Hoʻohālikelike i nā ana koko kiʻekiʻe a me lalo

ʻO ka hoʻohālikelike ʻana i ke ana ʻana o ke koko ma ka ʻaoʻao o luna a me lalo me ke ana ʻana o ke koko i nā keiki ma lalo o ka maʻi anesthesia āpau
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 Oihana Anesthesiology and Pain Medicine, National Children's Halemai Columbus, Ohio 43205, USA;2 Keʻena o nā Pediatrics, Ohio State University, Columbus, Ohio, 43210, USA;3 ʻOihana Hoʻomaʻamaʻa Pediatric, Halemaʻi Lahui o nā keiki, Columbus, Ohio, 43205, USA;4 Keʻena o ka Anesthesiology and Pain Management, Ohio State University, Columbus, OH 43210, USA ʻO ka mea kākau kūpono: Seth Hayes Department of Anesthesiology and Pain Management, Children's National Hospital, 700 Children's Drive, Columbus, OH 43205, USATel +1 614 722 4200 Fax +1 614 722 4203 Heluhelu ʻia ke koko invasive (IBP) kūʻē i ke ana ʻana o ke koko non-invasive (NIBP) me nā cuffs oscillometric o ka ʻaoʻao o luna a lalo i nā pēpē a me nā keiki ma lalo o ka maʻi anesthesia āpau.NA MA'i a me na ano.Hoʻokomo ʻia kā mākou aʻo ʻana i nā maʻi ma lalo o ka makahiki 10 inā loaʻa iā lākou ka maʻi maʻi maʻamau a hoʻolālā i kahi catheterization radial artery.Ua ana ʻia ʻo IBP i kēlā me kēia 5 mau minuke me kahi transducer hydrodynamic, a ua ana ʻia ʻo NIBP me ʻelua oscilloscopes me nā cuffs kūpono i kau ʻia ma ka lima luna a me ka wāwae lalo, a ua lawe ʻia nā ana he 10 i kēlā me kēia maʻi.Nā hualoaʻa: Ua pili ka haʻawina i nā keikikāne 18 a me nā kaikamahine 12 mai 0 a 8 mau makahiki.Ma 300 mau helu ʻikepili, ʻo ka ʻokoʻa loa ma waena o ka lima mean arterial pressure (MAP) a me nā ana invasive he 7 ± 7 mmHg.Art.(ka laulā: 0–52 mmHg).ʻO ka ʻokoʻa loa ma waena o ke ana o SBP ma ka wāwae a me ke ʻano invasive ʻo 8 ± 8 mm Hg.Art.(ka laulā: 0–52 mmHg). ʻOiai ua hōʻike ʻia nā pae ana ʻelua ʻaʻole invasive i ka haʻalele pinepine ʻana mai ke ana invasive, ua ʻoi aku ka maʻamau o nā deviations nui i ka wā i ana ʻia ai ka BP ma ka wāwae (81 o 298 nānā (27%) deviating e> 10 mmHg) i hoʻohālikelike ʻia me ka lima (60 o 300 nānā. (20%) e hoʻokaʻawale ana ma> 10 mmHg) . Ka hopena: ʻO ka pinepine o ka hoʻololiʻana o ka NIBP nui i nā keiki ma lalo o ka anesthesia āpau e kākoʻo i ke koʻikoʻi o ka nānāʻana i ka IBP i ka wā e hiki ai i ka hemodynamic fluctuations a he meaʻino loa ia. ʻOiai ua hōʻike ʻia nā pae ana ʻelua ʻaʻole invasive i ka haʻalele pinepine ʻana mai ke ana invasive, ua ʻoi aku ka maʻamau o nā deviations nui i ka wā i ana ʻia ai ka BP ma ka wāwae (81 o 298 nānā (27%) deviating e> 10 mmHg) i hoʻohālikelike ʻia me ka lima (60 o 300 nānā. (20%) e hoʻokaʻawale ana ma> 10 mmHg) . Ka hopena: ʻO ka pinepine o ka hoʻololiʻana o ka NIBP nui i nā keiki ma lalo o ka anesthesia āpau e kākoʻo i ke koʻikoʻi o ka nānāʻana i ka IBP i ka wā e hiki ai i ka hemodynamic fluctuations a he meaʻino loa ia.ʻOiai ua hōʻike pinepine ʻia nā wahi ana ʻelua ʻaʻohe invasive mai ke ana invasive, ua ʻoi aku ka maʻamau o nā deviations nui me nā ana BP wāwae (81 o 298 nānā (27%), ʻoi aku ma mua o 10 mmHg) i hoʻohālikelike ʻia me ka lima (60 o 300 nānā). .(20%), e haʻalele ana ma mua o 10 mm Hg.Art.).Ka hopena.ʻO ke alapine o nā mea ʻino NIBP koʻikoʻi i loko o nā keiki ma lalo o ka anesthesia āpau e hōʻoia i ke koʻikoʻi o ka nānā ʻana i ka NIBP i ka wā e hiki mai ana ka hemodynamic fluctuations a hiki ke pōʻino loa.E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%) a me ka 10 mmHg).尽管 两 个 非侵入性 测量 部位 都 出 与 侵入性 测量 频繁 偏差 ， 但 丂 3 我）的 的 的 次） 相比 ， 在 测量 的 的 bp （298 次 中 的 81 次 （27（27 （27 （27 （27 %） Aia ma kahi o 10 mmHg) (20%) a me 10 mmHg). Хотя оба неинвазивных места измерения показали частые отклонения от инвазивных измерений, АД, измеренногеидел (8 бел. 27) по сравнению с рукой (60 из 300 наблюдений) %), отклонение> 10 мм рт.ст.) чаще (20 % отклонение). ʻOiai ua hōʻike ʻia nā wahi ana ʻelua non-invasive i nā haʻalele pinepine mai nā ana invasive, ua ana ʻo BP ma ka wāwae (81 mai 298 nānā (27) i hoʻohālikelike ʻia me ka lima (60 mai 300 nānā) %), deviation> 10 mmHg) pinepine ( 20 % kaawale). > 10 мм рт.ст.). > 10 mmHg).OLELO HOOLAHA.ʻO ka pinepine o nā mea ʻino NIBP koʻikoʻi i loko o nā keiki ma lalo o ka anesthesia āpau e hōʻoia i ke koʻikoʻi o ka nānā ʻana i ka NIBP i ka wā e hiki mai ana ka hemodynamic fluctuations a ʻoi aku ka pōʻino.Ke hoʻohālikelike ʻia me nā waiwai NIBP i loaʻa ma ka lima kiʻekiʻe, ʻoi aku ka nui o ke ana ʻana o NIBP ma ka wāwae haʻahaʻa e hopena i kahi hoʻokaʻawale koʻikoʻi mai ke ana invasively mean arterial pressure.Hua'ōlelo nui: ke koko invasive, non-invasive blood pressure, blood pressure cuff.
