Ukuthelekiswa kwemilinganiselo ephezulu kunye nesezantsi yoxinzelelo lwegazi

Ukuthelekiswa kwemilinganiselo yoxinzelelo lwegazi kwiindawo eziphezulu kunye nezantsi kunye nemilinganiselo yoxinzelelo lwegazi kubantwana phantsi kwe-anesthesia jikelele
USeth 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 iSebe le-Anesthesiology kunye nePain Medicine, iNational Children's Medicine. Isibhedlele saseColumbus, eOhio 43205, eUnited States;2 iSebe lezoNyango lwaBantwana, kwiYunivesithi yaseOhio State, eColumbus, eOhio, 43210, eU.SA;IYunithi e-3 yoNyango lwaBantwana, iSibhedlele seSizwe saBantwana, eColumbus, eOhio, 43205, eMelika;I-4 iSebe le-Anesthesiology kunye noLawulo lweentlungu, iYunivesithi yase-Ohio State, eColumbus, OH 43210, eU.SA Umbhali ohambelanayo: iSebe le-Anesthesiology kunye noLawulo lweentlungu ze-Seth Hayes, iSibhedlele seSizwe saBantwana, i-700 ye-Children's Drive, Columbus, OH 43205, USAtel +1 614 702 Fax420 + 1 614 722 4203 Uxinzelelo lwegazi olungenayo (IBP) ityhubhu yokufundwa kwe-tube ngokubhekiselele kwi-non-invasive blood pressure (NIBP) imilinganiselo kunye ne-oscillometric cuffs ye-oscillometric ye-oscillometric ephezulu kunye nezantsi kwiintsana kunye nabantwana phantsi kwe-anesthesia jikelele.IZIGULI KUNYE NEINDLELA.Uphononongo lwethu lubandakanya izigulane ezingaphantsi kweminyaka eyi-10 ukuba zifumana i-anesthesia jikelele kwaye zicwangcise i-catheterization ye-radial artery.I-IBP yalinganiswa yonke imizuzu ye-5 kunye ne-transducer ye-hydrodynamic, kwaye i-NIBP yalinganiswa kunye ne-oscilloscopes ezimbini kunye ne-cuffs efanelekileyo ngokufanelekileyo ebekwe kwingalo ephezulu kunye nomlenze ophantsi, kwaye imilinganiselo ye-10 ithathwe kwisigulane ngasinye.Iziphumo: Uphononongo lubandakanya abafana be-18 kunye namantombazana angama-12 aneminyaka eyi-0 ukuya kwi-8 iminyaka.Kwiindawo zedatha ye-300, ulwahlulo olupheleleyo phakathi kwengalo yoxinzelelo lwe-arterial (MAP) kunye nemilinganiselo ephazamisayo yi-7 ± 7 mmHg.Ubugcisa.(uluhlu: 0-52 mmHg).Umahluko opheleleyo phakathi komlinganiselo we-SBP emlenzeni kunye nendlela yokuhlasela yayiyi-8 ± 8 mm Hg.Ubugcisa.