Kev sib piv ntawm kev ntsuas ntshav siab thiab qis qis

Kev sib piv ntawm kev ntsuas ntshav siab nyob rau sab sauv thiab qis qis nrog kev ntsuas ntshav siab hauv cov menyuam yaus hauv cov tshuaj loog
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 Department of Anesthesiology and Pain Medicine, National Children's Tsev Kho Mob Columbus, Ohio 43205, Tebchaws USA;2 Department of Pediatrics, Ohio State University, Columbus, Ohio, 43210, USA;3 Pediatric Intensive Care Unit, Children's National Hospital, Columbus, Ohio, 43205, USA;4 Department of Anesthesiology and Pain Management, Ohio State University, Columbus, OH 43210, USA Corresponding author: Seth Hayes Department of Anesthesiology and Pain Management, Children's National Hospital, 700 Children's Drive, Columbus, OH 43205, USATel +1 6142022 +1 614 722 4203 Invasive blood pressure (IBP) tube readings vs non-invasive blood pressure (NIBP) ntsuas nrog oscillometric cuffs ntawm sab sauv thiab qis extremities nyob rau hauv cov me nyuam mos thiab cov me nyuam nyob rau hauv cov tshuaj loog.Cov neeg mob thiab cov txheej txheem.Peb txoj kev tshawb fawb suav nrog cov neeg mob uas muaj hnub nyoog qis dua 10 xyoo yog tias lawv tau txais tshuaj loog dav dav thiab npaj ib txoj hlab ntsha radial catheterization.IBP tau ntsuas txhua 5 feeb nrog lub tshuab hloov hluav taws xob hydrodynamic, thiab NIBP tau ntsuas nrog ob lub oscilloscopes nrog rau qhov loj me me tso rau ntawm sab caj npab thiab sab ceg, thiab 10 qhov ntsuas tau coj los ntawm txhua tus neeg mob.Cov txiaj ntsig: Txoj kev tshawb no koom nrog 18 tus tub thiab 12 tus ntxhais hnub nyoog 0 txog 8 xyoo.Ntawm 300 cov ntaub ntawv cov ntsiab lus, qhov sib txawv kiag li ntawm txhais caj npab txhais tau hais tias lub siab siab (MAP) thiab kev ntsuas ntsuas yog 7 ± 7 mmHg.Art.(ntau: 0-52 mmHg).Qhov sib txawv kiag li ntawm qhov ntsuas ntawm SBP ntawm ceg thiab txoj kev tawm tsam yog 8 ± 8 mm Hg.Art.(ntau: 0-52 mmHg). Txawm hais tias ob qho tib si tsis yog qhov chaw ntsuas qhov ntsuas tau pom qhov sib txawv ntawm qhov ntsuas qhov ntsuas, qhov sib txawv loj tau ntau dua thaum BP ntsuas ntawm ceg (81 ntawm 298 kev soj ntsuam (27%) deviating los ntawm> 10 mmHg) piv rau caj npab (60 ntawm 300 kev soj ntsuam. (20%) deviating los ntawm> 10 mmHg).Zoov: Qhov zaus ntawm kev kho mob tseem ceeb NIBP sib txawv ntawm cov me nyuam nyob rau hauv cov tshuaj loog pab txhawb qhov tseem ceeb ntawm IBP kev saib xyuas thaum hemodynamic fluctuations yuav thiab yuav muaj kev puas tsuaj tshwj xeeb. Txawm hais tias ob qho tib si tsis yog qhov chaw ntsuas qhov ntsuas tau pom qhov sib txawv ntawm qhov ntsuas qhov ntsuas, qhov sib txawv loj tau ntau dua thaum BP ntsuas ntawm ceg (81 ntawm 298 kev soj ntsuam (27%) deviating los ntawm> 10 mmHg) piv rau caj npab (60 ntawm 300 kev soj ntsuam. (20%) deviating los ntawm> 10 mmHg).Zoov: Qhov zaus ntawm kev kho mob tseem ceeb NIBP sib txawv ntawm cov me nyuam nyob rau hauv cov tshuaj loog pab txhawb qhov tseem ceeb ntawm IBP kev saib xyuas thaum hemodynamic fluctuations yuav thiab yuav muaj kev puas tsuaj tshwj xeeb.Txawm hais tias ob qho tib si tsis yog qhov kev ntsuas qhov ntsuas tau pom qhov sib txawv ntawm qhov ntsuas qhov ntsuas, qhov sib txawv loj tau tshwm sim ntau dua nrog kev ntsuas BP ceg (81 ntawm 298 kev soj ntsuam (27%), deviating ntau dua 10 mmHg) piv nrog caj npab (60 ntawm 300 kev soj ntsuam) .(20%), deviating ntau tshaj 10 mm Hg.Art.).Xaus.Qhov zaus ntawm kev kho mob tseem ceeb NIBP qhov txawv txav hauv cov menyuam yaus hauv cov tshuaj loog dav dav lees paub qhov tseem ceeb ntawm kev saib xyuas NIBP thaum hemodynamic hloov pauv thiab tuaj yeem ua rau muaj kev puas tsuaj tshwj xeeb.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（300 次）腿部测量的BP (298 次观察中的81 次(27) %) 偏差> 10 mmHg) 10 mmHg (20%) thiab 10 mmHg).尽管两 个非侵入性测量 部位都 出 与 侵入性测量 频繁的 偏差 ， 但与 手臲次）相比，在测量的的 bp（298次中的81次（27）（27） (27 (27 (27 %) 偏差> 10 mmHg) 更常见(20%) 偏差> 10 mmHg). Хотя оба неинвазивных места измерения показали частые отклонения от ининазивных измерений, АД, измер 8 назомер ений (27) по сравнению с рукой (60 из 300 наблюдений) %), отклонение> 10 мм рт.ст.) чаще (20 % отклонение). Txawm hais tias ob qho tib si tsis yog qhov chaw ntsuas qhov ntsuas tau pom qhov sib txawv ntawm qhov ntsuas ntsuas, BP ntsuas ntawm ceg (81 ntawm 298 kev soj ntsuam (27) piv nrog caj npab (60 tawm ntawm 300 kev soj ntsuam) %), sib txawv> 10 mmHg) ntau dua ( 20% kev sib txawv). > 10 мм рт.ст.). > 10 mmHg).Cov lus xaus.Qhov zaus ntawm kev kho mob tseem ceeb NIBP qhov txawv txav hauv cov menyuam yaus hauv cov tshuaj loog dav dav lees paub qhov tseem ceeb ntawm kev saib xyuas NIBP thaum cov kev hloov pauv ntawm hemodynamic yuav ua rau muaj kev puas tsuaj tshwj xeeb.Piv nrog rau NIBP qhov tseem ceeb tau txais ntawm caj npab sab sauv, NIBP ntsuas ntawm sab ceg qis dua yuav ua rau muaj qhov txawv txav ntawm qhov chaw kho mob los ntawm qhov ntsuas qhov ntsuas siab txhais tau tias lub siab.Ntsiab lus: invasive ntshav siab, non-invasive ntshav siab, ntshav siab cuff.
