Kuenzanisa kwepamusoro uye kuderera kweropa kuyerwa

Kuenzanisa kweyero yeropa mukati mepamusoro nepamusoro pemigumo ine zviyero zveropa muvana pasi peanesthesia.
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 Dhipatimendi reAnesthesiology uye Pain Medicine, National Children's Hospital Columbus, Ohio 43205, USA;2 Dhipatimendi rePediatrics, Ohio State University, Columbus, Ohio, 43210, USA;3 Pediatric Intensive Care Unit, Children's National Hospital, Columbus, Ohio, 43205, USA;4 Dhipatimendi reAnesthesiology uye Pain Management, Ohio State University, Columbus, OH 43210, USA Munyori anowirirana: Seth Hayes Dhipatimendi reAnesthesiology uye Pain Management, Children's National Hospital, 700 Children's Drive, Columbus, OH 43205, USAtel +1 614 702 Fax420 + 1 614 722 4203 Invasive blood pressure (IBP) kuverenga kwechubhu kunopesana ne-non-invasive blood pressure (NIBP) zviyero ne oscillometric cuffs yekumusoro uye pasi pemigumo mucheche nevana pasi peanesthesia yakawanda.VARWERE NENZIRA.Chidzidzo chedu chaisanganisira varwere vari pasi pezera remakore gumi kana vakagamuchira anesthesia yakawanda uye vakaronga radial artery catheterization.IBP yakayerwa maminetsi ega ega e5 ine hydrodynamic transducer, uye NIBP yakayerwa nemaoscilloscopes maviri ane cuffs akaenzana akaiswa paruoko rwepamusoro nepagumbo rezasi, uye zviyero gumi zvakatorwa kumurwere wega wega.Results: Chidzidzo ichi chaisanganisira vakomana gumi nevasere nevasikana gumi nevaviri vane makore 0 kusvika 8 makore.Pamapoinzi e300 data, musiyano wakakwana pakati peruoko zvinoreva arterial pressure (MAP) uye zviyero zvinopinda zvaive 7 ± 7 mmHg.Art.(kusiyana: 0–52 mmHg).Musiyano wakakwana pakati pekuyera kweSBP pagumbo uye nzira inoparadza yaive 8 ± 8 mm Hg.Art.(kusiyana: 0–52 mmHg). Kunyange zvazvo nzvimbo dzose dziri mbiri dzisiri dzezviyereso dzakaratidza kutsauka kazhinji kubva pachiyero chinopinda, kutsauka kukuru kwaiwanzoonekwa apo BP yaiyerwa pagumbo (81 ye298 zvakaonekwa (27%) zvichitsauka ne> 10 mmHg) zvichienzaniswa neruoko (60 ye300 zvakaonekwa. (20%) kutsauka ne> 10 mmHg) Mhedziso: Kuwanda kwekliniki inokosha yeNIBP kutsauka muvana pasi peanesthesia yakawanda inotsigira kukosha kweIBP kutarisa apo kushanduka kwehemodynamic kungangoitika uye kungave kwakanyanya kukanganisa. Kunyange zvazvo nzvimbo dzose dziri mbiri dzisiri dzezviyereso dzakaratidza kutsauka kazhinji kubva pachiyero chinopinda, kutsauka kukuru kwaiwanzoonekwa apo BP yaiyerwa pagumbo (81 ye298 zvakaonekwa (27%) zvichitsauka ne> 10 mmHg) zvichienzaniswa neruoko (60 ye300 zvakaonekwa. (20%) kutsauka ne> 10 mmHg) Mhedziso: Kuwanda kwekliniki inokosha yeNIBP kutsauka muvana pasi peanesthesia yakawanda inotsigira kukosha kweIBP kutarisa apo kushanduka kwehemodynamic kungangoitika uye kungave kwakanyanya kukanganisa.Kunyange zvazvo nzvimbo dzose dziri mbiri dzisiri dzezviyereso dzakaratidza kutsauka kazhinji kubva pachiyero chinopinda, kutsauka kukuru kwaiwanzoonekwa nemakumbo BP zviyero (81 ye298 zvakaonekwa (27%), zvichitsauka kupfuura 10 mmHg) zvichienzaniswa neruoko (60 ye300 zvakaonekwa) .(20%), kutsauka nekupfuura 10 mm Hg.Art.).Mhedziso.Kuwanda kwemakiriniki akakosha eNIBP abnormalities muvana vari pasi peanesthesia inosimbisa kukosha kwekutarisisa NIBP kana hemodynamic fluctuations ingangoita uye inogona kunyanya kukuvadza.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，但与手观部位都显示出，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 侵入性 测量 偏差 ，次） 相比 , 在 测量 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 инвазивных измерений, АД, измеренное на ноге (81 из 298 298 на39 из 300 наблюдений) %), отклонение> 10 мм рт.ст.) чаще (20 % отклонение). Kunyange zvazvo nzvimbo dzose dziri mbiri dzisiri dzisiri dzezviyero dzakaratidza kutsauka kakawanda kubva pazviyero zvinopinda, BP yakayerwa pagumbo (81 kunze kwe298 zvakaonekwa (27) zvichienzaniswa neruoko (60 kunze kwe300 zvakaonekwa) %), kutsauka> 10 mmHg) kakawanda ( 20% kutsauka). > 10 мм рт.ст.). > 10 mmHg).MHEDZISO.Kuwanda kwemakiriniki akakosha eNIBP abnormalities muvana pasi peanesthesia inosimbisa kukosha kwekutarisisa NIBP kana hemodynamic kushanduka kungangoitika uye kunyanya kukuvadza.Zvichienzaniswa nenhamba dzeNIBP dzakawanikwa kuruoko rwepamusoro, NIBP yakayerwa pagumbo repazasi ingangokonzeresa kutsauka kwakakosha kubva kune invasively kuyerwa kunoreva arterial pressure.Mazwi akakosha: kupindira kweropa, kusingapindike kweropa, BP.
