102例危重病患者有创血压和无创血压的对比
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摘要
目的比较102例危重病患者有创血压(IBP)和无创血压(NBP)测量结果的一致性。方法收集2016年3～9月在西安交通大学第二附属医院重症医学科住院治疗的102例危重病患者的尺/桡动脉IBP和同侧上臂NBP数据1072对,先对所有数据分别按收缩压、舒张压、脉压(PP)和平均动脉压(MAP)进行配对t检验;再将数据分为高血压组(MAP≥107 mmHg)(1 mmHg=0.133 kPa)、正常血压组(70 mmHg≤MAP <107 mmHg)和低血压组(MAP <70 mmHg)三个亚组,分别进行IBP和NBP的收缩压、舒张压、PP以及MAP间的配对t检验。以P <0.05为差异具有统计学意义。结果有创收缩压和无创收缩压之间比较,差异具有统计学意义[(128.08±35.48)mmHg vs(122.56±24.84)mmHg,t=7.896,P <0.001)];有创舒张压和无创舒张压之间比较,差异具有统计学意义[(65.66±13.69)mmHg vs(67.98±13.31)mmHg,t=-8.294,P <0.001];有创PP和无创PP之间比较,差异具有统计学意义[(62.42±28.93)mmHg vs(54.58±20.00)mmHg,t=11.697,P <0.001];有创MAP和无创MAP之间比较,差异无统计学意义[(86.47±18.94)mmHg vs(86.17±15.33)mm Hg,t=0.867,P=0.386]。亚组分析显示高血压组(n=254):有创收缩压和无创收缩压之间比较,差异具有统计学意义[(163.75±33.93)mm Hg vs(152.16±16.78)mm Hg,t=6.52,P <0.001],有创舒张压和无创舒张压之间比较,差异具有统计学意义[(79.17±11.03)mm Hg vs(83.69±9.50)mmHg,t=-6.85,P <0.001)],有创PP和无创PP之间比较,差异具有统计学意义[(84.57±31.50)mmHg vs (68.47±20.72)mmHg,t=9.76,P <0.001];正常血压组(n=687):有创收缩压和无创收缩压之间比较,差异具有统计学意义[(122.66±24.74)mmHg vs(118.70±15.14)mm Hg,t=5.071,P <0.001)],有创舒张压和无创舒张压之间比较,差异具有统计学意义[(63.97±10.34)mmHg vs(65.60±8.49)mmHg,t=-5.049,P <0.001)],有创PP和无创PP之间比较,差异具有统计学意义[(58.69±23.05)mmHg vs (53.10±11.90)mmHg,t=7.682,P <0.001];低血压组(n=131):有创收缩压和无创收缩压之间比较,差异无统计学意义[(87.35±24.33)mm Hg vs(85.41±11.99)mmHg,t=1.109,P=0.269],有创舒张压和无创舒张压之间比较,差异具有统计学意义[(48.32±8.27)mmHg vs(49.98±8.06)mmHg,t=-2.073,P=0.040],有创PP和无创PP之间比较,差异具有统计学意义[(39.03±24.00)mmHg vs(35.43±13.97)mmHg,t=1.806,P <0.001]。结论有创收缩压大于无创收缩压、有创舒张压小于无创舒张压、有创PP大于无创PP,而有创MAP等于无创MAP。采用MAP数值较采用收缩压和(或)舒张压数值可以消除IBP和NBP测量之间的差异。
Objective To compare the differences between noninvasive and invasive blood pressure in critical ill patients. Methods 1072 pairs of invasive blood pressure by radial/ulnar artery catheter and noninvasive blood pressure by cuff on the same arm were collected from March 2016 to September2016. The systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure were analyzed by paired t-test. In addition, the same comparison was performed in subgroups, high blood pressure(MAP ≥ 97 mmHg)(1 mmHg=0.133 kPa), normal blood pressure(70 mmHg ≤ MAP < 97 mmHg) and low blood pressure(MAP < 70 mmHg) according to the noninvasive mean blood pressure. Two-tailed P-values <0.05 were considered statistically significant. Results There was a significant statistically difference between invasive systolic blood pressure and the noninvasive systolic pressure [(128.08±35.48) mmHg vs(122.56±24.84) mmHg, t=7.896, P < 0.01). Similar results were found between invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(65.66±13.69) mmHg vs(67.98±13.31) mmHg, t=-8.294,P < 0.01], also the invasive pulse pressure and the noninvasive pulse pressure [(62.42±28.93) mmHg vs(54.58±20.00) mmHg, t=11.697, P < 0.01]. However, no significant difference was found between the invasive and noninvasive mean arterial pressure [(86.47±18.94) mmHg vs(86.17±15.33) mmHg, t=0.867,P=0.386]. Subgroups analysis showed that in the high blood pressure subgroup(n=254), a significant statistically difference exists between invasive systolic blood pressure and the noninvasive systolic pressure[(163.75±33.93) mmHg vs(152.16±16.78) mmHg, t=6.52, P < 0.001] as well as invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(79.17±11.03) mmHg vs(83.69±9.50) mmHg,t=-6.85, P < 0.001], similarly results were also found in invasive pulse pressure and the noninvasive pulse pressure [(84.57±31.50) mmHg vs(68.47±20.72) mmHg, t=9.76, P < 0.001]; in normal blood subgroup(n=687), a statistically difference exists in systolic blood pressure, diastolic blood pressure and pulse pressure,respectively between invasive and non-invasive measurements [(122.66±24.74) mmHg vs(118.70±15.14) mmHg, t=5.071, P < 0.001;(63.97±10.34) mmHg vs(65.60±8.49) mmHg, t=-5.049, P < 0.001;(58.69±23.05) mmHg vs(53.10±11.90) mmHg, t=7.682, P < 0.001]; by contrast, in low blood pressure subgroup(n=131), no signi?cant statistically difference was found in invasive systolic blood pressure and the noninvasive systolic pressure [(87.35±24.33) mmHg vs(85.41±11.99) mmHg, t=1.109, P=0.269], signi?cant