Kev saib xyuas ntshav siab (BP) yog qhov tseem ceeb hauv kev nyab xeeb ntawm kev siv tshuaj loog txij li lub sphygmomanometer tau pom zoo los ntawm Dr. Harvey Cushing thaum xyoo 1900s.Txij li xyoo 1986, qhov no yog tus qauv xav tau los ntawm American Society of Anesthesiologists (ASA) thaum lub sij hawm txhua lub sijhawm ntawm kev siv tshuaj loog.Vim tias kev ntsuas ntshav siab ua rau muaj kev txiav txim siab tseem ceeb ntawm kev tswj xyuas kev ua haujlwm, qhov tsis raug tuaj yeem cuam tshuam rau kev kuaj mob raws sijhawm thiab kev kho mob ntawm hemodynamic instability.Pediatric anesthesiologists feem ntau txiav txim siab los tswj cov kua dej, ntshav cov khoom, thiab inotropes raws li deviations los ntawm "ib txwm" BP.1 Vim tias kev mob ntshav siab thiab ntshav siab tau pom tias cuam tshuam nrog cov teeb meem tom qab phais, suav nrog mob raum tsis ua haujlwm, encephalopathy, myocardial infarction, mob stroke, thiab nce 30-hnub tuag, kev ntsuas BP tsis raug tuaj yeem ua rau muaj kev phom sij, tsis paub txog BP txawv txav.2-5
Thaum lub sijhawm phais, ntshav siab tuaj yeem ntsuas qhov tsis muaj qhov cuam tshuam nrog lub oscillometric ntshav siab cuff (NIBP) lossis invasively nrog indwelling arterial cannula (IBP).Ib qho oscillometric cuff occludes tus neeg mob cov hlab ntsha los ntawm inflating nws mus rau lub siab tshaj tus neeg mob lub systolic ntshav siab (SBP) thiab ces ntsuas lub siab hloov raws li lub cuff maj mam deflates.Lub ntsiab lus ntawm qhov siab hloov pauv ntau tshaj plaws yog qhov nruab nrab ntawm cov hlab ntsha siab (MAP).SBP thiab diastolic ntshav siab (DBP) yog tom qab ntawd xam raws li txhais tau tias arterial siab thiab oscillometric qauv.Cov algorithms rau cov kev suav no yog tus tswv thiab nyob ntawm NIBP cuff chaw tsim khoom.6 Nyob rau hauv sib piv, invasive arterial cannulation ntsuas SBP thiab DBP ncaj qha los ntawm lub siab pulse waves.MAP yog muab los ntawm cov nqi no.7
Ntau qhov kev tshawb fawb tau tshawb xyuas kev koom tes ntawm VBP nrog NIBP hauv cov menyuam yaus nrog cov txiaj ntsig sib xyaw. Hauv xyoo 2010, Meyer thiab al tau ua ib txoj kev tshawb fawb qhia tias kev tsis ncaj ncees tsawg (<1 mmHg) ntawm Bland-Altman tsom xam ntawm qhov ntsuas tsis zoo ntawm cov hlab ntsha hauv cov menyuam mos yug ntxov thiab qhia tias kev sib raug zoo ntawm IBP thiab NIBP tau txhim kho raws li NIBP thev naus laus zis tau nce qib. .8 Txawm li cas los xij, O'Shea et al tau sau tseg tias muaj kev nyiam mus rau qhov tsis tseeb nce NIBP qhov tseem ceeb hauv cov neeg mob no txawm hais tias kev txhim kho cov khoom siv NIBP tshiab, zoo dua qub, txawm tias muaj peev xwm ua rau muaj teeb meem xws li cuff loj thiab qib ntawm kev ua haujlwm raug tshem tawm.9 Cov kev tshawb fawb ntxiv. tau soj ntsuam BP ntsuas hauv cov neeg mob hnyav. Hauv xyoo 2010, Meyer et al tau ua ib txoj kev tshawb fawb qhia tias kev tsis ncaj ncees tsawg (<1 mmHg) ntawm Bland-Altman tsom xam ntawm qhov ntsuas tsis tau ntsuas qhov siab ntawm cov hlab ntsha hauv cov menyuam mos yug ntxov thiab qhia tias kev sib raug zoo ntawm IBP thiab NIBP tau txhim kho raws li NIBP thev naus laus zis. tau nce siab .8 Txawm li cas los xij, O'Shea et al tau sau tseg ib qho kev nyiam mus rau qhov tsis tseeb nce NIBP qhov tseem ceeb hauv cov neeg mob no txawm hais tias kev txhim kho cov khoom siv NIBP tshiab, ntau dua, txawm tias muaj peev xwm ua rau muaj kev tsis sib haum xeeb xws li cuff loj thiab qib ntawm kev ua haujlwm raug tshem tawm. .9 Cov kev tshawb fawb ntxiv tau soj ntsuam cov kev ntsuas BP hauv cov neeg mob hnyav. Xyoo 2010 xyoo.Meyer и соавторы провели исмследование, показывающее низкую погрешность (<1 мм рт. ст.) в анализе Блавьта-манализе Блавьта еренного среднего артериального давления у недоношенных детей и предположили, что кориеля Дуса кориеля Дед ь по мере того, как технология НИАД .8 Тем не менее, O'Shea et al. Hauv xyoo 2010, Meyer et al tau ua ib txoj kev tshawb fawb qhia tias qhov yuam kev tsawg (<1 mmHg) hauv Bland-Altman tsom xam ntawm qhov ntsuas tsis tau ntsuas qhov siab ntawm cov hlab ntsha hauv cov menyuam mos yug ntxov thiab qhia tias kev sib raug zoo ntawm IBP thiab NIBP tau txhim kho raws li NIBP thev naus laus zis .8 Txawm li cas los xij , O'Shea et al.tau sau tseg ib qho qauv ntawm qhov tsis tseeb siab NIBP qhov tseem ceeb hauv cov neeg mob no txawm tias muaj kev txhim kho tshiab, zoo dua NIBP cov cuab yeej, txawm tias muaj peev xwm ua rau muaj kev ntxhov siab xws li cuff loj thiab qib kev ua haujlwm tau raug tshem tawm..9 Cov kev tshawb fawb ntxiv tau soj ntsuam kev ntsuas BP hauv cov menyuam yaus mob hnyav. 2010 年，Meyer 等人进行了一项研究，显示Bland-Altman 分析对早产儿无创测量的平均动脉压蛽。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，但即丿嶈閰。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 藠 创 测量 的 厨差 (<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 之间的相关性有所 改善牀 改善牌然耇 尭，o'开发了更新、更复杂 nibp 设备，即使 消除了 袖带 尺寸活动等可能的 混杂，该患者 群体 nibp 值值的 nibp 值 值 nibp 值 值 nibp 值 值 值有倯升高的趋势. Xyoo 2010 xyoo.Мейер и др.