(uluhlu: 0-52 mmHg). Nangona zombini iindawo zokulinganisa ezingabonakaliyo zibonise ukuphambuka rhoqo kwimilinganiselo ephazamisayo, ukuphambuka okukhulu kwakuxhaphake kakhulu xa i-BP ilinganiswa emlenzeni (i-81 ye-298 yoqwalaselo (27%) itenxa nge> 10 mmHg) xa kuthelekiswa nengalo (60 ye-300 yokuqwalaselwa (20%) ukutenxa nge->10 mmHg) .Isiphelo: Ukuphindaphinda okubalulekileyo kwe-NIBP kwikliniki kubantwana abaphantsi kwe-anesthesia jikelele isekela ukubaluleka kokubeka iliso kwi-IBP xa ukuguquguquka kwe-hemodynamic kunokwenzeka kwaye kuya kuba yingozi kakhulu. Nangona zombini iindawo zokulinganisa ezingabonakaliyo zibonise ukuphambuka rhoqo kwimilinganiselo ephazamisayo, ukuphambuka okukhulu kwakuxhaphake kakhulu xa i-BP ilinganiswa emlenzeni (i-81 ye-298 yoqwalaselo (27%) itenxa nge> 10 mmHg) xa kuthelekiswa nengalo (60 ye-300 yokuqwalaselwa (20%) ukutenxa nge->10 mmHg) .Isiphelo: Ukuphindaphinda okubalulekileyo kwe-NIBP kwikliniki kubantwana abaphantsi kwe-anesthesia jikelele isekela ukubaluleka kokubeka iliso kwi-IBP xa ukuguquguquka kwe-hemodynamic kunokwenzeka kwaye kuya kuba yingozi kakhulu.Nangona zombini iindawo zokulinganisa ezingabonakaliyo zibonise ukuphambuka rhoqo kwimilinganiselo ephazamisayo, ukuphambuka okukhulu kwakuxhaphake kakhulu kunye nemilinganiselo ye-BP yomlenze (i-81 ye-298 ukujonga (27%), ukuphambuka ngaphezu kwe-10 mmHg) xa kuthelekiswa nengalo (i-60 ye-300 yokuqwalaselwa) .(20%), ukuphambuka ngaphezu kwe-10 mm Hg.Art.).Ukuqukumbela.Ubuninzi bezinto ezingaqhelekanga ngokweklinikhi ze-NIBP kubantwana abaphantsi kwe-anesthesia jikelele kuqinisekisa ukubaluleka kokubeka iliso kwi-NIBP xa ukuguquguquka kwe-hemodynamic kunokwenzeka kwaye kunokuba yingozi ngakumbi.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 2988 из 300 наблюдений) %), отклонение> 10 мм рт.ст.) чаще (20 % отклонение). Nangona zombini iindawo zokulinganisa ezingabonakaliyo zibonise ukuphambuka rhoqo kwimilinganiselo ephazamisayo, i-BP ilinganiswe emlenzeni (i-81 ngaphandle kwe-298 yokuqwalaselwa (27) xa kuthelekiswa nengalo (i-60 ngaphandle kwe-300 iqwalaselwe) %), ukuphambuka> 10 mmHg) ngokuphindaphindiweyo ( 20 % ukutenxa). > 10 мм рт.ст.). > 10 mmHg).IZIGQIBO.Ubuninzi bezinto ezingaqhelekanga ngokweklinikhi ze-NIBP kubantwana abaphantsi kwe-anesthesia jikelele kuqinisekisa ukubaluleka kokubeka iliso kwi-NIBP xa ukuguquguquka kwe-hemodynamic kunokwenzeka kwaye kuyingozi ngakumbi.Xa kuthelekiswa nexabiso le-NIBP elifunyenwe kwingalo engaphezulu, i-NIBP elinganiswe kumlenze ongezantsi inokuthi ibangele ukutenxa okubalulekileyo ngokweklinikhi ukusuka kuxinzelelo olulinganisiweyo loxinzelelo oluphakathi.Amagama aphambili: uxinzelelo lwegazi oluhlaselayo, uxinzelelo lwegazi olungaphazamisiyo, uxinzelelo lwegazi.
