Kwatanta ma'aunin hawan jini na sama da na ƙasa

Kwatanta ma'auni na hawan jini a cikin babba da na ƙasa tare da ma'aunin hawan jini a cikin yara da ke ƙarƙashin maganin sa barci.
Seth Hayes, 1 Rebecca Miller, 1 Ambrish Patel, 2, 3 Dmitry Tumin, 1, 2 Hina Valiya, 1 Mohammed Hakim, 1 Fayzaan Syed, 1 Joseph D. Tobias 1, 2, 41 Sashen Nazarin Anesthesiology da Magungunan Ciwo, Ƙungiyar Yara ta Ƙasa. Asibitin Columbus, Ohio 43205, Amurka;2 Sashen Ilimin Yara, Jami'ar Jihar Ohio, Columbus, Ohio, 43210, Amurka;3 Sashin Kula da Lafiyar Yara, Asibitin Yara na Ƙasa, Columbus, Ohio, 43205, Amurka;4 Sashen Nazarin Anesthesiology da Kula da Raɗaɗi, Jami'ar Jihar Ohio, Columbus, OH 43210, Amurka Mawallafin Mawallafi: Ma'aikatar Anesthesiology da Kula da Raɗaɗi na Seth Hayes, Asibitin Ƙasa na Yara, 700 Yara Drive, Columbus, OH 43205, USATel +1 614 722 4200 Fax +1 614 722 4203 Ƙwayoyin cutar hawan jini (IBP) da ma'auni masu ma'auni tare da ma'auni na oscillometric na babba da na ƙasa a cikin jarirai da yara a karkashin maganin sa barci.MASU LAFIYA DA HANYOYI.Nazarin mu ya haɗa da marasa lafiya a ƙarƙashin shekaru 10 idan sun sami maganin sa barci na yau da kullum kuma sun tsara maganin catheterization na radial.An auna IBP kowane minti 5 tare da transducer hydrodynamic, kuma an auna NIBP tare da oscilloscopes guda biyu tare da nau'i mai kyau da aka sanya a kan hannu na sama da ƙananan ƙafa, kuma an dauki ma'auni 10 akan kowane mai haƙuri.Sakamako: Binciken ya shafi maza 18 da 'yan mata 12 masu shekaru 0 zuwa 8.A maki 300 na bayanai, cikakken bambanci tsakanin hannu yana nufin matsa lamba (MAP) da ma'auni masu ɓarna shine 7 ± 7 mmHg.Art.(kewayon: 0-52 mmHg).Babban bambanci tsakanin ma'auni na SBP a kan kafa da kuma hanyar cin zarafi shine 8 ± 8 mm Hg.Art.(kewayon: 0-52 mmHg). Ko da yake duka wuraren da ba su da ma'auni sun nuna sau da yawa sabawa daga ma'auni mai haɗari, manyan ɓarna sun fi yawa lokacin da aka auna BP a kafa (81 na 298 lura (27%) ya karkata ta> 10 mmHg) idan aka kwatanta da hannu (60 na 300 lura). (20%) karkacewa ta> 10 mmHg.Kammalawa: Yawan ƙetare mahimmancin NIBP na asibiti a cikin yara a ƙarƙashin maganin sa barci na gabaɗaya yana goyan bayan mahimmancin kulawar IBP lokacin da haɓakar haemodynamic zai iya zama mai lahani. Ko da yake duka wuraren da ba su da ma'auni sun nuna sau da yawa sabawa daga ma'auni mai haɗari, manyan ɓarna sun fi yawa lokacin da aka auna BP a kafa (81 na 298 lura (27%) ya karkata ta> 10 mmHg) idan aka kwatanta da hannu (60 na 300 lura). (20%) karkacewa ta> 10 mmHg.Kammalawa: Yawan ƙetare mahimmancin NIBP na asibiti a cikin yara a ƙarƙashin maganin sa barci na gabaɗaya yana goyan bayan mahimmancin kulawar IBP lokacin da haɓakar haemodynamic zai iya zama mai lahani.Kodayake duka wuraren ma'aunin da ba su da haɗari sun nuna sabani akai-akai daga ma'auni mai banƙyama, manyan ɓarna sun fi yawa tare da ma'aunin BP na kafa (81 na 298 lura (27%), karkata fiye da 10 mmHg) idan aka kwatanta da hannu (60 na 300 lura) .(20%), karkacewa da fiye da 10 mm Hg.Art.).Kammalawa.Yawan raunin rashin lafiya na NIBP na asibiti a cikin yara da ke ƙarƙashin maganin sa barci na gabaɗaya yana tabbatar da mahimmancin sa ido kan NIBP lokacin da yuwuwar canjin haemodynamic kuma yana iya zama mai lahani.尽管两个非侵入性测量部位都显示出与侵入性测量的频繁偏差，但与手臂？相比，在腿部测量的BP（298 次观察中的81 次（27 %）偏差> 10 mmHg）更常见(20%) 偏差> 10 mmHg).尽管 两 个 非侵入性 测量 部位 都 出 与的 的 次） 相比 ， 在 测量 的 的 bp （298 (27 （27 （27 ））偏差> 10 mmHg）更常见 (20%) Хотя оба неинвазивных места измерения показали частые отклонения от измерений блюдений (27) по сравнению с рукой (60 из 300 наблюдений) %), отклонение> 10 мм рт.ст.) чаще (20) % отклонение). Kodayake duka wuraren ma'aunin da ba su da haɗari sun nuna sabani akai-akai daga ma'auni masu haɗari, BP da aka auna a kan kafa (81 daga cikin 298 lura (27) idan aka kwatanta da hannu (60 daga 300 lura)%), karkacewa> 10 mmHg) sau da yawa ( 20% karkacewa). > 10 мм рт.ст.). 10 mmHg.KAMMALAWA.Yawan rashin lafiyar NIBP mai mahimmanci na asibiti a cikin yara da ke ƙarƙashin maganin sa barci na gabaɗaya yana tabbatar da mahimmancin sa ido kan NIBP lokacin da hawan jini yana iya yiwuwa kuma yana da lahani.Idan aka kwatanta da ƙimar NIBP da aka samu a hannu na sama, NIBP da aka auna a ƙananan ƙafa zai iya haifar da wata mahimmanci na asibiti daga ma'anar ma'anar ma'anar bugun jini.Mahimman kalmomi: hawan jini mai ɓarna, hawan jini mara ƙarfi, bugun jini.