провели исследование, показывающее, что анализ Биланда-Альтмана дает низкую погрешность (<1 мнм рт. с . нного среднего артериального давления у недоношенных детей, и показал, что с развитием технологии ьная разница между ИАД. Xyoo 2010, Meyer et al.tau ua ib txoj kev tshawb fawb qhia tias Bland-Altman tsom xam muab qhov yuam kev tsawg (<1 mmHg) rau qhov tsis ntsuas qhov ntsuas siab ntawm cov hlab ntsha hauv cov menyuam mos yug ntxov thiab pom tias nrog kev txhim kho ntawm NIBP thev naus laus zis, muaj qhov sib txawv tseem ceeb ntawm IAD.thiab NIBP, kev sib raug zoo tuaj.ntawm cov pejxeem Txoj kev mus rau qhov nce ntawm tus lej ntawm qhov yuam kev txuas ntxiv mus.9 Lwm qhov kev tshawb fawb tau ntsuas ntshav siab hauv cov menyuam yaus mob hnyav.Ob tug ntawm lawv pom "qhov sib txawv loj" ntawm kev saib xyuas tsis zoo thiab tsis cuam tshuam thiab xaus lus tias kev kwv yees tsis txaus siab thiab hypotension hauv PICU cov neeg mob tuaj yeem ua rau tsis zoo.10,11 In contrast, Ray et al.tau kawm txog ntshav siab qhov tseem ceeb hauv ob chav saib xyuas menyuam yaus thiab, raws li qhov sib txawv ntawm qhov qis dua thiab diastolic NIBP qhov tseem ceeb, xaus lus tias kev kho mob ntawm hypotension tuaj yeem nyob hauv thaj tsam li 40% ntawm lub sijhawm.12
Nws yog qhov paub zoo tias yuav tsum siv lub cuff me me kom tau txais qhov tseeb tshaj plaws uas tsis yog kev nyeem ntawv.Lub koom haum American Heart Association (AHA) pom zoo tias qhov dav thiab qhov ntev ntawm lub zais zis yog 40% thiab 80% ntawm qhov nruab nrab ntawm caj npab, feem.13 Nws paub zoo tias NIBP cuam tshuam los ntawm kev txav mus los thiab kev ua haujlwm ntawm qhov kev kawm, vim tias cov stimuli sab nraud tuaj yeem cuam tshuam qhov tseeb ntawm BP ntsuas.13,14 Txawm hais tias cov peev txheej muaj peev xwm ntawm kev ua yuam kev hauv NIBP kev ntsuas tau lees paub zoo, qhov cuam tshuam ntawm kev ntsuas NIBP hauv cov menyuam yaus tsis tau pom zoo.Yog tias qhov kev soj ntsuam tsis muaj kev cuam tshuam zoo li overestimate lossis underestimate ntshav siab, nws yuav ua rau muaj txiaj ntsig zoo rau cov neeg mob hemodynamically tsis ruaj khov.Thaum kawm NIBP qhov tseem ceeb hauv cov menyuam yaus nyob rau hauv cov tshuaj loog dav dav, kev txav thiab kev ua ntawm cov ntsiab lus raug cais tawm, uas tuaj yeem ua rau muaj kev ntsuas ntau dua.Yog li ntawd, peb tau ua qhov kev soj ntsuam yav tom ntej no los sib piv arterial cannulation IBP nrog NIBP ntsuas nrog rau sab sauv thiab qis qis oscillometric cuffs hauv cov menyuam yaus hauv qab tshuaj loog.Peb lub tswv yim tseem ceeb yog tias NIBP nyeem ntawv overestimate BP piv rau cov khoom siv nkag.Muaj cov ntaub ntawv me me los sib piv cov ntawv nyeem sab sauv thiab sab NIBP, yog li qhov kev txiav txim siab siv cov ceg tawv feem ntau yog qhov ua tau zoo raws li kev yooj yim ntawm kev nkag mus thiab qhov xav tau kom tsis txhob muaj cov khoom siv sab hauv IV.Yog li ntawd, peb lub hom phiaj thib ob yog los tshawb xyuas qhov kev sib raug zoo thiab kev tsis ncaj ncees ntawm NIBP kev ntsuas ntawm lub xub pwg nyom thiab sab ceg.
Txoj kev tshawb no tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb (IRB) ntawm National Children's Hospital (Columbus, Ohio, USA) thiab tau ua raws li Kev Tshaj Tawm ntawm Helsinki.Txoj kev tshawb no tau sau npe nrog Clinicaltrials.gov (NCT03220906).Raws li qhov muaj nyob ntawm tus neeg tshawb xyuas, 30 tus neeg mob tau raug xaiv los ua kom tiav txoj kev tshawb fawb.Kev pom zoo ntawm qhov ncauj tau txais los ntawm tus neeg mob cov niam txiv ua ntej koom nrog hauv txoj kev tshawb no (kev zam ntawm daim ntawv tso cai tau txais los ntawm IRB).Cov neeg mob uas muaj hnub nyoog qis dua 10 xyoo, American Society of Anesthesiologists (ASA) kev faib tawm 1-3, tau suav nrog hauv peb txoj kev tshawb fawb yog tias lawv yuav tsum tau txais tshuaj loog dav dav nrog kev xaiv radial artery cannulation.IBP tau ntsuas los ntawm kev siv lub tshuab hluav taws xob hydrodynamic siab transducer (Edwards Lifesciences TruWave) nrog cov zaub BP txuas ntxiv (Philips Intellivue).NIBP tau ntsuas siv ob qhov sib cais oscilloscopes ntawm tib lub hom (Philips Intellivue) nrog rau qhov loj me me (raws li AHA cov lus qhia) siv rau sab caj npab thiab sab ceg.
Systolic, diastolic thiab mean arterial pressure (MAP) ntawm 3 cov ntsiab lus (radial artery, caj npab cuff thiab ceg cuff) tau sau tseg ntawm 5-feeb intervals nrog 10 ntsuas rau ib tus neeg mob.Rau cov neeg mob nyob rau hauv intraoperative cardiopulmonary bypass (CPB), 5 indications tau txais ua ntej pib ntawm CPB thiab 5 indications tau txais tom qab ua tiav ntawm bypass.Ib qho kev ntsuam xyuas lub zog ua ntej tau ua rau ib qho piv txwv piv txwv.Peb suav tias txoj kev tshawb fawb yuav xav tau lub zog ntawm 80% hauv 185 qhov xwm txheej los ua kom pom qhov ua yuam kev ntau dua 10% rau kev ntsuas tsis muaj kev cuam tshuam, nrog qhov ua yuam kev siab tshaj plaws ntawm 5% thiab qhov tseem ceeb ntawm cov lej ntawm 95%.Kev sau npe raug txo qis tom qab 30 tus neeg mob raug xaiv rau tag nrho 300 BP kev soj ntsuam.