He mea koʻikoʻi ka nānā ʻana i ke kahe koko (BP) i ka palekana o ka anesthesia maʻamau mai ka wā i ʻae ʻia ai ka sphygmomanometer e Kauka Harvey Cushing i nā makahiki 1900 mua.Mai ka makahiki 1986, ʻo ia ka maʻamau i koi ʻia e ka American Society of Anesthesiologists (ASA) i kēlā me kēia manawa o ka anesthesia maʻamau.Ma muli o ke ana ʻana o ke kahe koko e hoʻoholo i nā hoʻoholo koʻikoʻi e pili ana i ka hoʻokele perioperative, hiki i ka hemahema ke hoʻopili i ka ʻike kūpono a me ka mālama ʻana i ka hemodynamic instability.Hoʻoholo pinepine ka poʻe anesthesiologists e lawelawe i nā wai, nā huahana koko, a me nā inotropes e pili ana i nā ʻokoʻa mai ka "maʻamau" BP.1 No ka mea, ua hōʻike ʻia ka pili ʻana o ka hypertension intraoperative a me ka hypotension me nā pilikia postoperative, me ka hiki ʻole o ka renal acute, encephalopathy, myocardial infarction, stroke, a me ka hoʻonui ʻana i ka make 30-lā, hiki i nā ana BP kūpono ʻole ke alakaʻi i nā pōʻino BP hiki ʻole ke ʻike ʻia.2-5
I ka wā o ke kaʻa ʻana, hiki ke ana ʻia ke kahe koko me ka oscillometric blood pressure cuff (NIBP) a i ʻole invasively me ka indwelling arterial cannula (IBP).Hoʻopaʻa ʻia ke aʻa o ka mea maʻi i kahi puʻupuʻu oscillometric ma ka hoʻonui ʻana iā ia i ke kaomi ma luna o ke koko systolic o ka mea maʻi (SBP) a laila e ana i ka loli ʻana o ke kaomi i ka wā e hoʻoemi mālie ʻia ka cuff.ʻO ke kiʻekiʻe e loli nui ai ke kaomi ʻana, ʻo ia ka mean arterial pressure (MAP).A laila helu ʻia ʻo SBP a me ke koko diastolic (DBP) ma muli o ke ʻano o ke kaomi arterial a me nā kumu hoʻohālike oscillometric.ʻO nā algorithms no kēia mau helu ʻana he proprietary a hilinaʻi i ka mea hana cuff NIBP.6 I ka hoʻokaʻawale ʻana, hoʻopaʻa ʻia ka invasive arterial cannulation iā SBP a me DBP pololei mai nā hawewe pulse kaomi.Loaʻa ka MAP mai kēia mau waiwai.7
Ua noiʻi kekahi mau haʻawina i ka hui ʻana o VBP me NIBP i nā keiki me nā hopena like ʻole. I ka makahiki 2010, ua hana ʻo Meyer et al i kahi noiʻi e hōʻike ana i ka haʻahaʻa haʻahaʻa (<1 mmHg) ma kahi loiloi Bland-Altman o ke ana ʻana i nā puʻuwai arterial non-invasively i nā pēpē preterm a manaʻo ʻia ua hoʻomaikaʻi ka pilina ma waena o IBP a me NIBP i ka holomua ʻana o ka ʻenehana NIBP .8 Eia naʻe, ua ʻike ʻo O'Shea et al i kahi manaʻo e hoʻokiʻekiʻe wahaheʻe i nā koina NIBP i kēia heluna maʻi me ka hoʻomohala ʻana i nā mea hana NIBP hou aʻe, ʻoiai inā hiki ke hoʻopau ʻia nā mea hoʻohilahila e like me ka nui o ka cuff a me ka pae o ka hana. ua loiloi i nā ana BP i nā maʻi pediatric maʻi maʻi. I ka makahiki 2010, ua hana ʻo Meyer et al i kahi noiʻi e hōʻike ana i ka haʻahaʻa haʻahaʻa (<1 mmHg) ma kahi loiloi Bland-Altman o ke ana ʻana i ke ʻano o nā puʻuwai arterial non-invasively i nā pēpē preterm a manaʻo ʻia ua hoʻomaikaʻi ka pilina ma waena o IBP a me NIBP e like me ka ʻenehana NIBP ua holomua .8 Eia naʻe, ua ʻike ʻo O'Shea et al i ka manaʻo e hoʻokiʻekiʻe wahaheʻe i nā waiwai NIBP i kēia heluna maʻi me ka hoʻomohala ʻana i nā polokalamu NIBP hou aʻe, ʻoiai inā hiki ke hoʻopau ʻia nā mea hoʻohilahila e like me ka nui o ka cuff a me ka pae o ka hana. .9 Ua loiloi nā haʻawina hou i nā ana BP i nā maʻi pediatric maʻi maʻi. В 2010 г.Meyer и соавторы провели исследование, показывающее низкую погрешность (<1 мм рт. ст.) в анализе Бланда-Анльгиозиность его артериального давления у недоношенных детей и предположили, что корреляция между ИАД и НИАД и НИАД те хлуч огия НИАД .8 Тем не менее, O'Shea et al. Ma 2010, ua hana ʻo Meyer et al i kahi haʻawina e hōʻike ana i ka haʻahaʻa haʻahaʻa (<1 mmHg) ma ka Bland-Altman analysis of non-invasively mean