Kula da hawan jini (BP) yana da mahimmanci a cikin amincin maganin sa barci na gabaɗaya tun lokacin da Dokta Harvey Cushing ya amince da sphygmomanometer a farkon 1900s.Tun daga 1986, wannan shine ma'auni da ƙungiyar masanan likitancin Amurka (ASA) ke buƙata a kowane lokaci na maganin sa barci.Saboda ma'aunin hawan jini yana fitar da mahimman yanke shawara game da gudanarwar aiki, rashin daidaito na iya rikitar da ganowar lokaci da kuma magance rashin zaman lafiyar hemodynamic.Masu ilimin likitancin yara sukan yanke shawara don gudanar da ruwa, samfuran jini, da inotropes dangane da sabawa daga "al'ada" BP.1 Saboda hauhawar jini da hauhawar jini an nuna su da alaƙa da rikice-rikice na baya-bayan nan, gami da gazawar renal mai tsanani, ƙwayar cuta, cututtukan zuciya, bugun jini, da haɓakar mace-mace na kwanaki 30, ma'aunin BP mara kyau zai iya haifar da cutarwa, rashin daidaituwa na BP wanda ba a iya ganewa.2-5
A lokacin tiyata, ana iya auna hawan jini ba tare da lalacewa ba tare da ma'aunin hawan jini na oscillometric (NIBP) ko kuma tare da cannula mai ciki (IBP).Ƙwararren oscillometric cuff yana rufe jijiyar majiyyaci ta hanyar sanya shi zuwa matsa lamba sama da hawan jini na systolic na majiyyaci (SBP) sannan kuma auna saurin matsa lamba yayin da cuff a hankali ya ɓace.Ma'anar da matsa lamba ya fi canzawa shine matsakaicin matsa lamba (MAP).SBP da hawan jini na diastolic (DBP) ana ƙididdige su bisa ga ma'anar matsa lamba da kuma oscillometric model.Algorithms na waɗannan ƙididdiga na mallakar mallaka ne kuma sun dogara da masana'anta na NIBP.6 Sabanin haka, ma'aunin cannulation na arterial masu haɗari na SBP da DBP kai tsaye daga raƙuman bugun jini.An samo MAP daga waɗannan dabi'u.7
Yawancin karatu sun bincika haɗin gwiwar VBP tare da NIBP a cikin yara tare da sakamako mai gauraye. A cikin 2010, Meyer et al sun gudanar da binciken da ke nuna rashin tausayi (<1 mmHg) a kan nazarin Bland-Altman na marasa ma'auni na ma'anar ma'anar ma'auni a cikin jarirai da ba a haifa ba kuma sun nuna cewa haɗin kai tsakanin IBP da NIBP ya inganta kamar yadda fasahar NIBP ta ci gaba. .8 Duk da haka, O'Shea et al sun lura da dabi'a ga ƙimar ƙimar NIBP na ƙarya a cikin wannan yawan masu haƙuri duk da ci gaba da sababbin na'urorin NIBP, mafi mahimmanci, ko da lokacin da yiwuwar rikice-rikice kamar girman cuff da matakin aiki an kawar da su. sun kimanta ma'auni na BP a cikin marasa lafiya na yara marasa lafiya. A cikin 2010, Meyer et al sun gudanar da wani binciken da ke nuna rashin tausayi (<1 mmHg) akan binciken Bland-Altman na marasa ma'auni na ma'anar ma'anar ma'auni a cikin jariran da ba a haifa ba kuma sun nuna cewa haɗin kai tsakanin IBP da NIBP ya inganta kamar fasahar NIBP. Ya ci gaba .8 Duk da haka, O'Shea et al sun lura da dabi'a ga ƙimar ƙimar NIBP na ƙarya a cikin wannan yawan masu haƙuri duk da haɓaka sababbin na'urorin NIBP, mafi mahimmanci, ko da lokacin da za a iya kawar da abubuwa masu ban mamaki kamar girman cuff da matakin aiki. .9 Ƙarin karatu sun kimanta ma'auni na BP a cikin marasa lafiya na yara marasa lafiya. В 2010 G.Meyer и савторы провели исследование, показывающее низкую погрешность змеренного среднего артериального давления у недоношенных детей. шилась по мере того, как технология НИАД .8 Ma'anar sunan farko, O'Shea et al. A cikin 2010, Meyer et al sun gudanar da binciken da ke nuna ƙananan kuskure (<1 mmHg) a cikin nazarin Bland-Altman na rashin daidaituwa na ma'auni na ma'auni a cikin jarirai na farko da kuma nuna cewa haɗin kai tsakanin IBP da NIBP ya inganta a matsayin fasahar NIBP .8 Duk da haka. , O'Shea et al.An lura da yanayin zuwa ga ƙimar ƙimar NIBP na ƙarya a cikin wannan yawan majinyata duk da haɓaka sabbin na'urorin NIBP, mafi nagartaccen na'urorin, ko da an kawar da abubuwan ruɗani kamar girman cuff da matakin aiki..9 Ƙarin karatu sun kimanta ma'auni na BP a cikin yara marasa lafiya. 