Kuongororwa kweropa (BP) kwave kwakakosha mukuchengetedzwa kweanesthesia yakawanda kubvira apo sphygmomanometer yakagamuchirwa naDkt Harvey Cushing mukutanga kwe1900s.Kubva 1986, ichi chave chiri chiyero chinodiwa neAmerican Society of Anesthesiologists (ASA) panguva chero ipi zvayo yeanesthesia.Nekuda kwekuti kuyerwa kweBP kunotungamira sarudzo dzakakosha nezve perioperative manejimendi, kusarongeka kunogona kukanganisa kuongororwa panguva uye kurapwa kwehemodynamic instability.Vana chiremba anesthesiologists vanowanzo funga kupa zvinwiwa, zvigadzirwa zveropa, uye inotropes zvichibva mukutsauka kubva ku "zvakajairika" BP.1 Nemhaka yokuti intraoperative hypertension uye hypotension zvakaratidzwa kuti zvinosanganiswa nezvinetso zvepashure, kusanganisira acute renal failure, encephalopathy, myocardial infarction, sitiroko, uye kuwedzera kwekufa kwemazuva makumi matatu, zviyero zvisina kururama zveBP zvinogona kutungamirira kune zvinokuvadza, zvisingazivikanwi zveBP zvisina kunaka.2-5
Munguva yekuvhiyiwa, BP inogona kuyerwa isiri-invasively ne oscillometric blood pressure cuff (NIBP) kana invasively ine inwelling arterial cannula (IBP).Mushonga weoscillometric unovharira tsinga yemurwere nekuipinza kumhepo iri pamusoro pemurwere wesystolic blood pressure (SBP) uyezve kuyera kushanduka kwe pressure sezvo cuff inodzikira zvishoma nezvishoma.Iyo poindi apo kudzvanywa kunochinja zvakanyanya ndeyekureva arterial pressure (MAP).SBP uye diastolic blood pressure (DBP) zvinobva zvaverengerwa zvichibva pazvinoreva arterial pressure uye oscillometric models.Iwo maalgorithms ezviverengero aya ndeemuridzi uye anoenderana neNIBP cuff mugadziri.6 Kusiyana neizvi, invasive arterial cannulation inoyera SBP neDBP zvakananga kubva pakumanikidzwa kwemafungu emhepo.MAP inotorwa kubva pane izvi zvakakosha.7
Ongororo dzinoverengeka dzakaongorora kushamwaridzana kweVBP neNIBP muvana vane mhedzisiro yakasanganiswa. Muna 2010, Meyer et al vakaita chidzidzo chinoratidza kurerekera kwakaderera (<1 mmHg) paBland-Altman kuongororwa kweasina-invasively kuyerwa anoreva arterial pressure muvacheche vasati vazvarwa uye vakaratidza kuti kuwirirana pakati peIBP neNIBP kwakavandudzika sezvo tekinoroji yeNIBP yafambira mberi. .8 Zvisinei, O'Shea et al akacherechedza tsika yenhema dzakakwirira dzeNIBP muhuwandu hwevarwere pasinei nekusimudzirwa kwezvitsva zvitsva, zvakanyanyisa zveNIBP zvishandiso, kunyange kana zvichibvira zvinovhiringidza zvinhu zvakadai sehukuru hwecuff uye chiyero chebasa zvakabviswa.9 Zvimwe zvidzidzo vakaongorora zviyero zveBP muvarwere vanorwara zvakanyanya. Muna 2010, Meyer et al vakaita chidzidzo chinoratidza kurerekera kwakaderera (<1 mmHg) paBland-Altman kuongororwa kweasina-invasively kuyerwa anoreva arterial pressure muvacheche vasati vazvarwa uye vakaratidza kuti kuwirirana pakati peIBP neNIBP kwakavandudzika seNIBP tekinoroji. yafambira mberi .8 Zvisinei, O'Shea et al akacherechedza tsika yenhema dzakakwirira dzeNIBP muhuwandu hwevarwere pasinei nekuvandudzirwa kwezvitsva, zvigadziriswe zveNIBP zvishandiso, kunyange kana zvichibvira zvinovhiringidza zvinhu zvakadai sekukura kwecuff uye chiyero chechiitiko chakabviswa. .9 Zvimwe zvidzidzo zvakaongorora kuyerwa kweBP muvarwere vevana vanorwara zvakanyanya. В 2010 г.Meyer и соавторы провели исследование, показывающее низкую погрешность (<1 мм рт. ст.) в анализе Бланда-Альтмана неинновазиненого в песни Бланда-Альтмана неинвающее низкую погрешность. доношенных детей и предположили, что корреляция между ИАД и НИАД улучшилась по мере того, как технология НИАД .8 Тем не менее, O'Shea et al. Muna 2010, Meyer et al akaita chidzidzo chinoratidza kukanganisa kwakaderera (<1 mmHg) muBland-Altman kuongororwa kwevasina-invasively kuyerwa zvinoreva arterial pressure muvacheche vasati vasvika uye vakaratidza kuti kuwirirana pakati peIBP neNIBP kwakavandudzwa seNIBP teknolojia .8 Zvisinei. , O'Shea et al.akacherekedza maitiro ekunyepa ekunyepa kweNIBP kukosha muhuwandu hwevarwere kunyangwe kuvandudzwa kwezvitsva, zvakaomesesa zveNIBP zvishandiso, kunyangwe zvichibvira zvinovhiringidza zvinhu zvakaita senge cuff size uye chiitiko chiitiko chakabviswa..9 Zvimwe zvidzidzo zvakaongorora kuyerwa kweBP muvana vanorwara zvakanyanya. 