多种体位下血压测量的对比研究

[目的]探讨了临床实际工作中不同体位下的间接血压测定的准确性,提出了新的间接血压测定模式.[方法]使用汞柱式台式血压计,采用4种不同体位进行血压间接测量.[结果]同一被测对象4种不同体位下,血压值稍有差别,检验结果比较无统计学意义(P＞0.05).[结论]间接血压测量不一定要求体位因素,尤其在抢救危重病人时,可不强求血压计、被测肢体与心脏同一水平.     

不同体位四肢血压测量结果观察

动脉血压是检测循环系统功能的重要指标,临床上常规测量上肢肱动脉血压。《护理学基础》教科书[1,2 ] 从解剖学观点阐述了不同肢体之间、不同体位下血压值的差异。为弄清四肢血压有无区别,对不同体位四肢血压测量结果进行了观察,为临床选择测量部位、正确判断血压值提供科学依据。1　材料与方法1.1　实验对象　随机抽取本校健康女生5 5名为研究对象,年龄19岁～2 2岁,平均2 1.6岁。1.2　实验用具　选用台式汞柱血压计( 1mmHg =0 .13 3kPa) ,测量前先行血压计校对,检查各部件功能,听诊器传导性能等,使其均处于良好状态。测量下肢血压时所用袖…     

体位对肱动脉间接血压测量值的影响

[目的 ]体位及肱动脉位置变化对肱动脉间接血压测量结果的影响。 [方法 ]采用HEM— 75uzzy型智能电子血压计 ,对随机抽取的 3 0名健康女生测量其 5种体位的肱动脉血压 ,并进行自身配对t检验。[结果 ]坐位时左右上肢肱动脉收缩压有差异 (P <0 .0 1) ;肱动脉位置高于心脏水平时 ,收缩压、舒张压均低于肱动脉与心脏在同一水平时 (P <0 .0 1) ;坐位时肱动脉收缩压低于卧位时 (P <0 .0 1)。 [结论 ]不同体位及不同上肢对肱动脉血压测量结果有一定影响 ,进行个体血压监测比较时应考虑此影响 ,为保证坐位血压测量的准确性 ,须注意保持所测手臂的肱动脉与心脏在同一水平。     

术前访视对甲状腺手术病人焦虑的影响

[目的 ]探讨术前访视对甲状腺手术病人焦虑的影响。 [方法 ]将 10 1例病人随机分为观察组和对照组 ,观察组接受术前访视 ,对照组接受术前常规探视 ,测量两组病人访视前后的血压、心率、焦虑值 ,焦虑值采用状态 -特质焦虑量表进行测量。 [结果 ]观察组于术前访视后焦虑值降低 ,血压及心率波动小 ,与对照组比较有统计学意义 (P <0 .0 5 )。[结论 ]术前访视能有效缓解甲状腺手术病人的术前焦虑 ,减少血压、心率的波动 ,使病人以最佳状态接受手术。     

不同体位对中心静脉压的影响

[目的]探讨不同体位对中心静脉压（CVP）的影响。[方法]选择30例危重症病人,经右锁骨下静脉置入中心静脉导管,采取自身前后对照的方法,观察病人于30°、45°半卧位及平卧位时CVP的变化。[结果]30°半卧位与平卧位时CVP值比较无明显变化（P〉0.05）;45°半卧位时CVP值明显低于平卧位（P〈0.05）。[结论]对不同危重病人尽量保持平卧位进行CVP测量。     

不同规格袖带对血压测量值的影响

[目的]通过按臂围大小采用不同规格的袖带（气囊长度和宽度不同）对人群进行血压测量，以比较袖带过长、过短以及过窄对成人血压测量值造成的影响。[方法]采用横断面研究，连续入选520例门诊病人，根据臂围数值选用不同型号的血压测量袖带进行血压测量。[结果]袖带过长，可能低估病人的血压值（P〈0．05）；袖带过短或过窄，可能高估病人的血压值（P〈0．05）。[结论]在血压测量中，袖带过长、过短或过窄均影响病人血压测量值，建议尽可能根据臂围尺寸选择合适的血压测量袖带，以期获得准确的血压数值。     