Cov txiaj ntsig tseem ceeb yog kev saib xyuas tsis zoo raws li tau hais los ntawm qhov sib txawv ntawm BP ntawm> 5 mmHg ntawm IBP thiab NIBP. Cov txiaj ntsig tseem ceeb yog kev saib xyuas tsis zoo raws li tau hais los ntawm qhov sib txawv ntawm BP ntawm> 5 mmHg ntawm IBP thiab NIBP. Первичным исходом была клинически значимая систематическая ошибка, определяемая отклонением АД> 5 . Cov txiaj ntsig tseem ceeb yog qhov tseem ceeb hauv kev kho mob, txhais tau tias yog BP sib txawv> 5 mmHg.Art.ntawm IBP thiab 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 АДт> 5 мм . Thawj qhov kawg yog qhov sib txawv tseem ceeb hauv kev kho mob, txhais tau tias yog BP sib txawv> 5 mmHg.Art.ntawm IBP thiab NIBP.Peb kuj tau tshawb xyuas qhov tshwm sim ntawm qhov sib txawv ntau dua 10 mmHg.Cov ntaub ntawv txuas ntxiv ntawm cov chaw tau muab piv nrog kev tshuaj xyuas Bland-Altman.15 Hauv kev tshuaj xyuas ntau yam, peb tau siv cov teebmeem sib xyaw los ua qauv qhov sib txawv ntawm NIBP thiab IBP raws li kev ua haujlwm ntawm NIBP, hnub nyoog, poj niam txiv neej, qhov hnyav, thiab tus neeg mob txoj hauj lwm (pem los yog supine) linearly nrog random recurrence ntawm tus neeg mob theem. Tus neeg mob-theem random cuam tshuam tau siv los suav rau cov neeg mob yam uas tsis tau suav nrog hauv tus qauv, tab sis qhov tseem sib txawv ntawm cov neeg mob.16 Cov ntaub ntawv tsom xam tau ua los ntawm Stata/IC 14.2 (College Station, TX: StataCorp, LP), thiab p <0.05 tau suav hais tias yog qhov tseem ceeb. Tus neeg mob-theem random cuam tshuam tau siv los suav rau cov neeg mob yam uas tsis tau suav nrog hauv tus qauv, tab sis qhov tseem sib txawv ntawm cov neeg mob.16 Cov ntaub ntawv tsom xam tau ua los ntawm Stata/IC 14.2 (College Station, TX: StataCorp, LP), thiab p <0.05 tau suav hais tias yog qhov tseem ceeb. Случайный перехват на уровне пациента использовался для учета факторов пациента, которые не были я вено же различались между пациентами.16 Анализ данных был выполнен с использованием Stata/IC 14.2 (College CLP), TXp, Stata <0,05 считалось статистически значимым. Tus neeg mob-theem random cuam tshuam tau siv los suav rau cov neeg mob yam tsis tau suav nrog hauv tus qauv tab sis tseem sib txawv ntawm cov neeg mob.16 Cov ntaub ntawv tsom xam tau ua los ntawm Stata/IC 14.2 (College Station, TX: StataCorp, LP), thiab p < 0.05 tau suav tias yog qhov tseem ceeb.Cov neeg mob-theem random intercepts tau siv los suav rau cov neeg mob yam uas tsis tau suav nrog hauv tus qauv tab sis tseem txawv ntawm tus neeg mob. 16 使用Stata/IC 14.2 (College Station, 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 (College Station, 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 статистичес. 16 Kev tshuaj xyuas cov ntaub ntawv tau ua tiav siv Stata/IC 14.2 (College Station, TX: StataCorp, LP), p<0.05 tau suav tias yog qhov tseem ceeb.Cov kws tshawb fawb / cov kws sau ntawv yuav tsis qhia tus kheej cov ntaub ntawv ntawm cov neeg koom.
Txoj kev tshawb no suav nrog 30 tus neeg mob, 18 tus tub thiab 12 tus ntxhais hnub nyoog 0 txog 8 xyoo.Kev phais suav nrog 28 (93%) kev phais thoracic, 1 (3%) neurosurgery, thiab 1 (3%) orthopedic phais.Daim duab 1 thiab 2 qhia txog cov kev tshawb fawb pej xeem pej xeem thiab txhais tau tias SBP, DBP, thiab SBP qhov tseem ceeb ntawm txhua qhov chaw.Kaum qhov kev ntsuas BP lossis kwv yees li 50 feeb tau soj ntsuam rau txhua tus neeg mob, rau tag nrho ntawm 300 kev ntsuas lossis 15,000 feeb ntawm kev saib xyuas.