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聉压进了明随着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，但即使洹备，但即使洹备，但即使洹备，但即使洹备，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 的 动 脉 . g) ， 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 之间的 相关性 有所 改善 .8 出然而 ， o'Shea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 的 nibp 值 nibp 值 nibp 值 值 nibp 值 值 nibp .高的趋势. В 2010 г.Мейер и др.провели исследование, показывающее, что анализ Бланда-Альтмана дает низкую погрешность (<1 мм рт. ст.) оношенных детей, и показал, что с развитием технологии НИАД существует значительная разница между ИАД. Muna 2010, Meyer et al.akaita chidzidzo chinoratidza kuti kuongorora kweBland-Altman kunopa kukanganisa kwakaderera (<1 mmHg) nokuda kwekusayera kusinganzwisisi kunoreva kudzvinyirirwa kweropa muvana vasati vasvika uye yakaratidza kuti nekuvandudzwa kweNIBP teknolojia, pane musiyano mukuru pakati peIAD.uye NIBP, kuwirirana kwakavandudzwa.yehuwandu Mafambiro ekuwedzera kwenhamba yekukanganisa anoenderera mberi.9 Imwe ongororo yakaongorora BP muvana vanorwara zvakanyanya.Vaviri vavo vakawana "misiyano mikuru" pakati penzira dzinopinda uye dzisiri-invasive dzekutarisa uye vakagumisa kuti kuderera kwehypertension uye hypotension muvarwere vePICU kunogona kutungamirira mukusarapwa.10,11 Mukupesana, Ray et al.akadzidza kukosha kweBP mumakamuri maviri evana vanorwara zvakanyanya uye, zvichibva pamaitiro akananga kune yakaderera zvinoreva uye diastolic NIBP kukosha, akagumisa kuti kuwandisa kwe hypotension kunogona kunge kuri pakati pe40% yenguva.12
Zvinonyatsozivikanwa kuti cuff yakaenzana saizi inofanirwa kushandiswa kuwana iyo yakanyanya kunyatso kuverengera isingapindire.IAmerican Heart Association (AHA) inokurudzira kuti hupamhi nekureba kwedundira rine cuffed kuve 40% uye 80% yepakati-yepakati circumference, zvichiteerana.13 Zvinonyatsozivikanwa kuti NIBP inobatwa nekufamba uye basa rehurukuro, sezvo kunze kwekunze kunogona kukanganisa kururamisa kweBP kuyerwa.13,14 Kunyange zvazvo izvi zvinogona kukonzera kukanganisa muzviyero zveNIBP zvinonyatsozivikanwa, kuwanda kwekusarura mukuyera kweNIBP muvana hakuna kunyatsoratidzwa.Kana kusinga pindike kutarisa kuchiita kuwedzeredza kana kurerutsa BP, inogona kupa manyepo ekusimbisa hunhu muvarwere vasina kugadzikana vane hemodynamically.Paunenge uchidzidza tsika dzeNIBP muvana pasi peanesthesia, mafambiro uye zviito zvezvidzidzo hazvibatanidzwe, izvo zvinogona kutungamira kune mamwe mayero chaiwo.Nokudaro, takaita ichi chinotarisirwa chidzidzo chekucherechedza kuenzanisa arterial cannulation IBP neNIBP yakayerwa nepamusoro uye pasi pemakumbo oscillometric cuffs muvana vari pasi peanesthesia.Pfungwa yedu huru ndeyekuti kuverenga kweNIBP kwakawedzera BP kana ichienzaniswa nemidziyo inopinda.Pane data shoma yekuenzanisa nepamusoro uye yakaderera kumucheto kuverenga kweNIBP, saka sarudzo yekushandisa imwe nhengo inowanzova inoshanda yakavakirwa pakusununguka kwekuwana uye kudiwa kwekudzivirira peripheral IV catheters.Nokudaro, chinangwa chedu chechipiri chaiva chekuongorora kuwirirana uye kusarura pakati pezviyero zveNIBP zvepafudzi uye gumbo rezasi.