2010 年，Meyer 等人进行了一项研究，显示Bland-Altman并表明随着NIBP 技术的进步，IBP 和NIBP 之间的相关性有所改善.8 然而，O'Shea 等人指出，尽管开发了更新、更复杂的 NIBP 设备，佤卻指备，但卻寸和活动水平等可能的混杂因素，该患者群体的NIBP 值仍有错误升高的趋势。 2010 年 , meyer 等 了 一 研究 ， 显示偏差 (<1 mmhg) ， 表明 随着 nibp 技术 的 ， b 和 nibp 之间 nibp 之间nibp 之间 nibp 之间 nibp 之间 nibp 之间 nibp 之间 nibp 之间 nibp 之间的 相关性 有所 改善 .8 然而 ， o开发 了 更新 、 更 复杂 nibp 设备 即使 消除 了 袖带活动 等 可能 的 混杂 ， 该 患者 群体 nibp 值误升高的趋势。 В 2010 G.Мейер da др.провели исследование, показывающее, что анализ Бланда-Альтмана дает низкую погрявашность (<1 мм.) . еренного среднего артериального давления у недоношенных детей, и показал. ительная разница между ИАД. A cikin 2010, Meyer et al.gudanar da binciken da ke nuna cewa binciken Bland-Altman yana ba da kuskuren ƙananan kuskure (<1 mmHg) don rashin ma'auni na ma'auni na ma'auni a cikin jarirai na farko kuma ya nuna cewa tare da ci gaban fasahar NIBP, akwai bambanci mai mahimmanci tsakanin IAD.da NIBP, an inganta alaƙa.na yawan jama'a Halin karuwar yawan kurakurai yana ci gaba.9 Wani bincike ya tantance hawan jini a cikin yara masu fama da rashin lafiya.Biyu daga cikinsu sun sami "manyan bambance-bambance" tsakanin hanyoyin sa ido na cin zarafi da rashin cin zarafi kuma sun kammala cewa rashin kimanta hauhawar jini da hauhawar jini a cikin marasa lafiya na PICU na iya haifar da rashin kulawa.10,11 Sabanin haka, Ray et al.An yi nazarin ƙimar hawan jini a cikin rukunin kulawa na yara biyu kuma, bisa la'akari da yanayin zuwa ƙananan ma'ana da ƙimar NIBP diastolic, ya kammala cewa overtreatment na hypotension na iya kasancewa cikin kewayon har zuwa 40% na lokaci.12
Sanannen abu ne cewa dole ne a yi amfani da kumfa mai girman da ya dace don samun ingantacciyar karatun da ba na ɓarna ba.Ƙungiyar Zuciya ta Amirka (AHA) ta ba da shawarar cewa faɗi da tsayin mafitsara mai cuffed su kasance 40% da 80% na tsakiyar hannun hannu, bi da bi.13 An san cewa NIBP yana shafar motsi da aiki na batun, tun da kullun waje na iya rinjayar daidaiton ma'aunin BP.13,14 Ko da yake waɗannan yuwuwar tushen kuskure a ma'aunin NIBP an gane su sosai, ba a san girman son zuciya a ma'aunin NIBP a cikin yara ba.Idan saka idanu ba tare da cin zarafi ba yana son yin ƙima ko ƙima da cutar hawan jini, yana iya ba da ƙima mai gamsarwa a cikin marasa lafiya marasa ƙarfi na hemodynamically.Lokacin nazarin ƙimar NIBP a cikin yara a ƙarƙashin maganin sa barci na gabaɗaya, an cire motsi da ayyukan batutuwa, wanda zai haifar da ƙarin ma'auni daidai.Saboda haka, mun yi wannan binciken mai yiwuwa don kwatanta IBP cannulation arterial tare da NIBP da aka auna tare da babba da ƙananan ƙafafu na oscillometric cuffs a cikin yara a karkashin maganin sa barci.Babban hasashe namu shine cewa NIBP yana karanta BP fiye da kima idan aka kwatanta da na'urori masu lalata.Akwai ƙananan bayanai don kwatanta karatun NIBP na sama da na ƙasa, don haka yanke shawarar yin amfani da wani yanki na musamman sau da yawa abu ne mai amfani bisa sauƙi na samun dama da kuma buƙatar guje wa catheters na gefe na IV.Sabili da haka, burin mu na biyu shine bincika alaƙa da ƙiyayya tsakanin ma'aunin NIBP na kafada da ƙananan ƙafa.