arterial pressure i nā pēpē preterm a manaʻo ʻia e hoʻomaikaʻi ka pilina ma waena o IBP a me NIBP e like me ka ʻenehana NIBP .8 Eia naʻe , O'Shea et al.Ua ʻike ʻo ia i kahi ʻano i nā koina NIBP kiʻekiʻe hoʻopunipuni i kēia heluna maʻi ma muli o ka hoʻomohala ʻana o nā polokalamu NIBP hou aʻe, ʻoiai inā hiki ke hoʻopau ʻia nā mea hoʻohilahila e like me ka nui cuff a me ka pae hana..9 Ua loiloi hou nā haʻawina i nā ana BP i nā keiki maʻi koʻikoʻi. Meyer Meyer ，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 设夳，但夳，但了了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 进行 了 一 研究 ， 显示 显示 bland-altman 分析 早产儿 无 创 测量 住 莌动偏差 (<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 nibp 之间 nibp 之间的 相关性 有所 改善 .8 然而 ， 子而 ，开发 了 更新 、 更 复杂 nibp 设备 ， 即使 消除 了 袖带 尺寸nibp nibp nibp nibp nibp nibp nibp nibp nibp误升高的趋势。 В 2010 г.Мейер и др.провели исследование, показывающее, что анализ Бланда-Альтмана дает низкурею погрешность (<1 мм рт. стононо зля нено о артериального давления у недоношенных детей, и показал, что с развитием технологии НИАД существучует знамуц. Ma 2010, Meyer et al.ua hana i kahi noiʻi e hōʻike ana i ka hāʻawi ʻana o ka loiloi Bland-Altman i kahi haʻahaʻa haʻahaʻa (<1 mmHg) no ka non-invasively mean arterial pressure i nā pēpē preterm a hōʻike ʻia me ka hoʻomohala ʻana o ka ʻenehana NIBP, aia kahi ʻokoʻa nui ma waena o IAD.a me NIBP, hoʻomaikaʻi ʻia nā pilina.o ka heluna kanaka Ke hoʻomau nei ke au i ka piʻi ʻana o ka nui o nā hewa.9 ʻO kekahi haʻawina ʻē aʻe i loiloi i ke koko koko i nā keiki maʻi koʻikoʻi.ʻElua o lākou i ʻike i nā "ʻokoʻa nui" ma waena o nā ʻano nānā invasive a me ka ʻole invasive a hoʻoholo i ka hoʻohaʻahaʻa ʻana i ka hypertension a me ka hypotension i nā maʻi PICU hiki ke alakaʻi i ka undertreatment.10,11 Ma keʻano likeʻole, Ray et al.ua aʻo i nā koina o ke koko i loko o ʻelua mau ʻāpana mālama kino pediatric a, e pili ana i kahi ʻano i ka haʻahaʻa haʻahaʻa a me nā koina NIBP diastolic, ua manaʻo ʻo ka overtreatment o ka hypotension hiki ke piʻi i ka 40%% o ka manawa.12
Ua ʻike maopopo ʻia he pono e hoʻohana ʻia kahi cuff i hoʻopaʻa ʻia no ka loaʻa ʻana o ka heluhelu pono ʻole ʻole.Manaʻo ka American Heart Association (AHA) i ka laulā a me ka lōʻihi o ka ʻōpū i hoʻopaʻa ʻia he 40% a me 80% o ka pōʻai waena o ka lima.13 Uaʻike nuiʻia ka hopena o ka NIBP e ka neʻe a me ka hana o ke kumuhana, no ka mea, hiki i nā mea hoʻouluulu waho ke hoʻopili i ka pololei o nā ana BP.13,14 ʻOiai uaʻike maikaʻiʻia kēia mau kumu kūpono o ka hewa i nā ana NIBP,ʻaʻole iʻike maikaʻiʻia ka nui o ka hoʻohaunaele i nā ana NIBP i nā keiki.Inā makemake ka nānā ʻole-invasive i ka overestimate a hoʻohaʻahaʻa paha i ke kahe koko, hiki ke hāʻawi i nā waiwai hōʻoia hoʻopunipuni i nā maʻi hemodynamically unstable.Ke aʻo ʻana i nā waiwai NIBP i nā keiki ma lalo o ka anesthesia maʻamau, kāpae ʻia nā neʻe a me nā hana o nā kumuhana, hiki ke alakaʻi i nā ana kūpono.No laila, ua hana mākou i kēia noiʻi nānā ʻana e hoʻohālikelike i ka arterial cannulation IBP me NIBP i ana ʻia me nā cuffs oscillometric limb o luna a me lalo i nā keiki ma lalo o ka anesthesia maʻamau.ʻO kā mākou kuhiakau nui ʻo ka heluhelu ʻana o ka NIBP i ka overestimate BP i hoʻohālikelike ʻia i nā mea hana invasive.He liʻiliʻi ka ʻikepili e hoʻohālikelike ai i nā heluhelu NIBP o luna a me lalo, no laila ʻo ka hoʻoholo ʻana e hoʻohana i kekahi lālā he mea maʻalahi ia e pili ana i ka maʻalahi o ke komo ʻana a me ka pono e pale i nā catheters IV peripheral.No laila, ʻo kā mākou pahuhopu lua, ʻo ia ka noiʻi ʻana i ka pilina a me ke ʻano ma waena o nā ana NIBP o ka poʻohiwi a me ka wāwae lalo.