Chidzidzo ichi chakabvumirwa neInstitutional Review Board (IRB) yeNational Children's Hospital (Columbus, Ohio, USA) uye yakaitwa maererano neDeclaration of Helsinki.Chidzidzo ichi chakanyoreswa neClinicaltrials.gov (NCT03220906).Zvichienderana nekuvapo kwemuongorori, varwere ve30 vakatorwa kuti vapedze chidzidzo.Mvumo yemuromo yakawanikwa kubva kuvabereki vemurwere vasati vatora chikamu muchidzidzo (kuregererwa kwemvumo yakanyorwa yakawanikwa kubva kuIRB).Varwere vari pasi pemakore gumi, American Society of Anesthesiologists (ASA) classification 1-3, vakaiswa muchidzidzo chedu kana vaizogamuchira anesthesia yakawanda neelective radial artery cannulation.IBP yakayerwa uchishandisa hydrodynamic pressure transducer (Edward Lifescience TruWave) ine inoenderera BP kuratidza (Philips Intellivue).NIBP yakayerwa pachishandiswa maoscilloscopes maviri akasiyana emhando imwe chete (Philips Intellivue) ine macuffs akaenzana akaenzana (maererano neAHA nhungamiro) akaiswa kuruoko rwepamusoro negumbo rezasi.
Systolic, diastolic uye zvinoreva arterial pressure (MAP) pa 3 points (radial artery, arm cuff uye gumbo cuff) zvakanyorwa pa5-minute intervals ne 10 zviyero pamurwere.Kune varwere vane intraoperative cardiopulmonary bypass (CPB), zviratidzo zve 5 zvakawanikwa kusati kwatanga CPB uye zviratidzo zve5 zvakawanikwa mushure mekupedzwa kwekupfuura.Kuongororwa kwesimba kwekutanga kwakaitwa kune imwe-sample chikamu bvunzo.Takaverenga kuti chidzidzo ichi chaizoda simba re80% muzviitiko 185 kuratidza kukanganisa kukuru kudarika 10% yezviyero zvisingabatsiri, nehupamhi hwekukanganisa kwe5% uye nhamba yakakosha ye95%.Kunyoreswa kwakaderedzwa mushure mekunge varwere ve30 vakanyorerwa kwehuwandu hwe300 BP.
Mhedzisiro yekutanga yaive yekiriniki yakakosha kusarura sekutsanangurwa nekutsauka kweBP ye> 5 mmHg pakati peIBP neNIBP. Mhedzisiro yekutanga yaive yekiriniki yakakosha kusarura sekutsanangurwa nekutsauka kweBP ye> 5 mmHg pakati peIBP neNIBP. Первичным исходом была клинически значимая систематическая ошибка, определяемая отклонением АД> 5 мм рт. Mhedzisiro yekutanga yaive yekiriniki yakakosha kusarura, inotsanangurwa seBP kutsauka> 5 mmHg.Art.pakati peIBP neNIBP.主要结果是临床上显着的偏差，定义為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5 мм рт. Mhedziso yekutanga yaive yekiriniki yakakosha kutsauka, inotsanangurwa seBP kutsauka> 5 mmHg.Art.pakati peIBP neNIBP.Isu takaongororawo kuitika kwekutsauka kukuru kupfuura 10 mmHg.Inoenderera data pakati pemasaiti yakaenzaniswa uchishandisa Bland-Altman ongororo.15 Mukuongorora kwakasiyana-siyana, takashandisa migumisiro yakavhenganiswa kuti tifananidze kusiyana kwakakwana pakati peNIBP neIBP sebasa reNIBP, zera, zvepabonde, uremu, uye nzvimbo yemurwere (yakagadzirirwa kana supine) zvakananga nekudzokorora kusingawanzoitiki pamwero wevarwere. Murwere-yepamusoro-soro yekudzivirira yakashandiswa kuverengera zvinhu zvevarwere izvo zvisina kunyatsobatanidzwa mumuenzaniso, asi izvo zvichiri kusiyana pakati pevarwere.16 Kuongororwa kwedata kwakaitwa uchishandisa Stata / IC 14.2 (College Station, TX: StataCorp, LP), uye p <0.05 yaionekwa seyakakosha. Murwere-yepamusoro-soro yekudzivirira yakashandiswa kuverengera zvinhu zvevarwere izvo zvisina kunyatsobatanidzwa mumuenzaniso, asi izvo zvichiri kusiyana pakati pevarwere.16 Kuongororwa kwedata kwakaitwa uchishandisa Stata / IC 14.2 (College Station, TX: StataCorp, LP), uye p <0.05 yaionekwa seyakakosha. Случайный перехват на уровне пациента использовался для учета факторов пациента, которые не были явно включены включены земли пациентами.16 Анализ данных был выполнен с использованием Stata/IC 14.2 (College Station, TX: StataCorp, LP), uye p. <0,05 считалось статистически значимым. Murwere-level random intercept yakashandiswa kuverengera zvinhu zvevarwere izvo zvisina kunyatsobatanidzwa mumuenzaniso asi zvichiri kusiyana pakati pevarwere.16 Kuongororwa kwemashoko kwakaitwa uchishandisa Stata / IC 14.2 (College Station, TX: StataCorp, LP), uye p < 0.05 yaionekwa seyakakosha.Murwere-level random intercepts akashandiswa kuverengera zvikonzero zvevarwere zvakanga zvisina kunyatsobatanidzwa mumuenzaniso asi zvichiri zvakasiyana nemurwere. 16 使用Stata/IC 14.2（College Station，TX：StataCorp，LP）进行数据分析，p<0.05 被认為具有统计学意义. 16 使用Stata/IC 14.2（College Station，TX：StataCorp，LP）进行数据分析，p<0.05 被认為具有统计学意义. 16 Анализ данных проводили с использованием Stata/IC 14.2 (College Station, TX: StataCorp, LP), p<0,05 считалось статистически значимым. 16 Kuongororwa kwedata kwakaitwa pachishandiswa Stata/IC 14.2 (College Station, TX: StataCorp, LP), p<0.05 yaionekwa senhamba yakakosha.Vatsvagiri / vanyori havazogovane data yega yevatori vechikamu.