Ukubeka iliso kwixinzelelo lwegazi (BP) kubaluleke kakhulu ekukhuselweni kwe-anesthesia jikelele ukususela ekubeni i-sphygmomanometer yamkelwe nguDkt Harvey Cushing ekuqaleni kwe-1900s.Ukususela ngo-1986, oku kuye kwaba ngumgangatho ofunwa yi-American Society of Anesthesiologists (ASA) ngexesha naliphi na ixesha le-anesthesia jikelele.Ngenxa yokuba imilinganiselo yoxinzelelo lwegazi iqhuba izigqibo eziphambili malunga nokulawulwa kwe-perioperative, ukuchaneka kunokubangela ukuxilongwa ngexesha elifanelekileyo kunye nokunyangwa kokungazinzi kwe-hemodynamic.Iingcali ze-anesthesiologists zabantwana zihlala zithatha isigqibo sokulawula ulwelo, iimveliso zegazi, kunye ne-inotropes ngokusekelwe ekuphambukeni kwi-BP "eqhelekileyo".I-1 Ngenxa yokuba i-hypertension ye-intraoperative kunye ne-hypotension ibonakaliswe ukuba idibene neengxaki ze-postoperative, kubandakanywa ukungaphumeleli kwe-renal acute, i-encephalopathy, i-myocardial infarction, i-stroke, kunye nokunyuka kokufa kweentsuku ze-30, imilinganiselo ye-BP engachanekanga inokukhokelela kwi-BP eyingozi, engabonakaliyo.2-5
Ngethuba lotyando, uxinzelelo lwegazi lunokulinganiswa ngokungaqhelekanga kunye ne-oscillometric blood pressure cuff (NIBP) okanye i-invasively kunye ne-indwelling arterial cannula (IBP).I-oscillometric cuff ivala umthambo wesigulana ngokuwufaka umoya kuxinzelelo olungaphezulu kwe-systolic blood pressure (SBP) yesigulane kwaye emva koko ilinganise ukuguquguquka koxinzelelo njengoko i-cuff iyancipha ngokuthe ngcembe.Inqaku apho uxinzelelo luguquguquka kakhulu luxinzelelo lwe-arterial (MAP).I-SBP kunye noxinzelelo lwegazi lwe-diastolic (i-DBP) lubalwe ngokusekelwe kuxinzelelo lwe-arterial kunye neemodeli ze-oscillometric.Ii-algorithms zezi zibalo zinobunikazi kwaye zixhomekeke kumvelisi we-NIBP cuff.I-6 Ngokwahlukileyo, i-invasive arterial cannulation imilinganiselo ye-SBP kunye ne-DBP ngokuthe ngqo ukusuka kumaza oxinzelelo lwe-pulse.I-MAP ithathwe kula maxabiso.7
Izifundo ezininzi ziye zaphanda umbutho we-VBP kunye ne-NIBP kubantwana abaneziphumo ezixubileyo. Kwi-2010, u-Meyer et al wenza uphando olubonisa i-bias ephantsi (<1 mmHg) kwi-Bland-Altman uhlalutyo lwe-non-invasively measurement ye-arterial pressure pressure kwiintsana zangaphambi kwexesha kwaye wacebisa ukuba ukulungelelaniswa phakathi kwe-IBP kunye ne-NIBP kuye kwaphuculwa njengoko iteknoloji ye-NIBP iqhubekile. .8 Nangona kunjalo, u-O'Shea et al waphawula ukutyekela ekunyuseni ngobuxoki kumaxabiso e-NIBP kwesi sigulana nangona uphuhliso lwezixhobo ezitsha, eziphucukileyo ze-NIBP, kwanaxa izinto ezididayo ezinokubakho ezifana nobukhulu be-cuff kunye nenqanaba lomsebenzi ziye zacinywa.9 Uphononongo olongezelelweyo baye bavavanya imilinganiselo ye-BP kwizigulana ezigula kakhulu. Kwi-2010, u-Meyer et al wenza uphando olubonisa i-bias ephantsi (<1 mmHg) kwi-Bland-Altman uhlalutyo lwe-non-invasively ukulinganisa uxinzelelo lwe-arterial kwiintsana zangaphambi kwexesha kwaye wacebisa ukuba ukulungelelaniswa phakathi kwe-IBP kunye ne-NIBP kuye kwaphuculwa njengeteknoloji ye-NIBP. uqhubele phambili .8 Nangona kunjalo, u-O'Shea et al waphawula ukuba utyekelo lokunyuka ngobuxoki kumaxabiso e-NIBP kwesi sigulana siphuculwe ngaphandle kophuhliso lwezixhobo ezitsha, eziphucukileyo zeNIBP, naxa izinto eziphazamisayo ezinjengobungakanani becuff kunye nenqanaba lomsebenzi ziye zapheliswa. .9 Uphononongo olongezelelekileyo luye lwavavanya imilinganiselo yeBP kwizigulana ezigula kakhulu zabantwana. В 2010 г.Meyer провели исследование, показывающее низкую погрешность (<1 мм рт. ст.) 