Ntawm Bland-Altman zaj duab xis (Daim duab 1), qhov yuam kev thiab qhov tseeb ntawm NIBP (SBP) ntsuas ntawm caj npab, nyob rau hauv kev sib raug zoo rau IBP, yog -2 thiab 10 mm Hg.Art.raws li (95% txwv tsis pub muaj: -21, +17 mmHg).Qhov kev tsis ncaj ncees thiab qhov tseeb ntawm qhov nruab nrab ntawm cov hlab ntsha siab txheeb ze rau ceg IBP yog -5 thiab 11 mmHg.Art.raws li (95% ntawm thaj tsam ntawm kev pom zoo: -26, +16 mmHg). Thaum muab piv IBP rau NIBP ntawm caj npab, qhov sib txawv ntawm MAP yog 7 ± 7 mmHg (ntau: 0–52 mmHg) nrog 143 ntawm 300 kev soj ntsuam (48%) deviating los ntawm> 5 mmHg thiab 60 ntawm 300 kev soj ntsuam (20%) deviating los ntawm> 10 mmHg. Thaum muab piv IBP rau NIBP ntawm caj npab, qhov sib txawv ntawm MAP yog 7 ± 7 mmHg (ntau: 0–52 mmHg) nrog 143 ntawm 300 kev soj ntsuam (48%) deviating los ntawm> 5 mmHg thiab 60 ntawm 300 kev soj ntsuam (20%) deviating los ntawm> 10 mmHg.Thaum muab piv IBP thiab NIBP ntawm caj npab, qhov sib txawv ntawm SBP yog 7 ± 7 mm Hg.Art.(диапазон: 0–52 мм рт. ст.) при 143 наблюдениях из 300 (48 %) с отклонением > 5 мм рт. (ntau: 0-52 mmHg) nrog 143 kev soj ntsuam ntawm 300 (48%) nrog qhov sib txawv> 5 mmHg.Art.thiab 60 kev soj ntsuam tawm ntawm 300 (20%).отклонение > 10 мм рт.ст. sib txawv> 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 次 5 察中的 143 次 5 % 8 mmHg察中的60 次(20%) thiab 10 mmHg.比较 手臂 上的 IBP 和 nibp 时 ， map 的 差异 为 为 为 7 mmhg (范围： 0-52 mmhg (的 40) 300%差> 5 mmhg , 300 次 中 的 60次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 次 60 gThaum muab piv IBP thiab NIBP ntawm caj npab, qhov sib txawv ntawm SBP yog 7 ± 7 mm Hg.(диапазон: 0-52 мм рт.ст.), с отклонениями > 5 мм рт.ст. (ntau: 0-52 mmHg), nrog kev sib txawv> 5 mmHg. в 143 из 300 наблюдений (48%) thiab 60 из 300 наблюдений (20%) Отклонение > 10 мм рт.ст. hauv 143 ntawm 300 kev soj ntsuam (48%) thiab 60 tawm ntawm 300 kev soj ntsuam (20%) Deviation> 10 mm Hg. Thaum muab piv IBP rau NIBP ntawm ceg, qhov sib txawv ntawm MAP yog 8 ± 8 mmHg (ntau: 0–52 mmHg) nrog 169 ntawm 298 kev soj ntsuam (57%) deviating los ntawm> 5 mmHg thiab 81 ntawm 298 kev soj ntsuam (27%) deviating los ntawm> 10 mmHg. Thaum muab piv IBP rau NIBP ntawm ceg, qhov sib txawv ntawm MAP yog 8 ± 8 mmHg (ntau: 0–52 mmHg) nrog 169 ntawm 298 kev soj ntsuam (57%) deviating los ntawm> 5 mmHg thiab 81 ntawm 298 kev soj ntsuam (27%) deviating los ntawm> 10 mmHg.Thaum muab piv VBP nrog NIBP ntawm ceg, qhov sib txawv ntawm SBP yog 8 ± 8 hli Hg.Art.(ntau: 0–52 mmHg), nrog 169 ntawm 298 kev soj ntsuam (57%) deviating los ntawm ntau tshaj 5 mmHg.Art.thiab 81 из 298 наблюдений (27%) отклонение > 10 мм рт.ст. thiab 81 ntawm 298 kev soj ntsuam (27%) sib txawv> 10 mmHg.IBP 与腿部的NIBP 进行比较时，MAP 的绝对差异为8 ± 8 mmHg (H2: 0-52 mmHg), 298 次观察 5 察 9 察> 1 98 次观察中的81 次 (27%) 偏差> 10 mmHg.将 IBP 与 腿部 nibp 进行时 ， ， map 的差异为 为 8 ± 8 mmhg (范围： 0-52 mmhg) , 298 的次差> 5 mmhg , 298 次 观察 的的 中 中 中 中 中 中 中 中 中 中 中 中 HIP 81 次 (27%)> 10 hli.Thaum muab piv VBP nrog NIBP hauv ceg, qhov sib txawv ntawm SBP yog 8 ± 8 mm Hg.Art.(диапазон: 0–52 мм рт. ст.), при этом 169 из 298 наблюдений (57%) имели отклонение > 5 мм рт. (ntau: 0–52 mmHg), nrog 169 ntawm 298 kev soj ntsuam (57%) muaj qhov sib txawv> 5 mmHg.Art.thiab 1 из 298 наблюдений 81 (27%) отклонения > 10 мм рт.ст. thiab 1 ntawm 298 kev soj ntsuam 81 (27%) sib txawv> 10 mmHg.
Rice.1. Bland-Altman zaj duab xis ntawm cov ntawv xov xwm ntawm invasive mean arterial pressure (MAP) ntsuas thiab tsis-invasive SBP ntsuas.
Table 3 qhia cov txiaj ntsig ntawm kev sib piv SBP thiab DBP ntawm qhov chaw.Txawm hais tias ob qho tib si NIBP qhov chaw pom qhov sib txawv ntawm NIBP, qhov sib txawv loj dua muaj ntau dua thaum NIBP tau txais ntawm ob txhais ceg.Table 4 qhia txog ntau yam qauv kwv yees qhov sib txawv ntawm SBP los ntawm IBP qhov tseem ceeb uas siv NIBP ntsuas ntawm caj npab thiab txhais ceg.Poj niam los txiv neej, hnub nyoog, qhov hnyav, thiab qhov chaw tus neeg mob tsis cuam tshuam nrog kev tsis ncaj ncees hauv kev ntsuas MAP.Piv rau kev ntsuas ntawm caj npab NIBP, qhov sib txawv ntawm SBP los ntawm IBP ntsuas yog 1.5 mmHg.Art.ntau hauv ob txhais ceg (95% CI: 0.4, 2.6; p = 0.009).Kev sib piv ncaj qha ntawm caj npab NIBP nrog ceg NIBP (Daim duab 2) pom qhov sib txawv ntawm SBP ntawm 2.5 ± 10 mmHg.Art.(95% txwv kev pom zoo: -17.1, +22.0 mmHg).
Table 3 Kev sib piv ntawm txhais tau tias arterial, systolic, thiab diastolic ntshav siab hauv caj npab thiab txhais ceg nrog arterial cannulation
Table 4 Kev sib txawv ntawm qhov sib txawv ntawm qhov kwv yees txhais tau tias lub siab lub siab thiab qhov kev ntsuas cuam tshuam siv cov kev sib xyaw ua ke ntawm cov qauv kev rov ua dua tshiab
Rice.2. Bland-Altman zaj duab xis ntawm cov ntawv xov xwm ntawm cov kev ntsuas uas tsis cuam tshuam ntawm txhais tau tias arterial siab (MAP) hauv caj npab thiab txhais ceg.
Cov kev tshawb fawb yav dhau los piv rau kev ntsuas NIBP thiab IBP hauv cov menyuam yaus uas muaj tshuaj loog yog txwv.Txawm hais tias cov ntaub ntawv hauv cov menyuam yaus muaj kev tsis sib haum xeeb, qee qhov kev tshawb fawb qhia txog kev nce ntshav siab thaum ntsuas tsis yog invasively.Joffe et al.pom tias nyob rau hauv ib qho tseem ceeb ntawm cov menyuam yaus, qhov sib txawv ntawm NIBP thiab IBP ntsuas hauv 100 cov menyuam yaus yog qhov nruab nrab, tab sis cov qauv sib txawv, qhov sib txawv ntawm qhov sib txawv, thiab Bland-Altman cov phiaj xwm muaj ntau qhov kev pom zoo.Cov kev tshawb fawb no tsis tau ua rau cov neeg mob nyob rau hauv kev siv tshuaj loog, uas muaj txiaj ntsig zoo ntawm peb txoj kev tshawb fawb uas yuav txo tau cov neeg mob yuam kev hauv kev txav los yog kev ua si.Txawm li cas los xij, zoo ib yam li Ioffe cov txiaj ntsig, peb cov txiaj ntsig tau pom tias txawm hais tias kev ntsuas IBP thiab NIBP hauv cov menyuam yaus uas muaj tshuaj loog feem ntau cuam tshuam nrog ib leeg, qhov kev ntsuas NIBP feem ntau tsis raug, qhia tias ob qho tib si overestimation thiab underestimation ntawm BP.Cov kev sib txawv tseem ceeb hauv kev siv NIBP nquag tshwm sim thaum lub sijhawm kawm.Cov kev sib txawv no hauv IBP tau txais los ntawm kev ntsuas NIBP ntawm sab ceg qis yog qhov loj dua thiab ntau dua li qhov sib txawv tau los ntawm kev ntsuas ntawm NIBP ntawm lub xub pwg nyom.