Chidzidzo ichi chaisanganisira varwere makumi matatu, vakomana 18 nevasikana gumi nevaviri vane makore 0 kusvika 8 makore.Kuvhiya kwaisanganisira 28 (93%) kuvhiyiwa thoracic, 1 (3%) neurosurgery, uye 1 (3%) kuvhiyiwa kwemapfupa.Matafura 1 uye 2 anopfupikisa huwandu hwehuwandu hwekudzidza uye zvinoreva SBP, DBP, uye SBP kukosha panzvimbo yega yega.Zviyero gumi zveBP kana anenge maminetsi e50 akaongororwa kumurwere wega wega, kwehuwandu hwe300 zviyero kana 15,000 maminetsi ekutarisa.
Pamusoro peBland-Altman plot (Fig. 1), kukanganisa uye kururama kweNIBP (SBP) yakayerwa paruoko, maererano neIBP, yaiva -2 uye 10 mm Hg.Art.zvakateerana (95% kutevedzera miganhu: -21, + 17 mmHg).Kusarura uye kurongeka kwezvinoreva arterial pressure maererano negumbo IBP yaiva -5 uye 11 mmHg.Art.maererano (95% yemiganhu yechibvumirano: -26, + 16 mmHg). Kana tichienzanisa IBP neNIBP paruoko, musiyano wakakwana muMAP waiva 7±7 mmHg (renji: 0–52 mmHg) ne143 ye300 zvakaonekwa (48%) zvichitsauka ne> 5 mmHg uye 60 ye300 zvakaonekwa (20%). kutsvedza ne>10 mmHg. Kana tichienzanisa IBP neNIBP paruoko, musiyano wakakwana muMAP waiva 7±7 mmHg (renji: 0–52 mmHg) ne143 ye300 zvakaonekwa (48%) zvichitsauka ne> 5 mmHg uye 60 ye300 zvakaonekwa (20%). kutsvedza ne>10 mmHg.Kana tichienzanisa IBP neNIBP paruoko, musiyano wakakwana muSBP waiva 7±7 mm Hg.Art.(диапазон: 0–52 мм рт. ст.) при 143 наблюдениях из 300 (48 %) с отклонением > 5 мм рт. (range: 0-52 mmHg) ne 143 zvakaonekwa kunze kwe300 (48%) nekutsauka> 5 mmHg.Art.uye 60 zvakaonekwa kubva pa300 (20%).отклонение >10 мм рт.ст. kutsauka> 10 mmHg比较手臂上的IBP 和NIBP 时，MAP 的绝对差异為7±7 mmHg（范围:0-52 mmHg），300 次观察中的143 次次（300 次察中的143 次（50%察中的60 次(20%) 偏差> 10 mmHg.比较 手臂 上的 IBP 和 nibp 时 , map 的 差异 为 為 為 7 mmhg （范围 : 0-52 mmhg） 300 次 家 中 ） 143 ） 300 次 ） 300 次 ） 8 mm ） 143 hg, 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 次 60 宏 （20 .Kana tichienzanisa IBP neNIBP paruoko, musiyano wakakwana muSBP waiva 7±7 mm Hg.(диапазон: 0-52 мм рт.ст.), с отклонениями >5 мм рт.ст. (kusiyana: 0-52 mmHg), pamwe nekutsauka> 5 mmHg. в 143 из 300 наблюдений (48%) и 60 из 300 наблюдений (20% ) Отклонение > 10 мм рт.ст. mu143 kunze kwe300 zvakaonekwa (48%) uye 60 kunze kwe300 zvakaonekwa (20%) Kutsauka> 10 mm Hg. Kana tichienzanisa IBP neNIBP pagumbo, musiyano wakakwana muMAP waiva 8±8 mmHg (range: 0-52 mmHg) ne169 ye298 zvakaonekwa (57%) zvichitsauka ne> 5 mmHg uye 81 ye298 zvakaonekwa (27%). kutsvedza ne>10 mmHg. Kana tichienzanisa IBP neNIBP pagumbo, musiyano wakakwana muMAP waiva 8±8 mmHg (range: 0-52 mmHg) ne169 ye298 zvakaonekwa (57%) zvichitsauka ne> 5 mmHg uye 81 ye298 zvakaonekwa (27%). kutsvedza ne>10 mmHg.Kana tichienzanisa VBP neNIBP pagumbo, musiyano wakakwana muSBP waiva 8±8 mm Hg.Art.(range: 0-52 mmHg), ine 169 ye298 yekucherechedza (57%) inotsauka nekupfuura 5 mmHg.Art.и 81 из 298 наблюдений (27%) отклонение >10 мм рт.ст. uye 81 kunze kwe298 zvakaonekwa (27%) kutsauka> 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 次观察中%169 ） 777 》 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 為 為 8 ± 8 mmhg （范围 : 0-52 mmhg） , 298 次 的 Ａ 298 次 16 ）差> 5 mmhg , 298 次 观察的 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 中 HIP 81 次（27%）偏差> 10mmHg.Pakuenzanisa VBP neNIBP mugumbo, musiyano wakakwana muSBP waiva 8 ± 8 mm Hg.Art.(диапазон: 0–52 мм рт. ст.), при этом 169 из 298 наблюдений (57%) имели отклонение > 5 мм рт. (range: 0-52 mmHg), ine 169 ye298 yekucherechedza (57%) ine kutsauka> 5 mmHg.Art.и 1 из 298 наблюдений 81 (27%) отклонения > 10 мм рт.ст. uye 1 ye298 zvakaonekwa 81 (27%) kutsauka> 10 mmHg.
