢无创血压测量值的对比观察

血压是机体重要的生命体征。血压测量值的准确性和可靠性直接影响到患者的病情判断和治疗效果。为保证其测量的准确性，教材对测量血压进行了规范：要求测量上肢动脉血压时。手臂位置（肱动脉）与心脏同一水平。为探讨手臂位置与心脏不在同一水平时测得的血压值是否准确。我们选取100名健康青年女性，进行不同卧位的双上肢无创血压的测量，以了解卧位对血压值的影响。现报道如下。     

多功能监护仪与汞柱式血压计血压测量的差异性研究

目的：比较多功能监护仪与汞柱式血压计血压测量值的差异,为临床护理工作提供依据。方法使用多功能监护仪和汞柱式血压计同时测量血压,分别记录血压值。结果监护仪测量的收缩压均值、舒张压均值、脉压差均高于汞柱式血压计的测量值。监护仪与汞柱式血压计的血压测量值存在正相关性。结论多功能监护仪与汞柱式血压计血压测量值存在差异,但两者具有正相关性。     

监护仪与血压计测量血压值的比较研究

本研究采用通用电气医疗系统（中国）有限公司生产的DINAMAP PRO 1000监护仪，上海医疗设备有限公司生产的“玉兔”牌汞柱式血压计，将2种仪器的血压测量值进行对比研究，以便为临床工作提供可靠性依据，现报道如下。     

监护仪系统时间设置现状调查与分析

<正>生命体征监护仪(简称监护仪)能够对患者各种不同的生命体征参数的波形如:心电图、呼吸波、有创血压等,与数据如:心率、呼吸率、血压值、体温、动脉血氧饱和度等进行实时地、连续地监测并可以显示,是一种最常见的医疗设备,具有数量多、分布广     

袖带绑扎方向对监护仪无创血压值影响的研究

目的观察不同袖带绑扎方向对监护仪无创血压值的影响。方法按随机数字表将508例急诊科就诊患者分为A组和B组各254例。使用迈瑞公司生产的各种型号监护仪对508例患者进行无创血压测量。A组先采用常规方法测量血压,后将袖带测压管路朝上,并位于上臂外侧进行测量;B组则先采用袖带测压管路朝上绑扎袖带方法测量血压,而后采用常规测量方法,2次测量之间休息2min。记录所有患者每次测量的血压值。结果 508例患者前后2次血压值比较差异无统计学意义,508例患者不同测量方法下血压值比较差异无统计学意义,同种测量方法所测得的血压值两组组间比较差异无统计学意义,P均0.05。结论袖带测压管路朝上测量血压的方法能较准确的测量无创血压。     

尿毒症患者偶测血压与动态血压的对比研究

目的评价尿毒症患者不同偶测血压(CBP)水平的动态血压特点.方法选择75例服用或未用降压药物的尿毒症患者,男性44例,女性31例;平均年龄(52.4±16.5)岁,尿毒症病程平均(27.9±34.8)月.根据CBP结果分为正常血压组;1、2、3级高血压组;进行24小时动态血压测定(ABPM).结果4组资料显示随CBP值升高,ABPM值亦升高;各组ABPM均低于CBP值,随着血压分级的提高,其ABPM24小时均值,日间均值,夜间均值相应升高,各组间存在着非常显著,或显著性差异.随着血压总体水平的提高,血压负荷也增加,尤其是夜间血压负荷增加明显,本文各组的夜间血压负荷均高于日间.在6例未服降压药的正常血压尿毒症患者中发现,5/6例有昼夜节律消失或减弱,4/6例血压负荷异常,2/6例ABPM升高.75例中昼夜节律消失或减弱者为64例,占83%.结论尿毒症ABPM水平与CBP水平呈正比.尿毒症高血压患者ABPM特点与高血压患者相似,血压正常的尿毒症ABPM存在异常改变,值得进一步研究.     

无创与有创血压测量的对比研究

目的 通过无创间接血压测量与有创直接血压测量两种不同方法的比较，探讨无创间接血压测量法反映患者真实血压的可靠性、误差及原因。方法 患者选自2003年12月至2004年5月期间在我院心导管室行心血管介入检查治疗的患者。同时应用无创及有创方法测量血压，并测量在上肢袖带缠绕处上臂周径，统计学处理后分析有创与无创血压的相关性及上臂周径对无创血压测量的影响。结果 水银柱式血压计测得的结果与真实血压相比SBP、DBP、PP均有统计学意义，SBP（P〈0．01）、DBP（P〈0．01）、PP（P〈0．01），两种测量方法测得的SBP差和DBP差与臂围均无显著相关性（P〉0．05）。结论 用水银柱式血压计测量的血压值与真实值有一定误差，上臂周径对无创血压测量无明显影响；本研究提示对于危重患者有条件的情况下应尽量进行有创血压监测。     