Ua ʻae ʻia ke aʻo ʻana e ka Institutional Review Board (IRB) o ka National Children's Hospital (Columbus, Ohio, USA) a ua mālama ʻia e like me ka Declaration of Helsinki.Hoʻopaʻa inoa ʻia ke aʻo ʻana me Clinicaltrials.gov (NCT03220906).Ma muli o ka loaʻa o ka mea noiʻi, ua kiʻi ʻia nā maʻi 30 e hoʻopau i ke aʻo ʻana.Ua loaʻa ka ʻae ʻōlelo waha mai nā mākua o ka mea maʻi ma mua o ke komo ʻana i ke aʻo ʻana (ua loaʻa kahi waiver o ka ʻae palapala mai ka IRB).ʻO nā poʻe maʻi ʻoi aku ma mua o 10 mau makahiki, American Society of Anesthesiologists (ASA) classification 1-3, ua hoʻokomo ʻia i kā mākou noiʻi inā loaʻa lākou i ka maʻi maʻi āpau me ka elective radial artery cannulation.Ua ana ʻia ʻo IBP me ka hoʻohana ʻana i kahi transducer pressure hydrodynamic (Edwards Lifesciences TruWave) me ka hōʻike BP mau (Philips Intellivue).Ua ana ʻia ʻo NIBP me ka hoʻohana ʻana i ʻelua oscilloscope kaʻawale o ka hōʻailona like (Philips Intellivue) me nā cuffs kūpono (e like me nā kuhikuhi AHA) i hoʻopili ʻia i ka lima luna a me ka wāwae lalo.
Systolic, diastolic a me mean arterial pressure (MAP) ma 3 points (radial artery, arm cuff and leg cuff) ua hoʻopaʻa 'ia ma 5-minuke manawa me 10 ana no ka mea maʻi.No nā poʻe maʻi e loaʻa ana i ka intraoperative cardiopulmonary bypass (CPB), ua loaʻa nā hōʻailona 5 ma mua o ka hoʻomaka ʻana o ka CPB a loaʻa nā hōʻailona 5 ma hope o ka pau ʻana o ka bypass.Ua hana ʻia kahi kānana mana mua no ka hoʻāʻo hoʻohālikelike hoʻokahi.Ua helu mākou e koi ana ka noiʻi i ka mana o 80% i nā hihia 185 e hōʻike i kahi helu hapa ʻoi aku ka nui ma mua o 10% no nā ana non-invasive, me ka nui o ka hapa hapa o 5% a me kahi pae helu helu o 95%.Ua ho'ēmiʻia ke kākau inoaʻana ma hope o ka loaʻaʻana o nā maʻi 30 no ka huina o 300 BP nānā.
ʻO ka hopena mua heʻano koʻikoʻi koʻikoʻi e like me ka weheweheʻana o ka BP o> 5 mmHg ma waena o IBP a me NIBP. ʻO ka hopena mua heʻano koʻikoʻi koʻikoʻi e like me ka weheweheʻana o ka BP o> 5 mmHg ma waena o IBP a me NIBP. Первичным исходом была клинически значимая систематическая ошибка, определяемая отклонением АД> 5 мм рт. ʻO ka hopena mua he maʻi koʻikoʻi koʻikoʻi, i wehewehe ʻia he BP deviation> 5 mmHg.Art.ma waena o IBP a me NIBP.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 мм рт. ʻO ka hopena mua he hoʻololi koʻikoʻi nui, i wehewehe ʻia ʻo BP deviation> 5 mmHg.Art.ma waena o IBP a me NIBP.Ua noiʻi pū mākou i ka hiki ʻana o nā deviations ʻoi aku ma mua o 10 mmHg.Hoʻohālikelike ʻia ka ʻikepili mau ma waena o nā pūnaewele me ka hoʻohana ʻana i ka loiloi Bland-Altman.15 Ma kahi loiloi multivariate, ua hoʻohana mākou i nā hopena like ʻole e hoʻohālike i ka ʻokoʻa loa ma waena o NIBP a me IBP ma ke ʻano he hana o NIBP, ka makahiki, ke kāne, ke kaumaha, a me ke kūlana hoʻomanawanui (prone or supine) linearly me ka hoʻi hou ʻana i ka pae maʻi. Ua hoʻohana ʻia ka intercept maʻi maʻi-level no ka helu ʻana i nā mea maʻi i hoʻokomo ʻole ʻia i loko o ke kumu hoʻohālike, akā ua ʻano like ʻole ia ma waena o nā mea maʻi. a ua manaʻo ʻia ka p<0.05 i mea koʻikoʻi. Ua hoʻohana ʻia ka intercept maʻi maʻi-level no ka helu ʻana i nā mea maʻi i hoʻokomo ʻole ʻia i loko o ke kumu hoʻohālike, akā ua ʻano like ʻole ia ma waena o nā mea maʻi. a ua manaʻo ʻia ka p<0.05 i mea koʻikoʻi. Случайный перехват на уровне пациента использовался для учета факторов пациента, которые не были явно вклелюжно личались между пациентами.16 Анализ данных был выполнен с использованием Stata/IC 14.2 (College Station, TX: StataCorp, LP), и p <0,05 считалось статистически значимым. Ua hoʻohana ʻia ka intercept random level maʻi no ka helu ʻana i nā mea maʻi i hoʻokomo ʻole ʻia i loko o ke kŘkohu akā ʻokoʻa nō naʻe ma waena o nā maʻi.16 Ua hana ʻia ka ʻikepili ʻikepili me Stata/IC 14.2 (College Station, TX: StataCorp, LP), a p < Ua manaʻo ʻia ʻo 0.05 he mea koʻikoʻi.Ua hoʻohana ʻia nā intercepts maʻi-level no ka helu ʻana i nā mea maʻi i hoʻokomo ʻole ʻia i loko o ke kŘkohu akā ua ʻano like ʻole e ka mea maʻi. 16 使用Stata/IC 14.2（Ke Kulanui，TX：StataCorp，LP）进行数据分析， p<0.05 被认为具有统计学意义。 16 使用Stata/IC 14.2（Ke Kulanui，TX：StataCorp，LP）进行数据分析， p<0.05 被认为具有统计学意义。 16 Анализ данных проводили с использованием Stata/IC 14.2 (College Station, TX: StataCorp, LP), p<0,05 считалось статистически з.начимым 16 Ua hana 'ia ka 'ikepili me ka ho'ohana 'ana i Stata/IC 14.2 (College Station, TX: StataCorp, LP), p<0.05 i mana'o nui 'ia ma ka helu.ʻAʻole e kaʻana like nā mea noiʻi / mea kākau i ka ʻikepili pilikino o nā mea komo.