Mupunga.1. Bland-Altman chirongwa chekunyorerana pakati pezvipimo zvinopisa zvinoreva arterial pressure (MAP) zviyero uye zvisingasviki SBP zviyero.
Tafura 3 inoratidza mhedzisiro yekuenzanisa SBP neDBP pakati penzvimbo.Kunyangwe ese ari maviri mawebhusaiti eNIBP airatidza kutsauka kubva kuNIBP, kutsauka kwakakura kwaive kwakajairika apo NIBP yakawanikwa mumakumbo.Tafura 4 inoratidza multivariate modhi inofanotaura kuwanda kwekutsauka kweSBP kubva kuIBP kukosha uchishandisa NIBP zviyero mumaoko nemakumbo.Gender, zera, uremu, uye nzvimbo yemurwere hazvina kubatanidzwa nerusarura mune invasive MAP zviyero.Kuenzaniswa nezviyero zveNIBP zveruoko, kutsauka kwakakwana kweSBP kubva kuIBP kuyerwa kwaive 1.5 mmHg.Art.zvakawanda mumakumbo (95% CI: 0.4, 2.6; p = 0.009).Kuenzanisa kwakananga kwemaoko NIBP negumbo NIBP (Fig. 2) yakaratidza kusiyana kwakakwana muSBP ye2.5 ± 10 mmHg.Art.(95% miganhu yechibvumirano: -17.1, +22.0 mmHg).
Tafura 3 Kuenzanisa kwezvinorehwa arterial, systolic, uye diastolic blood pressure mumaoko nemakumbo ane arterial cannulation.
Tafura 4 Range yekutsauka pakati pezvakafanotaurwa zvinoreva arterial pressure uye invasive kuyerwa uchishandisa yakasanganiswa mhedzisiro mutsara regression modhi.
Mupunga.2. Bland-Altman chirongwa chekunyorerana pakati pezviyero zvisingasviki zvezvinoreva arterial pressure (MAP) mumaoko nemakumbo.
Zvidzidzo zvakapfuura zvichienzanisa zviyero zveNIBP uye IBP muvana vakanyimwa zvine mashoma.Kunyangwe data muvacheche ichipokana, dzimwe ongororo dzinoratidza maitiro ekukwira kweBP kana kuyerwa kusiri-invasive.Joffe et al.akawana kuti muhuwandu hunokosha hwevana, kusiyana pakati peNIBP neIBP kuyerwa muvana ve100 kwaive kuduku paavhareji, asi kutsauka kwemaitiro, interquartile ranges, uye Bland-Altman zvirongwa zvaive nekubvumirana kwakasiyana-siyana.Zvidzidzo izvi hazvina kuitwa kune varwere vari pasi peanesthesia, chinhu chinogona kubatsira chekudzidza kwedu chinogona kuderedza zvikanganiso zvevarwere mukufamba kana basa.Zvisinei, zvakafanana nemigumisiro yeIoffe, zvigumisiro zvedu zvinoratidza kuti kunyange zvazvo zviyero zveIBP neNIBP muvana vane anesthetized zvinowanzoenderana, zviyero zveNIBP zvega zvinowanzova zvisina kururama, zvichiratidza zvose kuwedzeredza uye kuderera kweBP.Misiyano yakakosha mukushandiswa kweNIBP inowanzoitika panguva yekudzidza.Uku kutsauka muIBP kwakawanikwa kubva kuNIBP kuyerwa kwegumbo rezasi kwaive kwakakura uye kwakawanda kupfuura kutsauka kunowanikwa kubva kuyero yeNIBP yepafudzi.
