小儿低血压状态时振荡法无创血压测量准确性研究

目的探讨小儿低血压状态下无创血压测量的准确性.方法选择术中需要静吸复合全麻并气管插管的婴幼儿24例,术中采用异氟醚降低患儿血压至大于基础值的30%,对比迈瑞公司的振荡法无创血压模块(采用迈瑞PM-9000监护仪)和听诊法对患儿血压监测的测量值.结果振荡法无创血压模块和听诊法比较差异无显著性(P＞0.05).收缩压平均偏差为-0.11,舒张压为4.57;收缩压标准方差为5.11,舒张压为5.98.结论低血压情况下振荡法无创血压测量方法是准确,可靠的.     

老年人主动脉有创血压测量与肱动脉无创血压测量对比研究

目的 了解老年人主动脉有创血压测量与肱动脉无创血压测量是否不同.方法 选择78例冠状动脉造影的老年患者,经周围动脉将导管送到升主动脉测量有创血压,同时用监护仪测量左侧上肢肱动脉无创血压.结果 无创血压测量的收缩压比有创测量的收缩压值平均低12.28 mm Hg(1 mm Hg=0.133 kPa)(P＜0.01),无创...     

冠状动脉造影前后有创及无创血压监测的临床价值

目的 评估冠状动脉造影对血压的影响及不同部位有创血压和无创血压监测的临床价值.方法 连续入选行冠状动脉造影者128例;其中,经桡动脉路径者31例,经股动脉路径者97例.记录冠状动脉造影前后经桡动脉、股动脉、主动脉根部监测的有创血压和肱动脉水平测量的无创血压.结果 在经股动脉路径造影时,术前收缩压监测结果:股动脉压[(163.8±25.1) mm Hg]＞中心动脉压[(142.8±24.1) mm Hg]＞无创血压[(130.5±22.3) mm Hg];舒张压监测结果:中心动脉压[(85.2±12.4) mm Hg]＞股动脉压[(81.8±12.0) mm Hg]＞无创血压[(77.9±12.1)mm Hg].股动脉造影前后收缩压和舒张压均无显著变化.在经桡动脉路径造影时,术前收缩压监测结果:桡动脉压[(157.2±22.8)mm Hg]＞中心动脉压[(144.9±20.8) mm Hg]＞无创血压[(133.2±23.2)mm Hg];经桡动脉造影后,中心动脉收缩压较术前显著升高(P＜0.05),但桡动脉收缩压、无创收缩压和舒张压较术前均显著下降(P＜0.05).结论 不同部位有创血压与无创血压监测结果不可相互替代,临床医生应根据不同血压监测结果和患者实际情况对患者进行适当的诊治.     

中心动脉压测定及对不同药物反应的临床观察

目的观察不同方法测得的中心动脉压和外周动脉压的差别，比较美托洛尔和培哚普利对中心动脉压的作用。方法通过桡动脉应用导管法测量中心动脉压和外周动脉压（桡动脉血压），同时测量肱动脉无创血压，比较高血压病患者应用关托洛尔和培哚普利后中心动脉压和外周动脉压的差别。结果非高血压病患者中心动脉收缩压和桡动脉收缩压明显高于肱动脉无创收缩压，桡动脉有创收缩压明显高于中心动脉收缩压，中心动脉舒张压明显高于桡动脉舒张压和肱动脉无创舒张压，桡动脉舒张压和肱动脉无创舒张压无统计学意义。结论不同测量方法测得中心动脉压和外周血压值不同，培哚普利比较关托洛尔降低中心动脉收缩压效果更为明显。     

有创动脉血压监测在ICU危重病人护理中的临床应用价值分析

目的:探讨有创动脉血压监测在ICU危重病人护理中的临床应用价值。方法:按随机数字表法将2016年6月-2017年11月90例ICU危重患者分组,对照组进行无创动脉血压监测,实验组开展有创动脉血压监测。比较两组ICU危重患者抢救成功率;自主循环恢复时间、住院时间;患者收缩压和舒张压。结果:实验组ICU危重患者抢救成功率高于对照组,P0.05;实验组自主循环恢复时间、住院时间优于对照组,P0.05;对于休克的患者,实验组收缩压和舒张压低于对照组,P0.05;对于非休克的患者,两组监测值无明显差异,P0.05。结论:有创动脉血压监测在ICU危重病人护理中的临床应用价值高,可有效反映危重患者真实血压,通过正确护理降低死亡率,加速循环恢复,缩短住院时间,提高抢救成功率。     

患儿有创血压与无创血压的相关性研究

目的探讨患儿动脉血压直接测量值与心电监护仪间接测量值的相关性.方法选择40例10岁以下先天性心脏病手术患儿,桡动脉穿刺置管用心电监护仪测量直接血压,用与上相同型号心电监护仪间接测量肱动脉血压,二者进行比较.结果动脉血压的直接测量值与间接测量值有明显差异(P＜0.05).结论在使用心电监护仪测量患儿动脉血压时,间接测量值存在偏差,收缩压比直接血压低10～15mmHg,舒张压比直接血压低5.5～9mmHg.     