不同卧位测量下肢动脉血压的研究

目的 :为选择正确卧位测量下肢血压提供实验依据。方法 :随机抽取 56名在校护生 ,进行自身对照实验研究。采取平卧位、俯卧位、侧卧位、屈膝仰卧位 4种不同卧位测量动脉血压。结果 :经方差分析 ,P <0 .0 0 0 1 ,各处理组间差别有统计学意义 ,再经两两比较的 q检验发现屈膝仰卧位组收缩压与舒张压偏低 ,差异有统计学意义。结论 :测量动脉血压时应尽量避免屈膝仰卧位     

多参数监护仪护理服务时间及质量的应用研究

目的：研究常规测量技术与多参数监护仪在生命体征监测中的优劣。比较两种方式所需基础护理服务时间及护理质量标准，方法：将32例监护病人按单双床号分别设为对照组（常规测量技术）和实验组（多参数监护仪）。统计两组基础护理服务时间和护理质量，进行统计学处理。结果：两组基础护理服务时间和护理质量，经X^2检验P＜0．05。结论：多参数监护仪明显优于常规测量技术。     

腕式电子血压计测量不同上肢体位血压值的比较研究

[目的]为正确选择电子血压计手腕测试动脉血压时上肢的摆放位置提供试验依据.[方法]随机抽取213名在校医学生进行自身对照试验.采取腕部低于心脏、腕部平心脏、腕部高于心脏3种不同上肢摆放位置测量动脉血压.[结果]3种不同上肢摆放位置测量出来的动脉血压值之间均存在差异(P<0.01),腕部低于心脏测出的血压值高.[结论]采用电子血压计手腕测试上肢动脉血压时,正确方法是采取腕部平心脏水平的上肢摆放位置.     

Comparative accuracies of a finger blood pressure monitor and an oscillometric blood pressure monitor

A noninvasive blood pressure monitor (Finapres) that uses the methodology of Peaz to continuously display the arterial waveform from the finger has been introduced recently. The Finapres monitor overestimated systolic pressure by 5.8±11.9 mm Hg, while the Dinamap monitor underestimated systolic pressure by –6.9±9.2 mm Hg (P=0.003). Dinamap mean and diastolic pressure biases were less than 2 mm Hg, while the Finapres biases for these variables were significantly greater (7.7±10.0 and 8.2±9.8 mm Hg, respectively). There was no difference in systolic or mean pressure precision between the two devices (approximately 10 mm Hg), but the diastolic precision of the Dinamap unit was superior to that of the Finapres. While in most patients the Finapres monitor provided continuous blood pressure data equivalent to the data from the radial artery, marked bias (>15 mm Hg) was exhibited in 2 patients for all three pressure variables. Despite this bias, blood pressure changes were tracked closely in these 2 patients. We conclude that, in its current form, the Finapres monitor cannot be relied upon independently to accurately measure blood pressure in patients undergoing general anesthesia. Since the Dinamap monitor measures mean pressure reliably and accurately, we suggest that mean blood pressure values between the Finapres and Dinamap monitors be compared to guide one in interpreting Finapres data.Supported in part by a grant from Ohmeda Company, Boulder, CO.Presented in part at the annual meeting of the American Society of Anesthesiologists, New Orleans, October 1989.     

高血压患者不同体位动态血压的监测

目的了解高血压患者仰卧位、侧卧位、坐位、站立位动态血压测量有否不同。方法对51例动态血压监测的高血压患者,选用右上肢肱动脉测压法,分别测量不同体位的血压。结果仰卧位、左侧卧位、右侧卧位、坐位、站立位时的收缩压平均分别是152.10±14.55、129.21±14.92、150.42±15.54、149.87±14.84、147.85±12.67 mm Hg;舒张压平均分别是87.81±6.92、70.83±8.32、88.33±11.52、88.81±9.15、87.25±11.15 mm Hg。与仰卧位时动态血压测量的结果比较,左侧卧位时收缩压平均低22.89 mm Hg,舒张压平均低16.98 mm Hg,P<0.01;右侧卧位时收缩压平均低1.68 mm Hg,舒张压平均高0.52 mm Hg,P>0.05;坐位时收缩压平均低2.23 mm Hg,舒张压平均高1.00 mm Hg,P>0.05;站立位时收缩压平均低4.25 mm Hg,舒张压平均低0.56 mm Hg,P>0.05。结论高血压患者右侧卧位、坐位、站立位时与仰卧位时动态血压测量的结果无明显变化,左侧卧位时动态血压测量的结果显著低于仰卧位时动态血压测量的结果。     