Aia i loko o ka haʻawina he 30 mau maʻi, 18 mau keikikāne a me 12 mau kaikamahine mai 0 a 8 mau makahiki.Hoʻokomo ʻia ka ʻokiʻoki ʻana he 28 (93%) o nā ʻoki ʻokiʻoki, 1 (3%) neurosurgery, a me 1 (3%) ʻoki orthopedic.Hōʻuluʻulu nā papa 1 a me 2 i ka heluna kanaka aʻo a me ka nui o SBP, DBP, a me SBP waiwai ma kēlā me kēia wahi.Ua nānā ʻia nā ana BP he ʻumi a i ʻole 50 mau minuke no kēlā me kēia maʻi, no ka huina o 300 ana a i ʻole 15,000 mau minuke o ka nānā ʻana.
Ma ka'āpana Bland-Altman (Fig. 1),ʻo ka hewa a me ka pololei o NIBP (SBP) i ana ma ka lima, e pili ana i ka IBP, he -2 a me 10 mm Hg.Art.kēlā me kēia (95% nā palena hoʻokō: -21, +17 mmHg).ʻO ke kuhi a me ka pololei o ka puʻuwai arterial mean e pili ana i ka IBP wāwae he -5 a me 11 mmHg.Art.kēlā me kēia (95% o nā palena o ka ʻaelike: -26, +16 mmHg). Ke hoʻohālikelike nei i ka IBP i ka NIBP ma ka lima, ʻo ka ʻokoʻa loa i ka MAP ʻo 7±7 mmHg (pae: 0-52 mmHg) me 143 o 300 mau nānā (48%) e haʻalele ana e> 5 mmHg a me 60 o 300 nānā (20%). kaʻe ʻana e >10 mmHg. Ke hoʻohālikelike nei i ka IBP i ka NIBP ma ka lima, ʻo ka ʻokoʻa loa i ka MAP ʻo 7±7 mmHg (pae: 0-52 mmHg) me 143 o 300 mau nānā (48%) e haʻalele ana e> 5 mmHg a me 60 o 300 nānā (20%). kaʻe ʻana e >10 mmHg.Ke hoʻohālikelike nei i ka IBP a me ka NIBP ma ka lima, ʻo ka ʻokoʻa loa i ka SBP ʻo 7 ± 7 mm Hg.Art.(диапазон: 0–52 мм рт. ст.) при 143 наблюдениях из 300 (48 %) с отклонением > 5 мм рт. (ka laulā: 0-52 mmHg) me 143 nānā mai 300 (48%) me kahi ʻokiʻoki > 5 mmHg.Art.a me 60 mau nānā mai 300 (20%).отклонение >10 мм рт.ст. hoʻokaʻawale > 10 mmHg比较手臂上的IBP 和NIBP 时，MAP 的绝对差异为7±7 mmHg（范围：0-52 mmHg），300 次观察中的143 次观察中的143 比较异为00 次观察中的60 次（20%）> 10 mmHg.比较 手臂 上 的 IBP 和 nibp 时 ， map 的 差异 为 为 为 为 为 为 7 mmhg （范围 ： 0-52 mmhg ） 0-52 mmhg 4 ） 48%） 偏差> 5 mmhg ， 300 次 中 中 的 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 ） ） 60 ） >20%Ke hoʻohālikelike nei i ka IBP a me ka NIBP ma ka lima, ʻo ka ʻokoʻa loa i ka SBP ʻo 7 ± 7 mm Hg.(диапазон: 0-52 мм рт.ст.), с отклонениями >5 мм рт.ст. (ka laulā: 0-52 mmHg), me nā haʻahaʻa> 5 mmHg. в 143 из 300 наблюдений (48%) и 60 из 300 наблюдений (20%) Отклонение > 10 мм рт.ст. i loko o 143 o 300 nānā (48%) a me 60 o 300 nānā (20%) Deviation > 10 mm Hg. I ka hoʻohālikelike ʻana i ka IBP i ka NIBP ma ka wāwae, ʻo ka ʻokoʻa loa i ka MAP ʻo 8±8 mmHg (pae: 0-52 mmHg) me 169 o 298 mau nānā (57%) e haʻalele ana e> 5 mmHg a me 81 o 298 nānā (27%). kaʻe ʻana e >10 mmHg. I ka hoʻohālikelike ʻana i ka IBP i ka NIBP ma ka wāwae, ʻo ka ʻokoʻa loa i ka MAP ʻo 8±8 mmHg (pae: 0-52 mmHg) me 169 o 298 mau nānā (57%) e haʻalele ana e> 5 mmHg a me 81 o 298 nānā (27%). kaʻe ʻana e >10 mmHg.Ke hoʻohālikelike nei i ka VBP me ka NIBP ma ka wāwae, ʻo ka ʻokoʻa loa i ka SBP ʻo 8±8 mm Hg.Art.(ka laulā: 0–52 mmHg), me 169 o 298 mau nānā (57%) e hoʻokae ana ma mua o 5 mmHg.Art.и 81 из 298 наблюдений (27%) отклонение >10 мм рт.ст. a me 81 mai loko o 298 nānā (27%) deviation >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 次观察（9%察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） ， 298 的桬（（偏差> 5 mmhg ， 298 次 观察 的的 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 HIP 81 次（20%mmH>。I ka hoʻohālikelikeʻana i ka VBP me ka NIBP ma ka wāwae,ʻo kaʻokoʻa loa ma SBP he 8 ± 8 mm Hg.Art.(диапазон: 0–52 мм рт. ст.), при этом 169 из 298 наблюдений (57%) имели отклонение > 5 мм рт. (ka laulā: 0–52 mmHg), me 169 o 298 mau nānā (57%) loaʻa ka ʻokoʻa > 5 mmHg.Art.и 1 из 298 наблюдений 81 (27%) отклонения > 10 мм рт.ст. a me 1 o 298 nānā 81 (27%) deviations > 10 mmHg.