Kev sib piv ntawm NIBP ntsuas ntawm caj npab thiab txhais ceg hauv cov menyuam yaus tau tshaj tawm yav dhau los.Xyoo 2000, Short et al.kawm NIBP hauv 50 cov menyuam yaus hauv qab tshuaj loog. Hauv cov menyuam yaus hnub nyoog 8 xyoo thiab qis dua, BP tau txais los ntawm cov ceg qis qis qis dua qhov ntsuas los ntawm caj npab sab sauv (p<0.05).17 Hauv qhov sib piv rau qhov no, peb txoj kev tshawb fawb piv caj npab thiab ceg NIBP rau IBP ntsuas. Hauv cov menyuam yaus hnub nyoog 8 xyoo thiab qis dua, BP tau txais los ntawm cov ceg qis qis qis dua qhov ntsuas los ntawm caj npab sab sauv (p<0.05).17 Hauv qhov sib piv rau qhov no, peb txoj kev tshawb fawb piv caj npab thiab ceg NIBP rau IBP ntsuas. У детей в возрасте 8 лет и младше АД, измеренное на голени, было значительно ниже, чем измеренное от на 5ренное от на 5ренное е от этого, в нашем исследовании НИАД руки и ноги сравнивали с измерениями НИАД. Hauv cov menyuam yaus hnub nyoog qis dua 8 xyoo thiab qis dua, cov ntshav ntsuas ntawm sab ceg qis qis dua qhov ntsuas ntawm caj npab sab sauv (p<0.05).17 Hauv qhov sib piv, hauv peb txoj kev tshawb fawb, caj npab thiab ceg NIBP tau muab piv nrog NIBP ntsuas.在8 岁及以下儿童中，从小腿测得的血压显着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, ччем на пле,00. Hauv cov menyuam yaus hnub nyoog qis dua 8 xyoos thiab qis dua, cov ntshav ntsuas ntawm sab ceg qis qis dua ntawm caj npab (p <0.05).17 Hauv qhov sib piv, peb txoj kev tshawb fawb piv NIBP ntawm caj npab thiab txhais ceg nrog kev ntsuas ntawm IBP.Peb cov txiaj ntsig tau pom tias BP thiab BP muaj ntau dua nyob rau hauv ob txhais ceg, uas yuav qhia tau tias calf NIBP tsis tshua muaj kev ntseeg siab dua li sab caj npab NIBP.
Hauv peb txoj kev tshawb fawb, qib ntawm BP hloov pauv tau raug ntsuas los ntawm kev ntsuas qhov ntsuas ntawm 5 thiab 10 mm Hg.Art., uas tau ua ntej hauv kev ntsuas qhov tseeb ntawm cov khoom siv tsis siv neeg ntsuas ntshav siab.18 Thaum qhov sib txawv hauv SBP ntawm 5 lossis 10 mmHg Art.yog txaus rau cov neeg laus uas muaj perfusion BP, qhov txawv txav no yuav qhia tau ntau dua rau cov menyuam yaus, tshwj xeeb tshaj yog cov uas muaj ciam teb siab lossis qis BP, raws li lawv cov BP ib txwm qis dua.Waking ntshav siab hauv cov menyuam yaus hnub nyoog 2 xyoos (lub hnub nyoog nruab nrab ntawm cov neeg kawm) yog 90-105/55-70.Cov ntshav siab li qub hauv cov menyuam mos hnub nyoog 0-3 lub hlis yog 65-85/45-55.Art.nyob rau hauv cov neeg mob tom kawg tuaj yeem ua rau mob hnyav hyperperfusion lossis hypoperfusion, ib qho teeb meem uas tuaj yeem ua rau muaj kev puas tsuaj thiab ua haujlwm tsis zoo ntawm lub hom phiaj ntawm lub cev.Tsis tas li ntawd, cov txiaj ntsig ntawm cov ntshav siab li qub no yuav raug txo qis dua nyob rau hauv cov tshuaj loog.nees nkaum
Txawm hais tias tsis muaj qhov sib xws hauv MAP dhau los yog ntsuas ntawm ob qhov chaw ntsuas NIBP, peb cov txiaj ntsig txuas ntxiv qhov kev tshawb pom ntawm cov kev tshawb fawb yav dhau los piv rau kev ntsuas BP invasive thiab non-invasive hauv cov menyuam yaus, uas tau sau tseg tias qhov sib txawv ntawm NIBP thiab IBP muaj ntau.Qhov tseem ceeb, peb txoj kev tshawb fawb tshem tawm NIBP kev ntsuas qhov yuam kev los ntawm cov neeg mob txav los yog ua haujlwm thaum peb cov neeg mob nyob rau hauv cov tshuaj loog.Peb cov txiaj ntsig tau qhia txog qhov xav tau rau kev txhim kho ntxiv ntawm qhov tseeb, tsis muaj kev cuam tshuam ntshav ntsuas ntshav thiab ua haujlwm hemodynamic.Qhov ntau zaus ntawm cov kev hloov pauv tseem ceeb hauv kev kho mob kuj tseem lees paub qhov tseem ceeb ntawm kev saib xyuas kev noj qab haus huv thaum hemodynamic instability lossis mob ntshav siab me ntsis lossis hypotension yuav tsum muaj kev txhawj xeeb tshwj xeeb rau cov neeg mob.