Kuenzanisa kweNIBP kuyerwa mumaoko nemakumbo muvana kwakambotaurwa.Muna 2000, Short et al.akadzidza NIBP muvana makumi mashanu pasi peanesthesia. Muvana vane makore 8 uye pasi, BP yakawanikwa kubva mugumbo rezasi yakaderera zvakanyanya kudarika iyo yakayerwa kubva kumusoro kwepamusoro (p <0.05) .17 Kusiyana neizvi, chidzidzo chedu chakafananidza ruoko negumbo NIBP kusvika kuIBP zviyero. Muvana vane makore 8 uye pasi, BP yakawanikwa kubva mugumbo rezasi yakaderera zvakanyanya kudarika iyo yakayerwa kubva kumusoro kwepamusoro (p <0.05) .17 Kusiyana neizvi, chidzidzo chedu chakafananidza ruoko negumbo NIBP kusvika kuIBP zviyero. 17 В детей в возрасте 8 лет и младше АД, измеренное на голени, было значительно ниже, чем измеренное на плече (p<0,05).17 ИАД руки и ноги сравнивали с измерениями НИАД. Muvana vane makore 8 uye vaduku, chiyero cheropa chakayerwa pagumbo rezasi chakanyanya kuderera pane icho chakayerwa paruoko rwepamusoro (p <0.05) .17 Kusiyana neizvi, mukudzidza kwedu, ruoko uye gumbo NIBP yakaenzaniswa nezviyero zveNIBP.在8 岁及以下儿童中，从小腿测得的血压显着低从上臂测得的血压(p<0.05). 8 8 Zvidzidzo 8, 10 было значительно ниже, чем на плече (p<0,05). Muvana vane makore 8 zvichidzika, BP yakayerwa pagumbo rezasi yakanga yakaderera zvikuru kupfuura paruoko rwepamusoro (p<0.05).17 Kusiyana neizvi, chidzidzo chedu chakafananidza NIBP yemaoko nemakumbo nezviyero zveBP.Zvigumisiro zvedu zvakaratidza kuti BP neBP zvaive zvakajairika mumakumbo, izvo zvingaratidza kuti mhuru NIBP haina kuvimbika kudarika ruoko rwepamusoro NIBP.
Muchidzidzo chedu, dhigirii rekuchinja kweBP rakaongororwa pachikumbaridzo kukosha kwe5 uye 10 mm Hg.Art., ayo ane muenzaniso mukuongorora huchokwadi hwezvishandiso zveotomatiki zvekuyera BP.18 Nepo musiyano muSBP we5 kana 10 mmHg Art.yakakwana kune vanhu vakuru vane perfusion BP, izvi zvisizvo zvinogona kunyanya kutaurwa muvana, kunyanya avo vane muganhu wepamusoro kana pasi peBP, sezvo BP yavo yakaderera yakaderera.Kusimudza BP muvana vane makore maviri (kureva zera rehuwandu hwekudzidza) yaive 90-105 / 55-70.Kuwanda kweropa muvana vane makore 0-3 mwedzi ndeye 65-85 / 45-55.Art.muvarwere vekupedzisira vanogona kutungamirira kune yakanyanya hyperperfusion kana hypoperfusion, dambudziko rinogona kutungamirira kukuvadza uye kusashanda kwenhengo dzakanangwa.Uye zvakare, aya akajairwa kumuka kweropa kukosha anozodzikiswa zvakare pasi peanesthesia.makumi maviri
Kunyange zvazvo pasina maitiro anowirirana muMAP pamusoro kana pasi pekuyera panzvimbo mbiri dzeNIBP dzekuyera, zvigumisiro zvedu zvinowedzera zvakawanikwa zvezvidzidzo zvekare zvichienzanisa zviyero zveBP zvinopinda uye zvisingasviki muvana, izvo zvakacherechedza kuti kusiyana pakati peNIBP neIBP kwakajairika.Zvakakosha, kudzidza kwedu kwakabvisa zvikanganiso zvekuyera kweNIBP zvakakonzerwa nekufamba kwemurwere kana chiitiko apo varwere vedu vaive pasi peanesthesia.Mhedzisiro yedu inosimbisa kudiwa kwekuwedzera kuvandudzwa kwechokwadi, kusapindira kweropa rekutarisa mamonitor uye hemodynamic mabasa.Kuwanda kwekuchinja kwakakosha kwekliniki kunosimbisawo kukosha kwekutarisa kwekuvhara kana kusagadzikana kwehemodynamic kana kunyorovesa kwepamusoro kana hypotension inotarisirwa kunyanya kunetseka kune varwere.
Zvigumisiro zvechidzidzo chezvino zvinogona kuganhurirwa nezvinobvira zvekukanganisa.Isu tinofunga IBP chiyero chedu chegoridhe chekuenzanisa zviyero zveNIBP.Pakuyera kuvharika kweropa ne-fluid-coupled transducer, kudarika- kana pasi-kuyera kusakwana kunogona kuitika zvichienderana nehukuru hwe intra-arterial catheter, mabhuru emhepo muhurongwa, kinked kana compressed tubing, kana displaced arterial cannula.9 Chekutanga Calibration Kana kukanganisa kunogona kuitika pakuisa transducer pamwero weatrium yekurudyi yemurwere.Zviyero zveNIBP zvinogona kukanganiswa neiyo isiriyo saizi yeBP cuff kana yekunze kukurudzira.Kunyange zvichikurudzirwa kutevedzera kurudziro yeAHA cuff kusarudzwa, kusarudzwa kwehukuru hwecuff kunopedzisira kwave pakufunga kwevashandi veanesthetist.Iyi nzira inogadzira nzira yekusarudza cuff inoenderana neyakajairwa kiriniki maitiro.Zvikonzero zvinokonzeresa kurerekera kusiri kwekiriniki kwakakosha kunotarisirwa kuitika kunze kwechikamu chechidzidzo ichi.Pamusoro pezvo, hapana kurudziro yeAHA yekuyera mhuru yeBP yeropa, saka vapepi vataura kune AHA's ruoko saizi yekurudziro kana uchishandisa mhuru cuffs.Chiyero chechiitiko chemurwere hachigone kuchinja pasi peanesthesia, asi kunze kwekumanikidzwa kwecuff nachiremba, midziyo, kana OR vashandi zvinogoneka.