Laiki.1. Paʻa Bland-Altman o ka pilina ma waena o nā ana invasive mean arterial pressure (MAP) a me nā ana SBP non-invasive.
Hōʻike ka papa 3 i nā hopena o ka hoʻohālikelike ʻana iā SBP a me DBP ma waena o nā pūnaewele.ʻOiai ua hōʻike ʻia nā pae NIBP ʻelua i nā deviations mai NIBP, ʻoi aku ka nui o nā deviations i ka wā i loaʻa ai ka NIBP i nā wāwae.Hōʻike ka Papa 4 i kahi hoʻohālike multivariate e wānana ana i ka nui o ka haʻalele ʻana o SBP mai nā waiwai IBP me ka hoʻohana ʻana i nā ana NIBP ma nā lima a me nā wāwae.ʻAʻole pili ʻia ke kāne, ka makahiki, ke kaumaha, a me ka wahi hoʻomanawanui me ka manaʻo ʻole i nā ana MAP invasive.Ke hoʻohālikelike ʻia me nā ana NIBP lima, ʻo ka hoʻokaʻawale loa o SBP mai nā ana IBP he 1.5 mmHg.Art.ʻoi aku i nā wāwae (95% CI: 0.4, 2.6; p = 0.009).ʻO ka hoʻohālikelike pololei o ka lima NIBP me ka wāwae NIBP (Fig. 2) i hōʻike i kahi ʻokoʻa loa ma SBP o 2.5 ± 10 mmHg.Art.(95% palena o ka ʻaelike: -17.1, +22.0 mmHg).
Papa 3 Ka hoʻohālikelike ʻana o ke koko maʻamau, systolic, a me ke koko diastolic ma nā lima a me nā wāwae me ka cannulation arterial.
Papa 4 Ka laula o ka hoʻokaʻawale ʻana ma waena o ka mean arterial pressure a me ke ana invasive me ka hoʻohana ʻana i ke ʻano hoʻohālike hoʻihoʻi laina laina hopena.
Laiki.2. Hoʻolālā ʻo Bland-Altman i ka pilina ma waena o nā ana ʻaʻole invasive o ka mean arterial pressure (MAP) ma nā lima a me nā wāwae.
ʻO nā haʻawina mua e hoʻohālikelike ana i nā ana NIBP a me IBP i nā keiki anesthetic i kaupalena ʻia.ʻOiai ke kūʻē nei ka ʻikepili i nā neonates, hōʻike kekahi mau haʻawina i ke ʻano o ke kahe koko kiʻekiʻe ke ana ʻia me ka ʻole invasive.ʻO Joffe et al.ʻike ʻia i loko o kahi heluna kanaka koʻikoʻi o nā keiki, ua liʻiliʻi nā ʻokoʻa ma waena o nā ana NIBP a me IBP i nā keiki 100 ma ka awelika, akā ʻo nā ʻokoʻa maʻamau, nā pae interquartile, a me nā ʻāpana Bland-Altman he ākea ākea.ʻAʻole i hana ʻia kēia mau haʻawina i nā poʻe maʻi ma lalo o ka anesthesia maʻamau, kahi hiʻohiʻona pono o kā mākou noiʻi e hōʻemi i nā hewa o ka maʻi i ka neʻe ʻana a i ʻole ka hana.Eia naʻe, e like me nā hualoaʻa a Ioffe, hōʻike kā mākou mau hopena ʻoiai ʻo nā ana IBP a me NIBP i nā keiki anesthetic i hoʻopili pinepine ʻia kekahi me kekahi, ʻaʻole pololei nā ana NIBP pākahi, e hōʻike ana i ka overestimation a me ka underestimation o BP.Ua puka pinepine nā ʻokoʻa koʻikoʻi ma ka hoʻohana ʻana i ka NIBP i ka wā aʻo.ʻO kēia mau hoʻololi i ka IBP i loaʻa mai nā ana NIBP o ka wāwae haʻahaʻa i ʻoi aku ka nui a ʻoi aku ka pinepine ma mua o nā deviations i loaʻa mai nā ana o ka NIBP o ka poʻohiwi.
Ua hōʻike mua ʻia kahi hoʻohālikelike o nā ana NIBP i nā lima a me nā wāwae i nā keiki.I ka makahiki 2000, Short et al.ua aʻo ʻo NIBP i nā keiki 50 ma lalo o ka anesthesia. I nā keiki i piha i ka makahiki 8 a ma lalo, ua emi loa ka BP i loaʻa mai ka wāwae haʻahaʻa ma mua o ka mea i anaʻia mai ka lima kiʻekiʻe (p<0.05).17 I ka hoʻohālikelikeʻana i kēia, ua hoʻohālikelike kā mākou haʻawina i ka lima a me ka wāwae NIBP i nā ana IBP. I nā keiki i piha i ka makahiki 8 a ma lalo, ua emi loa ka BP i loaʻa mai ka wāwae haʻahaʻa ma mua o ka mea i anaʻia mai ka lima kiʻekiʻe (p<0.05).17 I ka hoʻohālikelikeʻana i kēia, ua hoʻohālikelike kā mākou haʻawina i ka lima a me ka wāwae NIBP i nā ana IBP. У детей в возрасте 8 лет и младше АД, измеренное на голени, было значительно ниже, чем измереное измереное (p<7,эч ). того, в нашем исследовании НИАД руки и ноги сравнивали с измерениями НИАД. I nā keiki i piha i ka makahiki 8 a me ka liʻiliʻi, ʻoi aku ka haʻahaʻa o ke koko i ana ʻia ma ka wāwae haʻahaʻa ma mua o ka mea i ana ʻia ma ka lima o luna (p<0.05).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 пление (p<0,ч05). I nā keiki 8 makahiki a ʻoi aʻe, ʻoi aku ka haʻahaʻa o ke koko i ana ʻia ma ka wāwae haʻahaʻa ma mua o ka lima o luna (p<0.05).17 I ka hoʻohālikelike ʻana, ua hoʻohālikelike kā mākou haʻawina i ka NIBP o nā lima a me nā wāwae me nā ana o IBP.Ua hōʻike ʻia kā mākou mau hopena i ʻoi aku ka maʻamau o ka BP a me ka BP i nā wāwae, e hōʻike ana paha ʻaʻole i hilinaʻi ʻia ka bipi NIBP ma mua o ka NIBP lima kiʻekiʻe.