不同体位动态血压监测的对比研究

目的了解不同体位对动态血压测量值的影响。方法对120例动态血压监测的患者,选用右上肢肱动脉测压法,分别测量仰卧位、左侧卧位、右侧卧位、坐位、站立位时的血压,比较不同体位动态血压测量值的差异。结果与仰卧位时动态血压测量结果比较,左侧卧位时收缩压平均低17．07mmHg（1mmHg=0．133kPa）,舒张压平均低13．34mmHg,差异有统计学意义（P〈0．01）;右侧卧位时收缩压平均低1．22mmHg,舒张压平均低0．24mmHg,差异无统计学意义（P〉0．05）。结论选用右上肢肱动脉动态血压监测时,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低于仰卧位时动态血压测量的结果。     

台式血压计升高存放盒的制作与使用

血压是重要的生命体征之一,血压的测量值是高血压分级及危险程度评估的重要指标之一[1].准确测量血压对高血压的诊断、分类,以及评价血压相关的危险、指导治疗等至关重要[2].血压测量的标准体位是坐位[3],为保证血压测量的准确性,应注意保持所测手臂的肱动脉与心脏在同一水平.不同体位无创伤血压监测值的比较发现,手臂高于心脏时所测得的血压偏低,手臂低于心脏时所测得的血压偏高[4].     

隔衣厚度对住院病人血压测量值影响的循证护理实践

[目的]探讨住院病人着衣厚度对血压测量值的影响。[方法]运用澳大利亚循证护理中心(JBI)循证卫生保健模式,收集血压测量时衣物厚度对结果影响的证据,进行证据综合及证据传播,对护理人员展开系统培训,并将证据综合结果运用到临床实践,进一步检测循证护理实践是否能为解决临床问题提供依据。[结果]住院病人测量部位衣物厚度≤5 mm时不影响血压测量的准确性,并且在保证衣物厚度≤5 mm时,病人自身血压水平及血压计类型均对测量结果不产生影响。[结论]运用循证护理实践为血压测量时衣物厚度提出明确建议,允许衣物厚度≤5 mm时测量血压以缩短操作时间,减轻护理工作量,提高护理服务质量。     

不同体位对血压值的影响

在临床工作中测量肱动脉血压时,通常采取坐位或平卧位测量。但我们发现坐位和平卧位两种不同体位测量的血压值有所差别,为了探讨两种不同体位对血压值的影响,我们选择了我院健康医护人员25例进行对照测量,现报告如下。临床资料 25例健康医护人员中,男13例,女12例,年龄最大者48岁,最小者24岁。25例均在安静状态下测量右侧肱动脉,均由专人用同一个血压     

血压计零点及袖带位置对血压测量值的影响研究

目的通过对血压计零点不同位置及袖带与听诊器胸件不同位置关系所测血压值的比较,探讨适合的血压测量方法。方法在临床各科随机抽取住院患者230例随机分为A组110例和B组120例。A组采用血压计零点置于不同位置的测量,B组采用袖带与听诊器胸件不同位置关系的测量,采用自身对照的方法。分别对两组所测血压值进行比较。结果 A组血压计零点3种不同位置测量的血压值比较无显著性差异（P〉0.05）;B组听诊器胸件置于袖带内的血压值均低于袖带在肘窝上2～3 cm处的血压值,有显著性差异（P〈0.05）。结论测量血压时血压计可以放置于便于操作的位置,但袖带不应缠绕在肘窝肱动脉处,即听诊器胸件不宜放置于袖带内。     

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.     