difference was found between invasive diastolic blood pressure and the noninvasive diastolic blood pressure[(48.32±8.27) mmHg vs(49.98±8.06) mmHg, t=-2.073, P=0.040], as well as invasive pulse pressure and the noninvasive pulse pressure [(39.03±24.00) mmHg vs(35.43±13.97) mmHg, t=1.806, P < 0.001].Conclusions The invasive systolic blood pressure is higher than the noninvasive systolic blood pressure while the invasive diastolic blood pressure is lower than the noninvasive diastolic blood pressure and the invasive pulse pressure is higher than the noninvasive pulse pressure. No difference is found between the invasive and the noninvasive mean arterial pressure. The mean blood pressure may eliminate the differences between invasive and noninvasive blood pressure.
Objective To compare the differences between noninvasive and invasive blood pressure in critical ill patients. Methods 1072 pairs of invasive blood pressure by radial/ulnar artery catheter and noninvasive blood pressure by cuff on the same arm were collected from March 2016 to September2016. The systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure were analyzed by paired t-test. In addition, the same comparison was performed in subgroups, high blood pressure(MAP ≥ 97 mmHg)(1 mmHg=0.133 kPa), normal blood pressure(70 mmHg ≤ MAP < 97 mmHg) and low blood pressure(MAP < 70 mmHg) according to the noninvasive mean blood pressure. Two-tailed P-values <0.05 were considered statistically significant. Results There was a significant statistically difference between invasive systolic blood pressure and the noninvasive systolic pressure [(128.08±35.48) mmHg vs(122.56±24.84) mmHg, t=7.896, P < 0.01). Similar results were found between invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(65.66±13.69) mmHg vs(67.98±13.31) mmHg, t=-8.294,P < 0.01], also the invasive pulse pressure and the noninvasive pulse pressure [(62.42±28.93) mmHg vs(54.58±20.00) mmHg, t=11.697, P < 0.01]. However, no significant difference was found between the invasive and noninvasive mean arterial pressure [(86.47±18.94) mmHg vs(86.17±15.33) mmHg, t=0.867,P=0.386]. Subgroups analysis showed that in the high blood pressure subgroup(n=254), a significant statistically difference exists between invasive systolic blood pressure and the noninvasive systolic pressure[(163.75±33.93) mmHg vs(152.16±16.78) mmHg, t=6.52, P < 0.001] as well as invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(79.17±11.03) mmHg vs(83.69±9.50) mmHg,t=-6.85, P < 0.001], similarly results were also found in invasive pulse pressure and the noninvasive pulse pressure [(84.57±31.50) mmHg vs(68.47±20.72) mmHg, t=9.76, P < 0.001]; in normal blood subgroup(n=687), a statistically difference exists in systolic blood pressure, diastolic blood pressure and pulse pressure,respectively between invasive and non-invasive measurements [(122.66±24.74) mmHg vs(118.70±15.14) mmHg, t=5.071, P < 0.001;(63.97±10.34) mmHg vs(65.60±8.49) mmHg, t=-5.049, P < 0.001;(58.69±23.05) mmHg vs(53.10±11.90) mmHg, t=7.682, P < 0.001]; by contrast, in low blood pressure subgroup(n=131), no signi?cant statistically difference was found in invasive systolic blood pressure and the noninvasive systolic pressure [(87.35±24.33) mmHg vs(85.41±11.99) mmHg, t=1.109, P=0.269], signi?cant difference was found between invasive diastolic blood pressure and the noninvasive diastolic blood pressure[(48.32±8.27) mmHg vs(49.98±8.06) mmHg, t=-2.073, P=0.040], as well as invasive pulse pressure and the noninvasive pulse pressure [(39.03±24.00) mmHg vs(35.43±13.97) mmHg, t=1.806, P < 0.001].Conclusions The invasive systolic blood pressure is higher than the noninvasive systolic blood pressure while the invasive diastolic blood pressure is lower than the noninvasive diastolic blood pressure and the invasive pulse pressure is higher than the noninvasive pulse pressure. No difference is found between the invasive and the noninvasive mean arterial pressure. The mean blood pressure may eliminate the differences between invasive and noninvasive blood pressure.