I kā mākou aʻo ʻana, ua loiloi ʻia ke kiʻekiʻe o ka hoʻololi BP me ka hoʻohana ʻana i nā helu paepae o 5 a me 10 mm Hg.ʻO Art., ka mea i loaʻa ma mua o ka loiloi ʻana i ka pololei o nā mea ʻakomi no ke ana ʻana i ke koko.18 ʻOiai he ʻokoʻa ma SBP o 5 a i ʻole 10 mmHg Art.ua lawa no nā mākua me ka BP perfusion, ʻoi aku ka nui o kēia mau mea ʻino i nā keiki, ʻoi aku ka poʻe me ka palena palena kiʻekiʻe a haʻahaʻa paha, no ka mea he haʻahaʻa ko lākou BP maʻamau.He 90-105/55-70 ke ala ʻana i ke koko koko i nā keiki 2 makahiki (mean makahiki o ka heluna kanaka noiʻi).He 65-85/45-55 ke kahe koko maʻamau i nā pēpē 0-3 mahina.Art.i nā poʻe maʻi hope hiki ke alakaʻi i ka hyperperfusion koʻikoʻi a i ʻole hypoperfusion, kahi pilikia e hiki ai ke alakaʻi i ka pōʻino a me ka hana ʻole o nā kino i hoʻopaʻa ʻia.Eia kekahi, e hoʻohaʻahaʻa ʻia kēia mau koina maʻamau maʻamau ma lalo o ka anesthesia maʻamau.ʻiwakālua
ʻOiai ʻaʻohe mau ʻano like ʻole o ka MAP ma luna a i ʻole ma lalo o ke ana ʻana ma nā kahua ana ʻelua NIBP, ua hoʻonui kā mākou mau hopena i nā ʻike o nā haʻawina mua e hoʻohālikelike ana i nā ana invasive a me ka non-invasive BP i nā keiki, ka mea i ʻike i nā ʻokoʻa ma waena o NIBP a me IBP.ʻO ka mea nui, ua hoʻopau kā mākou noiʻi ʻana i nā hewa ana ʻana o ka NIBP ma muli o ka neʻe ʻana a i ʻole ka hana a ka poʻe maʻi ma lalo o ka anesthesia āpau.Hōʻike kā mākou mau hualoaʻa i ka pono no ka hoʻomohala hou ʻana i nā mākaʻikaʻi koko pololei, non-invasive a me nā hana hemodynamic.ʻO ke alapine o nā hoʻololi koʻikoʻi maʻi e hōʻoia pū ana i ke koʻikoʻi o ka nānā ʻana i ka invasive i ka wā e manaʻo ʻia ai ka hemodynamic instability a i ʻole hypertension haʻahaʻa a i ʻole hypotension i mea hopohopo nui i nā maʻi.
Hiki ke kaupalena ʻia nā hopena o ka haʻawina o kēia manawa e nā kumu kuhi hewa.Manaʻo mākou iā IBP ko mākou kūlana gula no ka hoʻohālikelike ʻana i nā ana NIBP.Ke ana ʻana i ke kahe koko invasive me kahi transducer i hui pū ʻia me ka wai, hiki ke ʻike ʻia nā hewa ʻoi aʻe a i ʻole ma lalo o ke ana ʻana ma muli o ka nui o ka catheter intra-arterial, nā ʻōhū ea i loko o ka ʻōnaehana, kinked a compressed tubing, a i ʻole ka hoʻoneʻe arterial cannula.9 Hoʻomaka ʻana a i ʻole nā ​​hewa i ka wā e hoʻonoho ai i ka transducer ma ke kiʻekiʻe o ka atrium ʻākau o ka mea maʻi.Hiki ke hoʻopili ʻia nā ana NIBP e kahi BP cuff hewa ʻole a i ʻole nā ​​mea hoʻoulu waho.ʻOiai e ʻōlelo ʻia e hahai i nā ʻōlelo aʻoaʻo no ke koho ʻana i ka cuff AHA, ʻo ke koho ʻana o ka nui cuff ma hope o ka manaʻo o ka limahana anestheist.Hoʻokumu kēia ala i kahi kaʻina koho cuff e kūlike me kā mākou hana lapaʻau maʻamau.ʻO ka hopena o ke kaomi ʻana he mau manaʻo koʻikoʻi koʻikoʻi i manaʻo ʻia e puka ma waho o ke ʻano o kēia noiʻi.Eia hou, ʻaʻohe ʻōlelo aʻoaʻo AHA no ka nui ʻana i ka cuff koko koko bipi, no laila ua kuhikuhi nā mea hoʻolako i nā ʻōlelo aʻoaʻo nui lima o AHA i ka wā e hoʻohana ai i nā cuffs bipi.ʻAʻole hiki ke loli ka pae hana o ka mea maʻi ma lalo o ka maʻi maʻi maʻi, akā hiki ke hoʻopili ʻia i waho o ka cuff e ke kauka, mea hana, a i ʻole nā ​​limahana OR.