袖带放置位置对肱动脉血压值的影响

目的探讨测量血压时,袖带放置位置对肱动脉血压值的影响。方法对207例住院患者进行血压观察,同一患者分别依次采用：袖带下缘距肘窝2～3cm（标准测量法）,下缘位于肘窝部（实验测量法1）,下缘位于肘窝下1cm（实验测量法2）,下缘位于肘窝下2cm（实验测量法3）4种方法测量血压,对标准测量法和另外3种测量方法所测得的收缩压和舒张压进行统计学处理并进行比较。结果实验测量法1所测得的血压值与标准测量法比较差异无统计学意义（P〉0．05）;实验测量法2和3两种方法所测得的血压值与标准测量法比较差异有统计学意义（P〈0．05）。结论袖带下缘位于肘窝部进行测量,所测得的血压值与标准测量方法比较影响不大,临床可采用,但袖带放置位置过低,测得的血压值将会下降。     

Systolic blood pressure at end-expiration measured by the automated systolic pressure variation monitor is equivalent to systolic blood pressure during apnea

Objective.It is necessary to define a reference systolic arterial blood pressure (RP) to calculate delta-Up (dUp) and delta-Down (dDown) for systolic pressure variation. Most studies define the reference pressure as the average systolic blood pressure during a short period of apnea. We describe an automated systolic pressure variation monitor that measures airway pressure and defines the reference pressure as the systolic blood pressure at end-expiration. The present study compares the reference systolic blood pressure measured at end-expiration by the automated systolic pressure variation monitor and the reference systolic blood pressure measured during apnea to test whether the end-expiration value is an adequate substitute for the value during apnea. Methods.After obtaining informed consent, 108sets of measurements of systolic pressure variation (SPV) were made in 20intubated, mechanically-ventilated, anesthetized patients by the automated SPV monitor and during apnea. Measurements were taken during periods of hemodynamic stability defined as three consecutive end-expiratory systolic blood pressures within four mmHg of each other. The three systolic pressure sat end-expiration were averaged (RP _monitor ). Immediately following these measurements, the ventilator was turned off and the systolic blood pressure was measured at 6, 8, 10 and 12 seconds of apnea. The reference pressure during apnea (RP _apnea ) was defined as the average of the systolic blood pressure at 8, 10 and 12 seconds of apnea. For each measurement set, RP _monitor and the systolic blood pressure at6 seconds of apnea (SBP₆) were compared to RP _apnea using Bland–Altman analysis. Results.Bland–Altman analysis for the difference between SBP₆ and RP _apnea yielded a small bias of −0.3 mmHg with standard deviation of 1.3, indicating that the systolic pressure tends to continue to increase slightly after 6seconds of apnea. Results were similar for the difference between RP _monitor and RP _apnea (−0.2 ± 3.1mmHg). Conclusions.dUp and dDown are calculated using the reference pressure. RP _monitor is an average of 0.2 mm Hg less than RP _apnea , thus dUp calculated by the automated SPV monitor is an average of 0.2 mm Hg greater than dUp measured by the reference pressure during apnea and dDown is 0.2 mm Hg less. Since the bias of −0.2 mm Hgis clinically insignificant, there is acceptable agreement between the reference pressure obtained during apnea and that obtained by the automated SPV monitor at end-expiration. The mean difference between RP _monitor and RP _apnea is explained by the continued rise in systolic pressure during the period of apnea as demonstrated by the difference between SBP₆ and RP _apnea . This revised version was published online in July 2006 with corrections to the Cover Date.     

隔衣测量血压对测量值的影响研究

目的：探讨血压计袖带缠绕上肢时隔衣物测量血压对血压测量值的影响。方法：以裸臂法为对照组,隔薄衣法和隔厚衣法为试验组。分别测量同一组研究对象的同侧上肢肱动脉血压,3种方法测得的血压值采用方差分析的方法进行统计学分析。结果：对照组与试验组1（隔薄衣法）测得的收缩压和舒张压值无统计学意义（P〉0.05）。对照组与试验组2（隔厚衣法）测得的收缩压和舒张压值在统计学上差异均有显著性。试验组2测得的收缩压和舒张压值均高于对照组。收缩压的平均差值为4.440mmHg（1 mmHg=0.133 kPa）,差值的95%置信区间为1.408～7.472 mmHg。舒张压的平均差值为4.640 mmHg,差值的95%置信区间为1.365～7.915 mmHg。结论：医护人员在为无血压异常病史的患者测量血压时,可以隔一层厚度〈1 mm的衣袖缠绕袖带进行测量,该方法对血压测量的结果不会有影响。     

A poor correlation exists between oscillometric and radial arterial blood pressure as measured by the Philips MP90 monitor