Cov txiaj ntsig ntawm txoj kev tshawb fawb tam sim no yuav raug txwv los ntawm cov peev txheej ntawm qhov yuam kev.Peb xav txog IBP peb tus qauv kub rau kev sib piv NIBP ntsuas.Thaum ntsuas cov ntshav siab nrog cov kua-coupled transducer, dhau- lossis qis ntsuas qhov tsis raug yuav tshwm sim nyob ntawm qhov loj ntawm cov hlab ntsha hauv lub plawv, cov npuas hauv lub cev, kinked lossis compressed tubing, lossis cov hlab ntsha tawg.9 Thaum pib Calibration Los yog yuam kev yuav tshwm sim thaum muab lub transducer nyob rau theem ntawm tus neeg mob txoj cai atrium.Kev ntsuas NIBP tuaj yeem cuam tshuam los ntawm qhov tsis raug qhov loj ntawm BP cuff lossis stimuli sab nraud.Thaum nws pom zoo kom ua raws li cov lus pom zoo rau AHA cuff xaiv, qhov kev xaiv ntawm cuff loj yog qhov kawg ntawm kev txiav txim siab ntawm cov neeg ua haujlwm tshuaj loog.Txoj hauv kev no tsim cov txheej txheem xaiv cuff raws li peb cov qauv kev kho mob.Cov kev tsis txaus siab uas tshwm sim yog kev tsis txaus ntseeg tseem ceeb hauv tsev kho mob uas xav tias yuav tshwm sim sab nraum qhov kev tshawb fawb no.Tsis tas li ntawd, tsis muaj AHA cov lus pom zoo rau sizing ib tug calf ntshav siab cuff, yog li cov kws kho mob tau xa mus rau AHA cov lus pom zoo ntawm caj npab thaum siv calf cuffs.Tus neeg mob qib kev ua ub no tsis zoo li yuav hloov pauv raws li kev siv tshuaj loog, tab sis sab nraud compression ntawm lub cuff los ntawm tus kws phais, khoom siv, lossis OR cov neeg ua haujlwm tuaj yeem ua tau.
Peb txoj kev tshawb fawb piv cov kev ntsuas siab ntawm cov hlab ntsha uas tau txais ncaj qha los ntawm cuff oscillation ntsuas thiab cov uas tau txais los ntawm kev cuam tshuam lub siab pulse waveforms.Ib yam li ntawd, qhov tau txais SBP thiab DBP ntawm oscillating cuff tau muab piv nrog cov ntsuas ncaj qha ntawm cov mem tes siab nthwv dej.Peb tsis tau suav txog qhov muaj peev xwm tsis txaus ntseeg xws li kev siv vasopressors, thiab radial vasoconstriction tuaj yeem ua rau muaj qhov yuam kev ntawm IBP thiab NIBP.Nws tseem ceeb heev uas yuav tsum nco ntsoov tias cov ntshav siab tuaj yeem sib txawv hauv ntau qhov chaw ntawm lub cev.Qhov sib txawv ntawm NIBP nyob rau hauv ob txhais ceg thiab BP nyob rau hauv caj npab (invasive los yog non-invasive) yuav muaj kev cuam tshuam qhov sib txawv ntawm cov ntshav siab nyob rau hauv cov chaw no.Tsis tas li ntawd, ntau ntawm peb cov neeg mob tau txais kev phais thoracic, uas tuaj yeem muaj kev cuam tshuam ntau dua rau cov ntshav siab hauv caj npab dua li ntawm ob txhais ceg.Txawm hais tias peb tsis tau tswj xyuas meej meej seb qhov kev ntsuas NIBP thiab IBP tau ua nyob rau tib qhov chaw tus neeg mob sib txawv, peb tau siv cov kev cuam tshuam sib xyaw ua ke los suav rau cov neeg mob qib yam tsis qhia meej hauv peb tus qauv.Yog li, random teebmeem absorbed cov neeg mob-theem sib txawv, uas yog tas li ntawm kev soj ntsuam ntawm tib tus neeg mob.Txawm hais tias peb cov txheej txheem suav nrog rau txoj kev tshawb fawb yog cov menyuam yaus hnub nyoog qis dua 10 xyoo, qhov tseeb ntawm peb cov neeg mob feem ntau tseem yau dua.Yog li ntawd, peb cov txiaj ntsig yuav tsis ua rau cov menyuam loj hlob tuaj.Peb cov txiaj ntsig kuj raug txwv los ntawm cov cuab yeej saib xyuas siv.Muaj qhov sib txawv ntawm kev nyeem ntshav siab ntawm cov tuam txhab saib xyuas sib txawv.Oscillometric cuff manufacturers siv ntau lub tswv yim algorithms thiab peb cov txiaj ntsig tsuas yog siv tau rau cov cuab yeej siv hauv peb txoj kev kawm.13:21–24
Qhov tseeb tias qee qhov txiaj ntsig txawv ntawm IBP nyeem ntawv ntau dua 30-40 mmHg cov ntsiab lus rau qhov muaj peev xwm ntawm qhov ua yuam kev.Vim tias cov ntaub ntawv raug kaw los ntawm cov kws tshawb fawb, nws tsis tuaj yeem txiav txim siab seb qhov twg ua rau muaj kev hloov pauv loj thiab txiav txim siab seb qhov kev nyeem ntawv puas yog.Txhawm rau khaws txoj kev ncaj ncees ntawm txoj kev kawm, cov txiaj ntsig no tau sau tseg thiab suav nrog hauv pawg kawm.Tsis tas li ntawd, peb tau sau cov ntaub ntawv BP ntawm 5-feeb ib ntus, tab sis peb xav tias kev soj ntsuam ntawm cov khoom siv hluav taws xob sib sau ua ke NIBP kev soj ntsuam cov ntaub ntawv tuaj yeem nthuav tawm ntau qhov tsis sib xws ntawm IBP thiab NIBP ntsuas.
Peb cov ntaub ntawv yog tshiab raws li lawv los ntawm cov neeg mob nyob rau hauv kev siv tshuaj loog, tab sis lawv ua raws li cov kev tshawb fawb yav dhau los piv cov kev sib raug ntawm invasive thiab non-invasive ntshav ntsuas ntsuas.Qhov zaus ntawm kev kho mob tseem ceeb NIBP qhov txawv txav tau lees paub qhov tseem ceeb ntawm kev saib xyuas NIBP thaum hemodynamic hloov pauv zoo li lossis thaum cov kev hloov pauv no tshwj xeeb tshaj yog txaus ntshai.Tsis tas li ntawd, sab ceg NIBP feem ntau yuav ua rau muaj qhov sib txawv ntawm qhov chaw kho mob los ntawm kev ntsuas qhov ntsuas siab ntawm cov hlab ntsha siab dua li sab caj npab NIBP.Muab peb cov txiaj ntsig, kev txiav txim siab txog kev tso cuff yuav tsum tsis yog qhov kev txiav txim siab, tab sis peb pom zoo kom siv lub caj npab thaum twg los tau thaum lub sij hawm intraoperative ntshav saib xyuas.
1. Mogane P. Kev ntsuas ntshav siab puas tseem ceeb rau menyuam yaus?Xyaum S Afr Fam.2013; 55(Annex 1): S36–S39.
2. Walsh M., Devereux PJ, Garg AS et al.Kev sib koom ua ke ntawm kev ua haujlwm txhais tau tias cov hlab ntsha siab thiab cov txiaj ntsig kev kho mob tom qab tsis yog kev phais mob plawv: ib qho kev txhais lus ntawm hypotension.Tshuaj loog.2013;119:507–515 : kuv.