Hukumar Binciken Cibiyoyi (IRB) na Asibitin Yara na Ƙasa (Columbus, Ohio, Amurka) ta amince da binciken kuma an gudanar da shi bisa ga sanarwar Helsinki.An yi rajistar binciken tare da Clinicaltrials.gov (NCT03220906).Dangane da kasancewar mai binciken, an dauki marasa lafiya 30 don kammala binciken.An sami izinin sanar da baki daga iyayen majiyyaci kafin shiga cikin binciken (an sami izini a rubuce daga IRB).Marasa lafiya da ke ƙasa da shekaru 10, Ƙungiyar Ma'aikatan Anesthesiologists na Amurka (ASA) rarrabuwa 1-3, an haɗa su a cikin bincikenmu idan za su sami maganin sa barci na gabaɗaya tare da zaɓen radial artery cannulation.An auna IBP ta amfani da transducer matsa lamba na hydrodynamic (Edwards Lifesciences TruWave) tare da ci gaba da nunin BP (Philips Intellivevue).An auna NIBP ta amfani da oscilloscopes daban-daban guda biyu na iri ɗaya (Philips Intellivevue) tare da madaidaitan cuffs (bisa ga jagororin AHA) da aka yi amfani da su a hannu na sama da ƙasa.
Systolic, diastolic da matsa lamba na jini (MAP) a maki 3 (jini na radial, cuff na hannu da kafa) an rubuta su a cikin tazara na minti 5 tare da ma'auni 10 ga kowane mai haƙuri.Ga marasa lafiya da ke fama da cututtukan zuciya na zuciya (CPB), an sami alamun 5 kafin fara CPB kuma an sami alamun 5 bayan kammalawa.An gudanar da bincike na farko don gwajin ma'auni guda ɗaya.Mun ƙididdige cewa binciken zai buƙaci ikon 80% a cikin shari'o'in 185 don nuna kuskuren kuskure fiye da 10% don ma'auni mara kyau, tare da matsakaicin kuskuren 5% da ƙimar mahimmancin ƙididdiga na 95%.An rage yawan rajista bayan an dauki marasa lafiya 30 don jimlar 300 BP.
Sakamakon farko ya kasance mai mahimmanci na asibiti kamar yadda aka bayyana ta hanyar karkatar da BP na> 5 mmHg tsakanin IBP da NIBP. Sakamakon farko ya kasance mai mahimmanci na asibiti kamar yadda aka bayyana ta hanyar karkatar da BP na> 5 mmHg tsakanin IBP da NIBP. Первичным исходом была клинически значимая систематическая 5 . Sakamakon farko ya kasance mai mahimmanci na asibiti, wanda aka bayyana azaman bambancin BP> 5 mmHg.Art.tsakanin IBP da NIBP.主要结果是临床上显着的偏差，定义为IBP 和NIBP 之间的BP 偏差> 5 mmHg.主要结果是临床上显着的偏差，定义为Первичной конечной точкой было клинически значимое отклонение, определяемое как отклонение АД> 5 . Maƙasudin ƙarshen farko shine rarrabuwa na asibiti, wanda aka ayyana azaman karkacewar BP> 5 mmHg.Art.tsakanin IBP da NIBP.Mun kuma bincika abin da ya faru na sabawa fiye da 10 mmHg.An kwatanta ci gaba da bayanai tsakanin shafuka ta amfani da bincike na Bland-Altman.15 A cikin bincike mai yawa, mun yi amfani da tasiri mai haɗuwa don samfurin cikakken bambanci tsakanin NIBP da IBP a matsayin aikin NIBP, shekaru, jinsi, nauyi, da matsayi na haƙuri (mai yiwuwa ko baya) a layi tare da sake dawowa a matakin haƙuri. An yi amfani da matakin bazuwar matakin haƙuri don yin lissafin abubuwan haƙuri waɗanda ba a haɗa su a sarari a cikin ƙirar ba, amma har yanzu ya bambanta tsakanin marasa lafiya.16 An yi nazarin bayanan ta amfani da Stata / IC 14.2 (Tashar Kwalejin, TX: StataCorp, LP), kuma p<0.05 an yi la'akari da mahimmancin ƙididdiga. An yi amfani da matakin bazuwar matakin haƙuri don yin lissafin abubuwan haƙuri waɗanda ba a haɗa su a sarari a cikin ƙirar ba, amma har yanzu ya bambanta tsakanin marasa lafiya.16 An yi nazarin bayanan ta amfani da Stata / IC 14.2 (Tashar Kwalejin, TX: StataCorp, LP), kuma p<0.05 an yi la'akari da mahimmancin ƙididdiga. Случайный перехват на уровне пациента использовался. но все же различались между пациентами.16 Анализ данных был выполнен с использованием Stata/IC 14.2, College Stata/IC 14.2 <0,05 считалось статистически значимым. An yi amfani da tsaka-tsakin bazuwar matakin haƙuri don lissafin abubuwan haƙuri waɗanda ba a haɗa su a sarari a cikin ƙirar ba amma har yanzu sun bambanta tsakanin marasa lafiya.16 An yi nazarin bayanan ta amfani da Stata / IC 14.2 (Tashar Kwalejin, TX: StataCorp, LP), da p < 0.05 an yi la'akari da mahimmancin ƙididdiga.An yi amfani da matakan bazuwar bazuwar matakin haƙuri don yin lissafin abubuwan haƙuri waɗanda ba a haɗa su kai tsaye a cikin ƙirar ba amma har yanzu sun bambanta ta wurin haƙuri. 16 使用Stata/IC 14.2 (College Station, TX：StataCorp，LP）进行数据分析， p<0.05 16 使用Stata/IC 14.2 (College Station, TX：StataCorp，LP）进行数据分析， p<0.05 16 Анализ данных проводили с использованием Stata/IC 14.2 An yi nazarin bayanan 16 ta amfani da Stata/IC 14.2 (Tashar Kwalejin, TX: StataCorp, LP), p<0.05 an yi la'akari da mahimmancin ƙididdiga.Masu bincike/marubuta ba za su raba bayanan sirri na mahalarta ba.