无创血压袖带缠绕方向和位置对血压测量的影响

目的探讨无创血压袖带缠绕方向和位置对血压测量的影响。方法将96例危重患者进行自身对照研究,将传感器置于肱动脉上和上臂外侧,每次间隔5分钟,进行正向和反向测量血压,记录测量数值。结果不同组间收缩压、舒张压和平均乐总体比较差异无统计学意义（P〉0．05）,进一步行各组间多重比较差异无统计学意义（P〉0．05）。结论心电监护仪无创血压测量时,袖带的缠绕方向和位置不影响血压值的准确性。     

婴幼儿体外循环术后有创与无创血压监测的对比性研究

目的：探讨婴幼儿体外循环心脏术后有创血压与无创血压监测值的差异。方法采用自身对照的方法对心脏外科60例先心病婴幼儿进行24 h有创血压和无创血压的监测比较，每位患儿选择前臂桡动脉穿刺行有创动脉血压连续监测，比较心脏术后回ICU0、6、12、18、24h两种测压法的临床效果，并对相关数据进行统计学分析。结果30例血压正常者有创血压与无创血压24 h内无差异性，P＞0．05；30例低血压者有创血压与无创血压监测值在术后12 h内有差异性，P＜0．05；术后13～24 h无差异性，P＞0．05。结论有创血压监测能连续更准确提供患儿瞬间血压变化值，为疾病观察提供可靠依据。婴幼儿体外循环术后早期低血压者12 h内，有创血压更能准确反映病情，12 h后有创血压与无创血压基本一致，无创测压可以替代有创测压，避免有创测压带来的危害和并发症。     

连续无创动脉血压监测在冠心病患者麻醉中的应用

目的探讨连续无创动脉血压监测在冠心病患者麻醉中的应用效果。方法选取2017年3月至2018年3月在本院行择期手术的80例冠心病患者作为本次研究的研究对象,麻醉诱导前行右手桡动脉处连接连续无创实时血压监测系统监测无创动脉血压,局麻下左手桡动脉穿刺动脉导管置入监测有创桡动脉血压,比较两种监测方法的舒张压、舒张压和平均压值。结果有创血压监测法的舒张压、舒张压和平均压值与无创血压监测法比较,P> 0.05。结论在行择期手术的冠心病患者全身麻醉中,采取连续无创动脉血压监测,可达到与有创血压监测法的效果,且该法无创、连续、安全,可用于冠心病手术患者麻醉中的血压监测。     

连续无创血压监测系统在老年患者全麻诱导期的应用

目的 评价TL-300 Tensymeter系统(TL-300)所测的连续无创血压(CNAP)在老年患者全麻诱导期的有效性及安全性.方法 择期全身麻醉手术的老年患者30例,ASAⅠ～Ⅲ 级.麻醉诱导前无菌操作下将动脉导管置入非优势手的桡动脉内行有创血压(IAP)监测,另一侧手臂连接TL-300系统行CNAP监测,稳定5 min后,于稳定后(T0)、诱导前(T1)、插管前(T2)、插管即刻(T3)、插管后1 min(T4)、插管后3 min(T5)、插管后5 min(T6)同时记录IAP和CNAP监测的收缩压、舒张压和平均压.结果 CNAP与IAP所测收缩压、舒张压和平均压偏倚分别为(-1.3±8.3)、(-1.6±4.4)、(-0.9±3.9)mmHg,在其相应的一致性界限范围内所占比值分别为95.2％、91.4％、91.9％.两种血压监测方法的收缩压、舒张压和平均压的相关系数分别为0.813、0.935和0.896,均P<0.001.结论 与IAP监测相比,CNAP监测在老年患者全麻诱导期可提供连续、无创、准确的血压监测.     