3. Salmasi V, Maheshwari K, Jan D, et al.Kev koom tes ntawm intraoperative hypotension (txhais tau tias yog qhov txo qis los ntawm qhov pib lossis qhov pib kiag) thiab mob raum thiab myocardial raug mob tom qab kev phais uas tsis yog mob plawv.Tshuaj loog.2017; 126:47-65.
4. Biiker JB, Persun S, Pilen L, et al.Intraoperative hypotension thiab perioperative ischemic stroke tom qab kev phais dav dav.Tshuaj loog.2012;116: 658–664.
5. McCann ME, Schouten ANJ, Dobija N, et al.Postoperative encephalopathy nyob rau hauv cov me nyuam mos: Perioperative yam yuav tsum tau txhawj txog.Pediatrics.2014;133: e751–757 : kuv.
6. Alpert BS, Quinn D, Gallik D. Oscillometric ntshav siab: tus kws kho mob tshuaj xyuas.J Am Soc Ntshav Qab Zib.2014; 12:930–938.
[PubMed] 7. Barash PG, Cullen BF, Stolting RK, Kakhalan MK, Stock MS, Ortega R. Clinical anesthesia.7th ib.Philadelphia, PA: LWW;2013: 706-709.
8. Meyer S, Sander J, Graber S, Gottschling S, Gortner L. Kev sib haum xeeb ntawm cov ntshav tsis txaus thiab tsis ua rau cov menyuam mos yug ntxov tsis hais qhov hnyav npaum li cas los yog hnub nyoog gestational.Phau ntawv Journal of Pediatric Child Health.2010; 46:249–254.
9. O'Shea J., Dempsey EM Kev sib piv ntawm kev ntsuas ntshav siab hauv cov menyuam mos.Kuv J. Perinatol.2009;26:113-116.
10. Holt TR, Withington DE, Mitchell E. Lub siab xav ntseeg dab tsi?Kev sib piv ntawm kev ntsuas ntshav siab ncaj qha thiab ntsuas ntshav siab tsis ncaj hauv chav saib xyuas menyuam yaus.Pediatric Crit Care Med.2011; 12:e391–e394.
11. Joffe R., Duff J., Guerra G.Kev kho mob tseem ceeb.Xyoo 2016; 20:177.
12. Ray S., Rogers L., Noren DP et al.Kev pheej hmoo ntawm overdiagnosis ntawm hypotension nyob rau hauv cov me nyuam: ib qho kev soj ntsuam sib piv ntawm ntau tshaj 50,000 ntshav ntsuas.Cov tshuaj kho mob hnyav.2017; 43(10): 1540–1541.
13. Pickering TG, Hall JE, Appel LJ et al.Cov lus pom zoo rau kev ntsuas ntshav siab hauv tib neeg thiab cov tsiaj nyob hauv chav kuaj: Cov lus tshaj tawm tshaj lij los ntawm Cov Kws Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij ntawm American Heart Association's Hypertension Research Committee.lub voj voog.2005;111: 697–716.
14. Clark JA, Li-Lai MV, Sarnaik A., Mattu TK Qhov txawv ntawm kev ntsuas ntshav siab ncaj thiab tsis ncaj uas siv cov kev xaiv cuff sib txawv.Pediatrics.2002;110: 920-923.
15. Manta S, Roizen MF, Fleisher LA, Thisted R, Foss J. Kev sib piv ntawm qhov chaw kho mob: cov qauv qhia rau Bland thiab Altman analyses.Tshuaj loog thiab kev nplij siab.2000;90:593–602 : kuv.
[PubMed] 16. Froyster AB, Tumin D, Whitaker EE, et al.Cov ntaub so ntswg hloov pauv thiab lub hlwb oxygenation tom qab kev siv tshuaj loog hauv cov menyuam mos: kev kawm yav tom ntej.J Anes.2018;32:288–292.
17. Luv me.Kev ntsuas cov ntshav siab nyob rau sab sauv thiab qis qis hauv cov menyuam yaus hauv qab tshuaj loog.Pediatric tshuaj loog.2000;10:591–593.
18. O'Brien E, Petrie J, Littler W, et al.British Hypertension Society raws tu qauv rau kev ntsuam xyuas ntawm tsis siv neeg thiab semi-automatic ntshav siab cov cuab yeej siv tshwj xeeb rau cov tshuab dynamic.G ntshav siab.Xyoo 1990;8:607–619.
19. Cat S, Lerman J, Anderson B. Kev siv tshuaj loog hauv cov menyuam mos thiab menyuam yaus.5th tsab.Philadelphia, Pa: Elsevier, 2013.
20. de Graaff JK, Pasma W, van Buuren S, et al.Non-invasive blood pressure reference values ​​nyob rau hauv cov me nyuam thaum lub sij hawm tshuaj loog: ib tug multicentre retrospective observational cohort kawm.Tshuaj loog.2016; 125(5): 904–913.
21. Dannevig I, Dale HC, Liestøl K, Lindemann R. Neonatal ntshav siab: peb yam uas tsis yog-invasive oscillometric pressure monitors versus invasive blood pressure.Phau ntawv Journal of Pediatrics.2005;94:191–196.
22. Papadopoulos G, Mike S, Elisaf M. Kev ntsuam xyuas kev ua tau zoo ntawm peb oscillometric tonometers hauv neonates siv lub simulator.Kev soj ntsuam ntshav siab.1999; 4:27–33.
23. Diproz GK, Evans D.Kh., Archer LN, Leven MI Dinamap tsis tuaj yeem kuaj pom cov ntshav siab hauv cov menyuam mos uas muaj qhov hnyav heev.Arch Dis tus tub.Xyoo 1986;61:771–773.
24. Philips kev kho mob.510(k) Daim ntawv ceeb toom ua ntej muag rau Intellivue Information Center software.Silver Springs, MD: US Department of Health thiab Human Services Food and Drug Administration; 2019. Muaj los ntawm: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICALMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICALMS=TEPPSYameS =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. Muaj los ntawm: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICALMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICALMS=TEPPSYameS =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=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=&Applicant%ApplicationSymptoms ype = &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumndes=dd. 2019. Muaj nyob rau ntawm: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL&TEP20SYAMESA =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. 可: https: //www.accessdata.fda.gov/scripts/cfripts/cfrmn/cfrmn/pmn.cmed |% | =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. 可: https: //www.accessdata.fda.gov/scripts/cfripts/cfrmn/cfrmn/pmn.cmed |% | =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=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=&Applicant%ApplicationSymptoms ype = &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumndes=dd. 2019. Muaj nyob rau ntawm: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL&TEP20SYAMESA =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc.Raws li lub Yim Hli 14, 2019