Binciken ya hada da marasa lafiya 30, maza 18 da 'yan mata 12 masu shekaru 0 zuwa 8.Tiyata ta haɗa da 28 (93%) tiyatar thoracic, 1 (3%) neurosurgery, da 1 (3%) tiyata orthopedic.Tables 1 da 2 sun taƙaita ƙididdigar yawan jama'a kuma suna nufin ƙimar SBP, DBP, da SBP a kowane wuri.An bincika ma'auni na BP goma ko kusan mintuna 50 ga kowane mai haƙuri, don jimlar ma'aunin 300 ko mintuna 15,000 na saka idanu.
A kan makircin Bland-Altman (Fig. 1), kuskure da daidaito na NIBP (SBP) da aka auna akan hannu, dangane da IBP, sun kasance -2 da 10 mm Hg.Art.bi da bi (95% iyakan yarda: -21, +17 mmHg).Rashin son zuciya da daidaito na ma'anar matsa lamba na jijiya dangane da kafa IBP shine -5 da 11 mmHg.Art.bi da bi (95% na iyakokin yarjejeniya: -26, +16 mmHg). Lokacin kwatanta IBP zuwa NIBP a hannu, cikakken bambanci a cikin MAP shine 7 ± 7 mmHg (kewaye: 0-52 mmHg) tare da 143 na 300 lura (48%) karkacewa ta> 5 mmHg da 60 na 300 lura (20%) karkacewa ta hanyar> 10 mmHg. Lokacin kwatanta IBP zuwa NIBP a hannu, cikakken bambanci a cikin MAP shine 7 ± 7 mmHg (kewaye: 0-52 mmHg) tare da 143 na 300 lura (48%) karkacewa ta> 5 mmHg da 60 na 300 lura (20%) karkacewa ta hanyar> 10 mmHg.Lokacin kwatanta IBP da NIBP akan hannu, cikakken bambanci a cikin SBP shine 7 ± 7 mm Hg.Art.(диапазон: 0–52 мм рт. ст.) при 143 наблюдениях из 300 (48%) с отклонением > 5 мм рт. (kewaya: 0-52 mmHg) tare da lura 143 daga cikin 300 (48%) tare da karkacewa> 5 mmHg.Art.da kuma lura 60 daga cikin 300 (20%).отклонение > 10 мм рт.ст. karkacewa> 10 mmHgMAP 300 次观察中的60 次(20%) da 10 mmHg.为 为 为 为 为 为 为 7 mmhg （范围 ： 0-52 ： 3 ： 0-52 (48%) 偏 差> 5 mmhg , 300 次 中 中 的 60次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 H 60 % 20%Lokacin kwatanta IBP da NIBP akan hannu, cikakken bambanci a cikin SBP shine 7 ± 7 mm Hg.(dali: 0-52 мм рт.ст.), с отклонениями >5 мм рт.ст. (kewaya: 0-52 mmHg), tare da karkatattun> 5 mmHg. в 143 из 300 наблюдений (48%) da 60 из 300 наблюдений (20%) Отклонение > 10 мм рт.ст. a cikin 143 cikin 300 lura (48%) da 60 daga cikin 300 lura (20%) Ragewa> 10 mm Hg. Lokacin kwatanta IBP zuwa NIBP a kafa, cikakken bambanci a cikin MAP shine 8 ± 8 mmHg (kewaye: 0-52 mmHg) tare da 169 na 298 lura (57%) karkacewa ta> 5 mmHg da 81 na 298 lura (27%) karkacewa ta hanyar> 10 mmHg. Lokacin kwatanta IBP zuwa NIBP a kafa, cikakken bambanci a cikin MAP shine 8 ± 8 mmHg (kewaye: 0-52 mmHg) tare da 169 na 298 lura (57%) karkacewa ta> 5 mmHg da 81 na 298 lura (27%) karkacewa ta hanyar> 10 mmHg.Lokacin kwatanta VBP tare da NIBP a kan kafa, cikakken bambanci a cikin SBP shine 8 ± 8 mm Hg.Art.(kewaya: 0-52 mmHg), tare da 169 na 298 lura (57%) karkacewa ta fiye da 5 mmHg.Art.и 81 из 298 наблюдений (27%) отклонение >10 мм рт.ст. da 81 daga cikin 298 lura (27%) sabawa> 10 mmHg.将IBP 与腿部的NIBP 进行比较时， MAP 的绝对差异为8±8 mmHg（范围：0-52 mmHg） 298差> 5 mmHg,298 次观察中的81 次 (27%) 10 mmHg.将 IBP 与 腿部 nibp 进行 时 ， map 的 差异 为 为 为 8 ± 8 mmhg （范围 ： 0-52 mmhg） 9 (((偏 差> 5 mmhg ， 298 次 观察 的的 中 中 中 中 中 中 中 中 中 中 中 中 中 中 (27%) 偏偏> 10mmhg.Lokacin kwatanta VBP tare da NIBP a cikin kafa, cikakken bambanci a cikin SBP shine 8 ± 8 mm Hg.Art.(Diyapazon: 0–52 mm rt. st.), da kuma 169 da 298 da rabi (57%) da kuma 5 m rt. (kewaya: 0-52 mmHg), tare da 169 na 298 lura (57%) suna da karkacewa> 5 mmHg.Art.и 1 из 298 наблюдений 81 (27%) отклонения > 10 мм рт.ст. da 1 na 298 lura 81 (27%) sabawa> 10 mmHg.