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。     

影响测压相关因素研究

目的　探讨几种影响测压相关因素及其对收缩压及舒张压的不同影响。方法　随机选择在校学生 10 0名 ,设计了 1)心脏与肱动脉的相对位置 ;2 )绷袖带的松紧程度 ;3)测压时间 ;4 )测压时体位 ;5 )测压部位共 5个影响因素 ,并做干预前后或相关自身血压对照。结果　血压计相对位置在很大程度上影响血压的值 ;绷袖带太紧明显使血压偏低 ;体位改变主要影响舒张压 ;右肱动脉的收缩压明显高于左肱动脉。结论　测压时尽量避免影响测压的相关因素     

同体自身坐卧位血压值差异性对比

目的:通过同体自身坐卧位血压值的测量,探讨坐位和卧位血压值差异情况,以指导临床护理工作。方法:对175名观察对象采用同体自身对照,分别测量坐位血压和卧位血压,对所测量的血压值采用配对t检验,进行统计学处理。结果:坐位测量的血压值明显高于卧位测量的血压值,以舒张压增高更明显,差异有统计学意义(P0.05)。结论:坐位血压值高于卧位血压值,临床上对血压进行评估时应注意体位影响。     

Blood pressure as a surrogate end point for hypertension

OBJECTIVE: To review relevant literature and provide opinions regarding the use of blood pressure as a surrogate measure to predict cardiovascular risk. DATA SOURCES: Primary and review articles were identified by MEDLINE search (1990-January 2001) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION: Studies and review articles that related to the interpretation of blood pressure as a surrogate measure were reviewed. Information that was relevant to this topic was included. DATA SYNTHESIS: The measurement of blood pressure is subject to numerous sources of error and bias. Patients who perform home blood pressure testing and self-report these values frequently leave out high values and add ghost values into logbooks. Additionally, analysis of recent data suggests that at any given level of blood pressure that is achieved, cardiovascular risk reduction may not be the same with different therapeutic agents. It is also now recommended that systolic blood pressure be used in preference to diastolic blood pressure to determine risk and to assess management strategies. Although 24-hour blood pressure measurements may be the best predictors of cardiovascular risk, this has not been demonstrated in a long-term morbidity trial. CONCLUSIONS: Blood pressure is a relatively poor surrogate measure. Unfortunately, no alternatives are available at this time. Therefore, every attempt must be made to accurately determine blood pressure and to assess risk and benefit from specific antihypertensive agents. Systolic blood pressure should be the predominant blood pressure measure used to evaluate patients, especially middle-aged and elderly individuals.     

同一肢体自身不同腕带松紧度测量血压值差异性研究

[目的]通过同一肢体自身不同腕带松紧度血压值的测量，探讨3种腕带松紧度血压值有无差异性，以指导临床护理工作。[方法]对198名观察对象采用同一肢体自身对照，分别测量腕带松紧度为0指、1指、2指的血压，对所测血压值进行统计学分析。[结果]腕带松紧度不同时舒张压差异无统计学意义，0指与2指收缩压相差2．1mmHg，差异有统计学意义（P〈0．05）。[结论]腕带松紧度在O指至2指之间测得的血压值差异均无临床意义。     

The effects of crossed leg on blood pressure measurement

BACKGROUND: It is clear that numerous factors influence an individual's blood pressure measurement. However, guidelines for accurately measuring blood pressure inconsistently specify that the patient should keep feet flat on the floor. OBJECTIVE: To determine if the crossing of a leg at the knee during blood pressure measurement has an effect on the patient's blood pressure reading. METHODS: A convenience sample of 100 hypertensive male subjects was selected from various outpatient clinics in an inner-city acute-care veterans' hospital. The first 50 subjects positioned their feet flat on the floor while their blood pressure was measured. After 3 minutes, the blood pressure was measured again with the subject's leg crossed at the knee. The procedure was reversed for the second 50 subjects. RESULTS: The results indicated that both systolic and diastolic blood pressure increased significantly (p < .0001) with the crossed leg position. CONCLUSION: When blood pressure is measured, patients should be instructed to have feet flat on the floor to eliminate a potential source of error.     