Ua hoʻohālikelike kā mākou noiʻi ʻana i nā ana kaomi arterial i loaʻa pololei mai nā ana cuff oscillation a me nā mea i loaʻa mai ka invasive pressure pulse waveforms.Pēlā nō, ua hoʻohālikelike ʻia ka SBP a me DBP o ka oscillating cuff me nā waiwai i ana pololei ʻia o ka nalu puʻupuʻu pulse.ʻAʻole mākou i helu i nā kumu hoʻohālikelike e like me ka hoʻohana ʻana i nā vasopressors, a hiki i ka vasoconstriction radial ke hoʻonui i ka hewa ma waena o IBP a me NIBP.He mea nui hoʻi e hoʻomaopopo he hiki ke ʻokoʻa ke kahe koko ma nā ʻāpana like ʻole o ke kino.Hiki i nā ʻokoʻa i loaʻa ma waena o NIBP ma nā wāwae a me BP ma nā lima (invasive a i ʻole invasive) ke hōʻike i nā ʻokoʻa maoli o ke kahe koko ma kēia mau wahi.Eia kekahi, nui ka poʻe maʻi o kā mākou maʻi e hana i ke kīpē thoracic, hiki ke ʻoi aku ka nui o ka hopena i ke kahe koko ma nā lima ma mua o nā wāwae.ʻOiai ʻaʻole mākou i kaohi i ka mana inā i hana ʻia nā ana NIBP a me IBP ma nā wahi maʻi like ʻole a ʻokoʻa paha, ua hoʻohana mākou i ka hoʻihoʻi ʻana i nā hopena like ʻole no ka helu ʻana i nā mea maʻi-level i hoʻokomo ʻole ʻia i kā mākou kumu hoʻohālike.No laila, ua komo nā hopena maʻamau i kēia mau ʻokoʻa o ka pae maʻi, i mau ma waena o nā nānā ʻana o ka mea maʻi hoʻokahi.ʻOiai he mau keiki ma lalo o ka 10 mau makahiki ko mākou hoʻokomo ʻana no ke aʻo ʻana, ʻoiai ʻo ka hapa nui o kā mākou poʻe maʻi he ʻōpio.No laila, ʻaʻole hiki ke hoʻohālikelike ʻia kā mākou hopena i nā keiki ʻōpio.Ua kaupalena ʻia kā mākou mau hopena e nā lako nānā i hoʻohana ʻia.Aia nā ʻokoʻa o ka heluhelu ʻana i ke koko ma waena o nā mea hana monitor like ʻole.Hoʻohana nā mea hana ʻo Oscillometric cuff i nā algorithm proprietary like ʻole a pili wale kā mākou hopena i nā mea i hoʻohana ʻia i kā mākou noiʻi.13:21–24
ʻO ka ʻoiaʻiʻo he ʻokoʻa kekahi mau waiwai mai ka heluhelu IBP ma mua o 30-40 mmHg e kuhikuhi ana i ka hiki ke kumu o ka hewa.No ka mea ua hoʻopaʻa ʻia ka ʻikepili e ka poʻe noiʻi, ʻaʻole hiki ke hoʻoholo i ke kumu i hoʻololi nui ai a hoʻoholo inā pololei nā heluhelu.No ka mālama ʻana i ka pono o ka haʻawina, ua hoʻopaʻa ʻia kēia mau waiwai a hoʻokomo ʻia i ka cohort study.Eia kekahi, ua hoʻopaʻa lima mākou i ka ʻikepili BP ma nā minuke 5-minute, akā ke manaʻo nei mākou ʻo ka nānā ʻana o ka ʻikepili i hōʻiliʻili ʻia i ka ʻikepili NIBP mau i hōʻiliʻili ʻia e hōʻike i nā mea like ʻole ma waena o nā ana IBP a me NIBP.
He mea hou kā mākou ʻikepili i ka wā e hele mai ai lākou mai nā maʻi ma lalo o ka maʻi maʻi maʻi maʻamau, akā ua kūlike lākou me nā haʻawina mua e hoʻohālikelike ana i ka hoʻopili ʻana o nā ana koko invasive a me ka non-invasive.ʻO ke alapine o nā mea ʻino NIBP koʻikoʻi ma ke kino e hōʻoia i ka pono o ka nānā ʻana i ka NIBP i ka wā e piʻi ai ka hemodynamic fluctuations a i ʻole i ka wā e pōʻino loa kēia mau loli.Eia kekahi, ʻoi aku ka maikaʻi o ka NIBP wāwae haʻahaʻa i ka hoʻokaʻawale ʻana i ka nui o ka maʻi mai ke ana ʻana invasively mean arterial pressure ma mua o ka NIBP lima lima.Hāʻawi ʻia i kā mākou hopena, ʻaʻole pono ka hoʻoholo ʻana e pili ana i ka hoʻokomo ʻana i ka cuff, akā makemake mākou e hoʻohana i ka lima inā hiki i ka wā o ka nānā ʻana i ke koko intraoperative.
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24. Nā ʻōnaehana olakino Philips.510(k) Hoolaha presale no ka lako polokalamu Intellivue Information Center.Silver Springs, MD: Ke Keʻena ʻOihana Ola a me nā lawelawe kanaka o ʻAmelika Hui Pū ʻIa a me nā lāʻau lapaʻau; 2019. Loaʻa mai: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&DeviceName=Thir&TyPedview= =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. Loaʻa mai: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&DeviceName=Thir&TyPedview= =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. No ka hoʻomaka ʻana: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=MEDIPS%20Device &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortFColumn=dd%5. 2019. Loaʻa ma: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&DeviceName=Thir&DeviceName=Thir&DeviceName= =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=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=PHILIPS%20MEDICAL&DeviceSYSTEme=PHILIPS%20MEDICAL&DeviceSYSTEmeTview =&ClinicalTrials=&Hoʻoholo=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&HuahanaHuahana=&ZNumber=&PAGENUM=10&SortColumn=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=PHILIPS%20MEDICAL&DeviceSYSTEme=PHILIPS%20MEDICAL&DeviceSYSTEmeTview =&ClinicalTrials=&Hoʻoholo=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&HuahanaHuahana=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. No ka hoʻomaka ʻana: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=MEDIPS%20Device &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortFColumn=dd%5. 2019. Loaʻa ma: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&DeviceName=Thir&DeviceName=Thir&DeviceName= =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc.Mai ʻAukake 14, 2019