Shinkafa1. Bland-Altman mãkirci na wasiƙun da ke tsakanin ma'aunin ma'aunin ma'aunin jijiya (MAP) da ma'auni na SBP marasa lalacewa.
Shafin 3 yana nuna sakamakon kwatanta SBP da DBP tsakanin shafuka.Ko da yake duka shafukan NIBP sun nuna bambance-bambance daga NIBP, manyan bambance-bambance sun fi yawa lokacin da aka samu NIBP a kafafu.Shafin 4 yana nuna nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i) yana tsinkaya adadin karkatar da SBP daga ƙimar IBP ta amfani da ma'aunin NIBP a cikin makamai da kafafu.Jinsi, shekaru, nauyi, da wurin haƙuri ba su da alaƙa da son zuciya a cikin ma'aunin MAP masu ɓarna.Idan aka kwatanta da ma'aunin NIBP na hannu, cikakkiyar sabawa na SBP daga ma'aunin IBP shine 1.5 mmHg.Art.ƙari a cikin ƙafafu (95% CI: 0.4, 2.6; p = 0.009).Kwatancen kai tsaye na hannu NIBP tare da NIBP na kafa (Fig. 2) ya nuna cikakken bambanci a cikin SBP na 2.5 ± 10 mmHg.Art.(Iyakokin 95% na yarjejeniya: -17.1, +22.0 mmHg).
Tebura 3 Kwatanta ma'anar jijiya, systolic, da hawan jini na diastolic a hannaye da kafafu tare da cannulation na jijiya.
Tebura 4 Matsakaicin karkacewa tsakanin ma'anar matsa lamba na jijiya da aka annabta da ma'aunin ɓarna ta hanyar amfani da gauraya tafsirin tsarin koma baya na layi.
Shinkafa2. Bland-Altman mãkirci na wasiƙun da ke tsakanin ma'aunin ma'aunin ma'aunin ma'aunin jijiya (MAP) a cikin hannaye da ƙafafu.
Karatun da ya gabata na kwatanta ma'aunin NIBP da IBP a cikin yaran da aka sawa su yana da iyaka.Kodayake bayanai a cikin jarirai suna cin karo da juna, wasu nazarin sun nuna yanayin hawan jini lokacin da aka auna ba tare da lalata ba.Joffe et al.ya gano cewa a cikin ƙananan yara masu mahimmanci, bambance-bambance tsakanin ma'aunin NIBP da IBP a cikin yara 100 sun kasance ƙananan a matsakaici, amma daidaitattun ƙididdiga, tsaka-tsakin tsaka-tsaki, da makircin Bland-Altman suna da yarjejeniya mai yawa.Ba a yi waɗannan karatun ba a kan marasa lafiya a ƙarƙashin maganin sa barci na yau da kullum, wani nau'i mai mahimmanci na binciken mu wanda zai iya rage kuskuren haƙuri a cikin motsi ko aiki.Duk da haka, kama da sakamakon Ioffe, sakamakonmu ya nuna cewa ko da yake ma'aunin IBP da NIBP a cikin yara marasa lafiya sukan yi daidai da juna, ma'aunin NIBP guda ɗaya sau da yawa ba daidai ba ne, yana nuna duka ƙima da ƙima na BP.Bambance-bambance a asibiti a cikin amfani da NIBP akai-akai ya bayyana a lokacin binciken.Wadannan sabani a cikin IBP da aka samu daga ma'aunin NIBP na ƙananan ƙafa sun fi girma kuma sun fi yawa fiye da sabawa da aka samu daga ma'auni na NIBP na kafada.
A baya an ba da rahoton kwatancen ma'aunin NIBP a hannu da ƙafafu a cikin yara.A cikin 2000, Short et al.yayi nazarin NIBP a cikin yara 50 da ke ƙarƙashin maganin sa barci. A cikin yara masu shekaru 8 da ƙasa, BP da aka samu daga ƙananan ƙafa ya kasance da ƙananan ƙananan fiye da wanda aka auna daga hannun babba (p<0.05) .17 Ya bambanta da wannan, bincikenmu ya kwatanta hannu da kafa NIBP zuwa ma'aunin IBP. A cikin yara masu shekaru 8 da ƙasa, BP da aka samu daga ƙananan ƙafa ya kasance da ƙananan ƙananan fiye da wanda aka auna daga hannun babba (p<0.05) .17 Ya bambanta da wannan, bincikenmu ya kwatanta hannu da kafa NIBP zuwa ma'aunin IBP. У детей в в возрасте 8 лет и младше АД, измеренное на голени, было значительно ниже, чем измеренное 1 (5). ko kuma, в нашем исслеdoвании НИАД руки и ноги сравниvaly с измеренияmy НИАД. A cikin yara masu shekaru 8 da ƙananan, hawan jini da aka auna a ƙananan ƙafa yana da ƙananan ƙananan fiye da wanda aka auna a hannun sama (p<0.05) .17 Sabanin haka, a cikin bincikenmu, an kwatanta hannu da kafa NIBP tare da ma'aunin NIBP.在8 岁及以下儿童中，从小腿测得的血压显着低于从上臂测得的血压(p<0.05)。 8 У детей 8 лет и младше артериальное давление, измеренное на голени, было значительно ниже, чем на (плем на 5<0). A cikin yara masu shekaru 8 da ƙanana, hawan jini da aka auna a ƙananan ƙafa ya ragu sosai fiye da na sama (p <0.05).17 Sabanin haka, bincikenmu ya kwatanta NIBP na makamai da kafafu tare da ma'auni na IBP.Sakamakonmu ya nuna cewa BP da BP sun fi yawa a cikin ƙafafu, wanda zai iya nuna cewa NIBP maraƙi ba shi da aminci fiye da NIBP na hannu.