Accuracy of four indirect methods of blood pressure measurement,with hemodynamic correlations

In 38 adults undergoing cardiac surgery, 4 indirect blood pressure techniques were compared with brachial arterial blood pressure at predetermined intervals before and after cardiopulmonary bypass. Indirect blood pressure measurement techniques included automated oscillometry, manual auscultation, visual onset of oscillation (flicker) and return-to-flow methods. Hemodynamic measurements or calculations included heart rate, cardiac index, stroke volume index, and systemic vascular resistance index. Indirect and intraarterial blood pressure values were compared by simple linear regression by patient and measurement period. Measurement errors (arterial minus indirect blood pressure) were calculated, and stepwise regression assessed the relationship between measurement error and heart rate, cardiac index, stroke volume index, and systemic vascular resistance index. Indirect to intraarterial blood pressure correlation coefficients varied over time, with the strongest correlations often occurring at the first and last measurement periods (preinduction and 60 minutes after cardiopulmonary bypass), particularly for systolic blood pressure. Within-patient correlations between indirect and arterial blood pressure varied widely—they were consistently high or low in some patients. In other patients, correlations were especially weak with a particular indirect blood pressure method for systolic, mean, or diastolic blood pressure; in some cases indirect blood pressure was inadequate for clinical diagnosis of acute blood pressure changes or trends. The mean correlations between indirect and direct blood pressure values were, for systolic blood pressure: 0.69 for oscillometry, 0.77 for auscultation, 0.73 for flicker, and 0.74 for return-to-flow; for mean blood pressure: 0.70 for oscillometry and 0.73 for auscultation; and for diastolic blood pressure: 0.73 for oscillometry and 0.69 for auscultation. The mean measurement errors (arterial minus indirect values) for the individual indirect blood pressure methods were, for systolic: 0 mm Hg for oscillometry, 9 mm Hg for auscultation, -5 mm Hg for flicker, 7 mm Hg for return-to-flow; for mean: -6 mm Hg for oscillometry, and -3 mm Hg for auscultation; and for diastolic: -9 mm Hg for oscillometry and -8 mm Hg for auscultation. Mean measurement error for systolic blood pressure was thus least with automated oscillometry and greatest with manual auscultation, while standard deviations ranging from 9 to 15 mm Hg confirmed the highly variable nature of single indirect blood pressure measurements. Except for oscillometric diastolic blood pressure, a combination of systemic hemodynamics (heart rate, stroke volume index, systemic vascular resistance index, and cardiac index) correlated with each indirect blood pressure measurement error, which suggests that particular numeric ranges of these variables minimize measurement error. This study demonstrates that striking variability occurs in the relationship between indirect and arterial blood pressure measurements, and that the systemic hemodynamic state influences accuracy of indirect blood pressure measurements. When the reproducibility of repeated indirect blood pressure measurements appears unsatisfactory or inconsistent with other clinical observations, clinicians may find that an alternative indirect blood pressure method is a better choice. Of the methods tested, no single indirect blood pressure technique showed precision superior to the others, but two methods yielded data only for systolic pressure. These findings lend support to intraarterial blood pressure measurement in conditions of hemodynamic variability, and suggest the theoretical benefits of continuous indirect blood pressure measurements. Annual meeting of the American Society of Anesthesiologists, New Orleans, LA, Oct 1984.     

Biases in the measurement of arterial pressure

We compared cuff to simultaneous direct intra-arterial pressure in 26 seriously ill patients, in order to: test the accuracy of oscillometric and auscultatory estimates of direct systolic pressure; test muffling and disappearance of sound as indices of direct diastolic pressure; gain insight into the timing of the different phases of Korotkoff sounds; and assess the local and general effects of cuff inflation on blood pressure. We found that conventional estimation of systolic blood pressure by auscultation of the first Korotkoff sound (K1) underestimates direct systolic pressure by an average of 16 to 17 mm Hg. Oscillometric pressure measurement provides a significantly better estimate than K1 but still underestimates by 7 to 8 mm Hg. These systolic cuff measurements are biased downward from direct values because of local cuff effect and cuff error. Diastolic cuff measurements deviate from direct values primarily because of a local cuff effect which produces an upward bias of 5 mm Hg at the point of sound muffling (K4), and 3 mm Hg at the point where sounds disappear (K5). We recommend oscillometric measurement of systolic pressure and K5 measurement of diastolic pressure as the best indirect estimates of blood pressure in critically ill patients.