体外冲击波对犬血流动力学影响的实验研究

目的：探讨体外冲击波（ESW）冲击犬心脏对血流动力学的影响。方法：以杂种犬的右室心尖部作为ESW的冲击靶点,右侧股动脉插管监测股动脉血压;采用Swan-Gans导管监测右房压、右室压、肺动脉压;热稀释法测定犬的心输出量。结果：ESW冲击犬心脏后,股动脉收缩压和右室收缩压下降（P〈0.05）,右室舒张压和肺动脉的收缩压、舒张压和平均压均升高（P〈0.05）;心输出量无明显改变（P〉0.05）。结论：ESW冲击犬心脏可导致血流动力学紊乱。     

Low frequency arterial wall movements for indirect blood pressure measurement in man. Validation of a method for non-invasive assessment of blood pressure under the influence of isoprenaline and angiotensin

In order to measure blood pressure noninvasively, the second derivative of the low frequency wall movements of the brachial artery were registered with a piezo-electric pressure probe during deflation of a Riva-Rocci cuff along with the actual cuff pressure. Two characteristic phenomena of this signal have been suggested to reflect systolic and diastolic blood pressure. Appearance of a positive spike phenomenon (S) was suggested to indicate systolic blood pressure and disappearance of a negative preanacrotic notch (D) to indicate diastolic blood pressure. To prove the validity of these suggestions, these phenomena were assessed in 10 young healthy males during isoprenaline and angiotensin induced changes of blood pressure. Intraarterial (A. radialis) and auscultatory (A. brachialis) blood pressures were recorded simultaneously. Determination of systolic blood pressure with the S phenomenon agreed well with invasive and auscultatory results. Invasive diastolic values agreed well with the cuff pressure at the last signal before disappearance of the preanacrotic notch (D1). Data from auscultation agreed less well with the D1 phenomenon. With increasing doses of isoprenaline, the diastolic measurements (D1) tended to be lower than the invasive ones. However, this discrepancy was far discreeter than that seen with ordinary auscultatory blood pressure measurement. We therefore conclude that registrations of low frequency arterial wall movements yield distinct characteristic spike phenomena useful for measurement of blood pressure in good agreement with the invasive method. In addition, the method provides clearly documented records and should be useful in situations which rely on a valid indirect method.     

ACCURACY OF THE TAKEDA TM-2420 AMBULATORY BLOOD PRESSURE MONITOR

1. The accuracy of blood pressure measurement with the Takeda TM-2420 ambulatory blood pressure monitor and the TM-2020 data recorder have been assessed by comparison with simultaneous measurements taken using auscultation and direct femoral artery measurements. 2. Systolic blood pressure was underestimated by the TM-2420 by a mean of 10 mmHg (s.d. = 6, 95% confidence interval (CI) = -13 to -7) over the range of pressures measured by auscultation. It was underestimated by 23 mmHg (s.d. = 12, 95% CI = -28 to -18) compared with direct femoral artery measurements. 3. Diastolic pressure measurements were similar to those obtained by auscultation. When compared with direct femoral artery recordings, diastolic pressure was overestimated by about 5 mmHg (s.d. = 4, 95% CI = 3.4-6.6), which is consistent with indirect readings, taken with a 'standard' cuff (inflatable bladder 23 cm X 12 cm). 4. The TM-2420/2020 is thus suitable for ambulatory measurements of blood pressure when diastolic pressure is the criterion of interest.     

Arterial stiffness and cardiovascular drugs

Arterial stiffness is the most important cause of increasing systolic and pulse pressure, and for decreasing diastolic pressure with ageing. Many measures can be applied to quantify arterial stiffness, but all are approximations only, on account of the nonhomogenous structure of the arterial wall, its variability in different locations, at different levels of distending pressure, and with changes in smooth muscle tone. This article summarizes those indices with a focus on newer non-invasive methods and provides an overview of physiological, pathological and pharmacological influences on arterial hemodynamics. In the near future, the ability to detect and monitor subclinical arterial damage will improve cardiovascular risk stratification and act as a better guide in assessing the efficacy of therapeutic interventions than monitoring blood pressure alone. However, large-scale clinical trials are needed to prove the hypothesis that treatment of these new therapeutic targets will translate into clinical benefit, expressed in cardiovascular events or even mortality.     

Psychological stress and arterial pulse transit time

Progress in isolating the psychological factors contributing to the development of arterial hypertension has been retarded by the absence of suitable, non-invasive and continuous measures of significant aspects of cardiovascular activity. Pulse transit time may help to resolve this problem since it reflects changes in arterial elasticity and diastolic blood pressure. A method of recording pulse transit time is described. Significant decreases in pulse transit time were observed in response to a cold pressor test, a video game, a reaction-time task and problem solving, regardless of site of measurement or method of pulse transduction.     