A cikin bincikenmu, an ƙididdige matakin motsi na BP ta amfani da ƙimar kofa na 5 da 10 mm Hg.Art., Waɗanda ke da fifiko wajen tantance daidaiton na'urorin atomatik don auna hawan jini.18 Yayin da bambanci a cikin SBP na 5 ko 10 mmHg Art.Ya isa ga manya masu ciwon BP, waɗannan abubuwan rashin daidaituwa na iya zama mafi bayyanawa a cikin yara, musamman ma waɗanda ke da iyaka ko ƙananan BP, kamar yadda BP na yau da kullum ya yi ƙasa.Tashe hawan jini a cikin yara masu shekaru 2 (ma'anar shekarun yawan binciken) ya kasance 90-105/55-70.Yawan hawan jini na al'ada a cikin jarirai masu shekaru 0-3 watanni shine 65-85 / 45-55.Art.a cikin marasa lafiya na ƙarshe na iya haifar da hyperperfusion mai tsanani ko hypoperfusion, matsalar da za ta iya haifar da lalacewa da rashin aiki na gabobin da aka yi niyya.Bugu da ƙari, waɗannan ƙimar hawan jini na farkawa na yau da kullun za a ƙara saukar da su a ƙarƙashin maganin sa barci.ashirin
Ko da yake babu daidaitattun yanayi a cikin MAP a kan ko a ƙarƙashin ma'auni a wuraren ma'auni na NIBP guda biyu, sakamakonmu yana ƙaddamar da binciken binciken da aka yi a baya wanda ya kwatanta ma'auni na BP masu cin zarafi da marasa cin nasara a cikin yara, wanda ya lura cewa bambance-bambance tsakanin NIBP da IBP na kowa.Mahimmanci, bincikenmu ya kawar da kurakuran ma'aunin NIBP da ke haifar da motsin haƙuri ko aiki yayin da marasa lafiyarmu ke ƙarƙashin maganin sa barci.Sakamakonmu yana nuna buƙatar ci gaba da haɓaka daidaitattun matakan hawan jini marasa ƙarfi da ayyuka na hemodynamic.Yawan sauye-sauye masu mahimmanci na asibiti kuma yana tabbatar da mahimmancin sa ido na cin zarafi yayin da ake sa ran rashin zaman lafiya na hemodynamic ko hauhawar jini mai sauƙi ko hauhawar jini zai zama damuwa na musamman ga marasa lafiya.
Sakamakon binciken na yanzu yana iya iyakancewa ta hanyar yuwuwar tushen kuskure.Muna la'akari da IBP ma'aunin gwal ɗin mu don kwatanta ma'aunin NIBP.Lokacin auna matsa lamba na jini tare da transducer hade-haɗe-haɗe-haɗe-haɗe-haɗe-haɗe-halaye na iya faruwa dangane da girman catheter na ciki, kumfa na iska a cikin tsarin, kinked ko matsawa tubing, ko gurɓataccen cannula arterial.9 Daidaitawar farko Ko kurakurai na iya faruwa lokacin sanya transducer a matakin atrium na dama na majiyyaci.Ma'aunin NIBP na iya shafar ma'aunin BP da ba daidai ba ko kuma abubuwan motsa jiki na waje.Duk da yake ana ba da shawarar bin shawarwarin don zaɓin AHA cuff, zaɓin girman cuff yana ƙarshe bisa ga shawarar ma'aikacin anesthetist.Wannan tsarin yana haifar da tsarin zaɓin cuff daidai da daidaitaccen aikin mu na asibiti.Sakamakon matsalolin matsa lamba sune mahimmancin ra'ayi na asibiti wanda ake tsammanin zai faru a waje da iyakokin wannan binciken.Bugu da ƙari, babu wani shawarwarin AHA don daidaita ma'aunin hawan jini na maraƙi, don haka masu samarwa sun yi la'akari da shawarwarin girman hannun AHA lokacin amfani da kullun maraƙi.Ba zai yuwu ba matakin aikin majiyyaci ya canza a ƙarƙashin maganin sa barci na gabaɗaya, amma matsawar waje na cuff ta likitan fiɗa, kayan aiki, ko ma'aikata na iya yiwuwa.