Chidzidzo chedu chakaenzanisa zviyero zvekumanikidzwa zvakawanikwa zvakananga kubva kune cuff oscillation zviyero uye izvo zvakawanikwa kubva kune invasive pressure pulse waveforms.Saizvozvo, iyo yakawanikwa SBP uye DBP yeiyo oscillating cuff yakaenzaniswa neyakayerwa yakananga kukosha kweiyo pulse pressure wave.Hatina kuverengera zvinhu zvinogona kuvhiringidza zvakadai sekushandiswa kwevasopressors, uye radial vasoconstriction inogona kuwedzera kukanganisa pakati peIBP neNIBP.Zvakakoshawo kuziva kuti BP inogona kusiyana munzvimbo dzakasiyana dzemuviri.Kutsauka kunowanikwa pakati peNIBP mumakumbo uye BP mumaoko (invasive kana isiri-invasive) inogona kuratidza misiyano yechokwadi yeropa munzvimbo idzi.Mukuwedzera, vazhinji vevarwere vedu vanovhiyiwa thoracic, iyo inogona kuva nemigumisiro yakawanda pahutano hweropa mumaoko kupfuura mumakumbo.Kunyange zvazvo tisina kudzora zvakajeka kana zviyero zveNIBP neIBP zvakaitwa panzvimbo imwe chete kana kuti yakasiyana-siyana yevarwere, takashandisa migumisiro yakavhenganiswa regression kuti tizvidavirire kune zvikonzero zvehutano zvisina kunyatsobatanidzwa mumuenzaniso wedu.Nokudaro, zvakangoerekana zvaitika zvakatora kusiyana kwemurwere-level, iyo yaigara iri pakati pekucherechedza kwemurwere mumwe chete.Kunyange zvazvo maitiro edu ekubatanidzwa kwekudzidza vaiva vana vari pasi pemakore e10, chaizvoizvo vazhinji vevarwere vedu vaiva vaduku zvikuru.Naizvozvo, mhedzisiro yedu inogona kunge isingaite kune vana vakura.Mhedzisiro yedu zvakare yakaganhurwa nemidziyo yekutarisa yakashandiswa.Pane misiyano yeropa rekuverenga pakati pevagadziri vakasiyana vanogadzira.Vagadziri veOscillometric cuff vanoshandisa akasiyana algorithms uye mhedzisiro yedu inongoshanda kune zvishandiso zvinoshandiswa muchidzidzo chedu.13:21–24
Icho chokwadi chekuti mamwe maitiro akasiyana kubva kuIBP kuverenga neinopfuura 30-40 mmHg inonongedza kune mukana wekudaro sosi yekukanganisa.Nokuti iyo data yakanyorwa nevatsvakurudzi, zvakanga zvisingakwanisi kuziva kuti chii chakakonzera kuchinja kukuru kwakadaro uye kuona kana kuverenga kwaiva kwakarurama.Kuti uchengetedze kutendeseka kwechidzidzo, izvi zvakakosha zvakarekodhwa uye zvakaverengerwa muboka rekudzidza.Pamusoro pezvo, isu takanyora nemaoko data yeBP panguva dze5-maminetsi, asi isu tinofungidzira kuti ongororo yemagetsi yakaunganidzwa inoenderera mberi NIBP yekutarisisa data inogona kuburitsa kazhinji kusawirirana pakati peIBP neNIBP kuyerwa.
Nhoroondo yedu itsva sezvavanobva kuvarwere vari pasi peanesthesia yakawanda, asi inopindirana nezvidzidzo zvekare zvichifananidza kuwirirana kwezvipimo zveropa uye zvisingasviki.Kuwanda kwemakiriniki akakosha eNIBP abnormalities inosimbisa kukosha kwekutarisisa NIBP kana hemodynamic kuchinja kungangoita kana kana kuchinja uku kuine njodzi.Pamusoro pezvo, gumbo rezasi NIBP rainyanya kukonzera kutsauka kwekiriniki kubva kune invasively kuyerwa zvinoreva arterial pressure kupfuura ruoko rwepamusoro NIBP.Tichifunga zvatawana, sarudzo dzine chekuita nekuiswa kwecuff hadzifanirwe kuita zvehumbimbindoga, asi tinokurudzira kushandisa ruoko pese pazvinogoneka panguva yekuongorora BP.
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24. Philips mishonga yezvokurapa.510(k) Presale chiziviso cheIntellivue Information Center software.Silver Springs, MD: US Department of Health and Human Services Food and Drug Administration; 2019. Inowanikwa kubva: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&TypeRevice&TypeReview =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. Inowanikwa kubva: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&TypeRevice&TypeReview =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. Nyaya inotevera: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL&Type=Device=PHILIPS%20MEDICAL&TypeSte &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5F 2019. Inowanikwa pa: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&TypeReview&TypeReview =&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%20SYSTEMS&TypeReview =&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%20SYSTEMS&TypeReview =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. Nyaya inotevera: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL&Type=Device=PHILIPS%20MEDICAL&TypeSte &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5F 2019. Inowanikwa pa: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&TypeReview&TypeReview =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc.Kubva Nyamavhuvhu 14, 2019