无创通气在治疗胸心外科急性呼吸衰竭患者中的运用

目的对比无创正压通气和有创正压通气的医学疗效,分析无创通气在治疗胸心外科急性呼吸衰竭患者中的医疗效果。方法随机抽取急性呼吸衰竭患者40例,分别采用无创正压通气和有创正压通气两种治疗方式,对比两种医疗方式的临床效果,以此来分析无创正压通气。结果使用无创正压通气技术的20例患者中有18例患者治疗后动脉血气的指标有明显改善,2例患者通气效果不佳,加用BiPAP辅助通气治疗后血压、心率等均有明显改善。治愈率达90%。使用有创正压通气技术的20例患者中有16例患者治疗后动脉血气的指标有明显改善,4例有创患者死亡,治愈率为80%。结论治疗胸心外科急性呼吸衰竭使用无创正压通气技术疗效显著,配合BiPAP辅助治疗则可以有效降低病死率。     

应用超声测量婴幼儿双侧桡、尺动脉的对比研究

目的 应用超声测量并分析婴幼儿双侧桡、尺动脉的内径及深度以探讨婴幼儿在超声引导下行桡、尺动 脉穿刺置管的差异性。方法 选取择期行全麻手术的婴幼儿120例,应用超声对患儿双侧桡、尺动脉进行检查测量, 记录双侧桡、尺动脉3个标志点的深度、内径及解剖变异情况,同时记录患儿的身高、体质量、禁饮禁食时间以及每个 测量时刻的平均动脉压（MAP）、心率（HR）和体温。结果 超声测得的患儿左、右前臂间桡动脉和尺动脉深度、内径 差异无统计学意义;双侧桡动脉均较尺动脉表浅（P＜0.05）。桡、尺动脉第2测量标志点深度较第1测量标志点深,第 3测量标志点较第2测量标志点深（P＜0.05）;桡、尺动脉内径在各个测量标志点间的比较差异无统计学意义。双侧 桡、尺动脉深度与年龄、身高、体质量、MAP均呈负相关,与HR呈正相关（P＜0.01）;双侧桡、尺动脉内径与年龄、身 高、体质量、MAP均呈正相关,与HR均呈负相关（P＜0.01）。结论 超声测得婴幼儿桡、尺动脉内径相当;在超声引 导下行婴幼儿桡、尺动脉穿刺置管均具有选择性价值。     

The effect of the carotid sinus reflex on large coronary artery diameter in anaesthetized dogs

1. The diameter of, and blood flow in, the left circumflex coronary artery was measured in anaesthetized dogs and the carotid sinus reflex was stimulated by bilateral occlusion of the carotid arteries (BCO) for 2 min. 2. The effect of BCO on coronary artery diameter and late diastolic coronary resistance was examined: (a) after bilateral vagotomy; (b) after vagotomy plus antagonism of beta-adrenoceptors with propranolol (1 mg/kg, i.v.); and (c) after vagotomy, antagonism of beta-adrenoceptors and antagonism of alpha-adrenoceptors with phentolamine (0.5 mg/kg, i.v.). 3. After vagotomy BCO increased mean arterial pressure (delta = 72 +/- 7 mmHg), heart rate (16 +/- 3 beats/min), coronary blood flow (37 +/- 11 ml/min) and coronary artery diameter (0.14 +/- 0.04 mm). Late diastolic coronary resistance initially fell (-0.26 +/- 0.13 mmHg min/ml at 30 s) but at the end of the 2 min occlusion it had returned to the baseline level (delta = 0.04 +/- 0.08 mmHg min/ml). 4. In the presence of propranolol BCO increased arterial pressure (28 +/- 12 mmHg), but did not alter heart rate (0.6 +/- 0.4 beats/min) or coronary blood flow (2 +/- 2 ml/min). There was a significant decrease in large artery diameter (-0.24 +/- 0.07 mm) and an increase in late diastolic coronary resistance (0.46 +/- 0.12 mmHg min/ml). A mechanical increase in afterload did not affect large coronary artery diameter or coronary resistance. 5. Antagonism of alpha-adrenoceptors abolished the reflex-induced constriction of the large coronary artery (delta = -0.02 +/- 0.02 mm) and the coronary resistance vessels (delta LDCR = -0.02 +/- 0.03 mmHg min ml).(ABSTRACT TRUNCATED AT 250 WORDS)