Bincikenmu ya kwatanta ma'aunin ma'aunin bugun jini da aka samu kai tsaye daga ma'aunin oscillation cuff da kuma waɗanda aka samu daga nau'ikan bugun bugun jini na mamayewa.Hakazalika, SBP da aka samu da DBP na oscillating cuff an kwatanta su tare da ma'aunin ma'auni kai tsaye na motsin bugun jini.Ba mu yi la'akari da abubuwan da za su iya rikicewa ba kamar amfani da vasopressors, kuma radial vasoconstriction na iya ƙara kuskuren tsakanin IBP da NIBP.Yana da mahimmanci a lura cewa hawan jini na iya bambanta a sassa daban-daban na jiki.Bambance-bambancen da aka samu tsakanin NIBP a cikin kafafu da BP a cikin makamai (masu cin zarafi ko maras kyau) na iya nuna ainihin bambance-bambance a cikin hawan jini a waɗannan wurare.Bugu da ƙari, da yawa daga cikin marasa lafiyarmu suna yin aikin tiyata na thoracic, wanda zai iya yin tasiri sosai akan hawan jini a cikin makamai fiye da kafafu.Ko da yake ba mu bayyana a sarari ba ko an yi ma'aunin NIBP da IBP a wuri ɗaya ko kuma daban-daban wuraren haƙuri, mun yi amfani da rikice-rikicen rikice-rikice don lissafin matakan matakin haƙuri waɗanda ba a haɗa su kai tsaye a cikin ƙirarmu ba.Don haka, illar bazuwar sun mamaye waɗannan bambance-bambancen matakin haƙuri, waɗanda suka kasance koyaushe tsakanin abubuwan lura na majiyyaci ɗaya.Kodayake ma'auni na haɗarmu don binciken yara ne 'yan ƙasa da shekaru 10, a gaskiya ma yawancin marasa lafiyarmu sun kasance ƙanana.Saboda haka, sakamakonmu bazai zama cikakke ga manyan yara ba.Hakanan an iyakance sakamakonmu ta kayan aikin sa ido da aka yi amfani da su.Akwai bambance-bambance a cikin karatun hawan jini tsakanin masana'antun saka idanu daban-daban.Masana'antun Oscillometric cuff suna amfani da algorithms na mallaka daban-daban kuma sakamakonmu yana aiki ne kawai ga na'urorin da aka yi amfani da su a cikin bincikenmu.13:21–24
Gaskiyar cewa wasu dabi'u sun bambanta da karatun IBP fiye da 30-40 mmHg suna nuna yiwuwar irin wannan tushen kuskure.Saboda masu binciken sun rubuta bayanan, ba zai yiwu ba a tantance abin da ya haifar da irin wannan babban canji da kuma tantance idan karatun ya kasance daidai.Don kiyaye amincin binciken, an rubuta waɗannan dabi'u kuma an haɗa su cikin ƙungiyar binciken.Bugu da ƙari, mun rubuta bayanan BP da hannu a cikin tazara na minti 5, amma muna zargin cewa nazarin bayanan da aka tattara ta hanyar lantarki na ci gaba da sa ido na NIBP na iya bayyana rashin daidaituwa akai-akai tsakanin ma'aunin IBP da NIBP.
Bayananmu sababbi ne kamar yadda suka fito daga marasa lafiya a ƙarƙashin maganin sa barci na gabaɗaya, amma sun yi daidai da binciken da aka yi a baya wanda ke kwatanta alaƙar ma'aunin hawan jini da ba ta da ƙarfi.Yawan rashin lafiyar NIBP mai mahimmanci na asibiti yana tabbatar da mahimmancin sa ido kan NIBP lokacin da yanayin hawan jini ya kasance mai yiwuwa ko lokacin da waɗannan sauye-sauye suna da haɗari musamman.Bugu da ƙari, ƙananan ƙafar NIBP ya fi dacewa ya haifar da wata mahimmanci na asibiti daga ma'aunin ma'auni na ma'auni fiye da NIBP na hannu.Idan aka ba da sakamakonmu, yanke shawara game da sanya cuff bai kamata ya zama na sabani ba, amma muna ba da shawarar amfani da hannu a duk lokacin da zai yiwu yayin saka idanu kan hawan jini na ciki.
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24. Philips tsarin kiwon lafiya.510 (k) Sanarwa na siyarwa don software na Cibiyar Bayanai ta Intelliveue.Silver Springs, MD: Ma'aikatar Lafiya da Ayyukan Jama'a Hukumar Abinci da Magunguna; 2019. Akwai daga: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICS% artyReviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&HadinKayayyakin=&ZNumber=&PAGENUM=10&SiyarwarColumn=dd%5Fdesc. 2019. Akwai daga: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICS% artyReviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&HadinKayayyakin=&ZNumber=&PAGENUM=10&SiyarwarColumn=dd%5Fdesc. 2019. Доступно по адресу: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber%2&LIPSYPplicate=0 ceName=&Nau'i= &PartyReviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10=%Columdes. 2019. Akwai shi a: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICS% artyReviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&HadinKayayyakin=&ZNumber=&PAGENUM=10&SiyarwarColumn=dd%5Fdesc. 2019. 可从:https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILISTEMS%20 Na uku Reviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&HadinKayayyakin=&ZNumber=&PAGENUM=10&SiyarwarColumn=dd%5Fdesc. 2019. 可从:https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILISTEMS%20 Na uku Reviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&HadinKayayyakin=&ZNumber=&PAGENUM=10&SiyarwarColumn=dd%5Fdesc. 2019. Доступно по адресу: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber%2&LIPSYPplicate=0 ceName=&Nau'i= &PartyReviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10=%Columdes. 2019. Akwai shi a: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICS% artyReviewed =&ClinicalTrials=&Decision=&DecisionDateDaga=&DecisionDateTo=07%2F24%2F2019&IVDPproducts=&Redact510K=&HadinKayayyakin=&ZNumber=&PAGENUM=10&SiyarwarColumn=dd%5Fdesc.Tun daga ranar 14 ga Agusta, 2019