引文
1 Whelton PK,Carey RM,Aronow WS,et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention,Detection,Evaluation,and Management of High Blood Pressure in Adults:Executive Summary:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J].J Am Soc Hypertens,2018,12(8):579.e1-579.e73.
2 Meidert AS,Saugel B.Techniques for non-invasive monitoring of arterial blood pressure[J].Front Med(Lausanne),2018,4:231.
3 Lele AV,Wilson D,Chalise P,et al.Differences in blood pressure by measurement technique in neurocritically ill patients:A technological assessment[J].J Clin Neurosci,2018,47:97-102.
4 Yamashita A,Irikoma S.Comparison of inflationary non-invasive blood pressure(iNIBP)monitoring technology and conventional deflationary non-invasive blood pressure(dNIBP)measurement in detecting hypotension during cesarean section[J].JA Clin Rep,2018,4(1):5.
5刘大为,王小亭,张宏民,等.重症血流动力学治疗--北京共识[J].中华内科杂志,2015,54(3):248-271.
6 Yannoutsos A,Bura-Rivière A,Priollet P,et al.Blood pressure target in 2017[J].J Med Vasc,2017,42(6):367-374.
7刘大为.休克复苏:流量指标的龙头效应[J].中华内科杂志,2017,56(5):321-323.
8 Lakhal K,Macq C,Ehrmann S,et al.Noninvasive monitoring of blood pressure in the critically ill:reliability according to the cuff site(arm,thigh,or ankle)[J].Crit Care Med,2012,40(4):1207-1213.
9 Holt TR,Withington DE,Mitchell E,et al.Which pressure to believe?A comparison of direct arterial with indirect blood pressure measurement techniques in the pediatric intensive care unit[J].Pediatr Crit Care Med,2011,12(6):e391-394.
10 Lehman LW,Saeed M,Talmor D,et al.Methods of blood pressure measurement in the ICU[J].Crit Care Med,2013,41(1):34-40.
2 Meidert AS,Saugel B.Techniques for non-invasive monitoring of arterial blood pressure[J].Front Med(Lausanne),2018,4:231.
3 Lele AV,Wilson D,Chalise P,et al.Differences in blood pressure by measurement technique in neurocritically ill patients:A technological assessment[J].J Clin Neurosci,2018,47:97-102.
4 Yamashita A,Irikoma S.Comparison of inflationary non-invasive blood pressure(iNIBP)monitoring technology and conventional deflationary non-invasive blood pressure(dNIBP)measurement in detecting hypotension during cesarean section[J].JA Clin Rep,2018,4(1):5.
5刘大为,王小亭,张宏民,等.重症血流动力学治疗--北京共识[J].中华内科杂志,2015,54(3):248-271.
6 Yannoutsos A,Bura-Rivière A,Priollet P,et al.Blood pressure target in 2017[J].J Med Vasc,2017,42(6):367-374.
7刘大为.休克复苏:流量指标的龙头效应[J].中华内科杂志,2017,56(5):321-323.
8 Lakhal K,Macq C,Ehrmann S,et al.Noninvasive monitoring of blood pressure in the critically ill:reliability according to the cuff site(arm,thigh,or ankle)[J].Crit Care Med,2012,40(4):1207-1213.
9 Holt TR,Withington DE,Mitchell E,et al.Which pressure to believe?A comparison of direct arterial with indirect blood pressure measurement techniques in the pediatric intensive care unit[J].Pediatr Crit Care Med,2011,12(6):e391-394.
10 Lehman LW,Saeed M,Talmor D,et al.Methods of blood pressure measurement in the ICU[J].Crit Care Med,2013,41(1):34-40.