In anesthesia and critical care, invasive arterial blood pressure monitoring is the gold standard against which other methods of monitoring are compared. In this assessment of the Philips MP90 monitor, the objective was to determine whether or not oscillometric measurements were within the accuracy standards set by the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS). Three hundred and one invasive and noninvasive paired measurements were obtained from eleven adult patients on the neurosurgical service at Stanford University Medical Center. Bland–Altman plots were created to assess agreement between the two measurement systems. Paired correlation analysis, bias and precision calculations were performed. Oscillometric blood pressure measurements correlated with arterial measurements yielding Pearson r values of 0.68, 0.67 and 0.62 for systolic, diastolic and mean pressures, respectively (P < 0.01.) Mean differences with 95% confidence intervals were −3.8 mmHg ± 13.6, −2.4 mmHg ± 10.0, and 4.0 mmHg ± 13.1 for systolic, diastolic and mean pressures, respectively. The mean difference for these measurements was ≤5 mmHg as stipulated by the AAMI guidelines, but the standard deviation was greater than the 8 mmHg allowed by the AAMI guidelines. When the BHS guidelines were applied, the device merited a grade “D” for systolic and mean arterial pressure, and a grade “C” for diastolic pressure, with the highest possible grade level being “A.” There was a poor correlation between noninvasive and invasive measurements of arterial blood pressure as measured with a cuff and radial arterial cannula using the Philips MP90 monitor. These inaccuracies could lead to unnecessary interventions, or lack of appropriate interventions in anesthetic management. Further study is needed to specify the absolute inaccuracy of the monitor, and to determine if accuracy between the two methods varies with patient co-morbidities, surgical procedures, or anesthetic management. Mireles SA, Jaffe RA, Drover DR, Brock-Utne JG. A poor correlation exists between oscillometric and radial arterial blood pressure as measured by the Philips MP90 monitor.     

Comparative effects of cuff size and tightness of fit on accuracy of blood pressure measurements

To determine the effect of snugness of cuff wrap on the accuracy of blood pressure (BP) measurements, we performed two studies on 6 healthy volunteers. In both studies, control values were obtained from the right upper arm with cuffs of appropriate size and snug fit. Study 1 had two phases. In the first, cuffs of appropriate size were wrapped snugly around the upper left arm of seated subjects. The effects of two other degrees of cuff snugness on the measurement of BP were evaluated by placing a filled 250-mL intravenous fluid bag between the cuff and arm over the triceps, measuring BP, then draining the same bag of half its contents and then all of its contents without rewrapping the cuff (loose, very loose fit), each time measuring BP. The second phase of study 1 was identical in procedure, except that the cuffs used on the left arm were one size too small. In study 2, the experimental cuffs were placed just above the right ankle. To alter the signal-to-noise ratio, BP was raised or lowered: the standing position elevated mean BP by an average of 90 mm Hg, and elevation of the legs decreased mean BP by an average of 43 mm Hg. In study 1, we found that appropriately sized cuffs, whether wrapped tightly or loosely, gave correct BP readings. Cuffs snugly wrapped, but too small for the subject, gave high BP readings, on the average by approximately 10 mm Hg. Loose wrapping of small cuffs gave variable results in individual subjects that exaggerated systolic BP from 2 to 80 mm Hg. In study 2, elevating the legs or standing decreased or increased BP consistently. Loose wrapping of appropriately sized cuffs around the ankles of the subjects had no additional significant effect on BP.     

The effect of different body positions on blood pressure

Aim. The aim of the present study was to test the effects of different body on BP readings in a Turkish healthy young adults. Background. It is known that many factors influence an individual's blood pressure measurement. However, guideliness for accurately measuring blood pressure inconsistently specify that patient's position and they should keep feet flat on the floor. Although there are more information on arm position in blood pressure measurement, surprisingly little information can be found in the literature with respect to the influence of body position on the blood pressure readings in healthy young people. Methods. A total of 157 healthy young students who had accepted to participate in the study were randomly selected. In all subjects the blood pressure was measured subsequently in four positions: Sitting blood pressure was taken from the left arm, which was flexed at the elbow and supported at the heart level on the chair. After at least one minute of standing, the blood pressure was then taken standing, with the arm supported at the elbow and the cuff at the heart level. After one minute of rest, the blood pressure was subsequently taken supine position. Finally, after one minute the blood pressure was again taken in this last position with supine position with crossed legs. Results. The blood pressure tended to drop in the standing position compared with the sitting, supine and supine with crossed legs. Systolic and diastolic blood pressure was the highest in supine position when compared the other positions. There was a difference between systolic blood pressures and this was statistically significant (P < 0·001) but the difference between diastolic blood pressure was not statistically significant (P > 0·05). All changes in systolic blood pressure were statistically significant except those from supine to supine position with crossed legs. Relevance to clinical practice. When assessing blood pressure it is important to take the position of the patient into consideration. Also, blood pressure measurement must be taken in sitting position with the arms supported at the right a trial level.