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. Kwi-2010, uMeyer et al wenza uphando olubonisa impazamo ephantsi (<1 mmHg) kuhlalutyo lwe-Bland-Altman lwe-non-invasively measurement arterial pressure kubantwana abancinci kwaye bacebisa ukuba ukulungelelaniswa phakathi kwe-IBP kunye ne-NIBP kuphuculwe njengeteknoloji ye-NIBP .8 Nangona kunjalo , O'Shea et al.kuphawulwe umkhwa obhekiselele kumaxabiso aphezulu e-NIBP ngobuxoki kwesi sigulana ngaphandle kophuhliso lwezixhobo ezitsha, ezinobunkunkqele be-NIBP, nokuba izinto ezinokuthi zibhideke njengobungakanani becuff kunye nenqanaba lomsebenzi zisusiwe..9 Uphononongo olongezelelekileyo luye lwavavanya imilinganiselo yeBP kubantwana abagula kakhulu. 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 请备，但即使洹备，但即使活公平和即使洹备，但即使洹备，和等可能的混杂因素，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 然而了 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 kunye 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. Kwi-2010, uMeyer et al.yenze uphando olubonisa ukuba uhlalutyo lwe-Bland-Altman lunika impazamo ephantsi (<1 mmHg) kwi-non-invasively measurement i-arterial pressure kwiintsana zangaphambi kwexesha kwaye ibonise ukuba ngokuphuhliswa kobuchwepheshe be-NIBP, kukho umehluko omkhulu phakathi kwe-IAD.kunye ne-NIBP, ulungelelwaniso luphuculwe.yabemi Umzila obhekiselele ekwandeni kwenani leempazamo uyaqhubeka.9 Olunye uphando luvavanye uxinzelelo lwegazi kubantwana abagula kakhulu.Ababini kubo bafumene "umahluko omkhulu" phakathi kweendlela zokubeka iliso ezihlaselayo kunye nezingangeneleli kwaye bagqiba ukuba ukujongelwa phantsi koxinzelelo lwegazi kunye ne-hypotension kwizigulana ze-PICU kunokukhokelela kunyango olungaphantsi.10,11 Ngokwahlukileyo, uRay et al.Ufunde amaxabiso oxinzelelo lwegazi kwiiyunithi ezimbini zokhathalelo lwabantwana kwaye, ngokusekwe kwindlela eya kumaxabiso asezantsi e-NIBP asezantsi kunye ne-diastolic, wagqiba kwelokuba ukunyanzelwa ngokugqithisileyo kwe-hypotension kunokuba kuluhlu ukuya kuthi ga kwi-40% yexesha.12
Kuyaziwa ukuba i-cuff enobungakanani obufanelekileyo kufuneka isetyenziswe ukufumana olona fundo luchanekileyo olungachanekanga.I-American Heart Association (AHA) incoma ukuba ububanzi kunye nobude be-bladder cuffed bube yi-40% kunye ne-80% ye-middle-arm circumference, ngokulandelanayo.I-13 Kuyaziwa ukuba i-NIBP ichaphazelekayo yintshukumo kunye nomsebenzi wesifundo, ekubeni i-stimuli yangaphandle inokuchaphazela ukuchaneka kwemilinganiselo ye-BP.13,14 Nangona le mithombo enokubakho yempazamo kwimilinganiselo ye-NIBP iqondwa kakuhle, ubungakanani becala kwimilinganiselo ye-NIBP ebantwaneni ayikabonakaliswa kakuhle.Ukuba ukujongwa okungahlaseliyo kukholisa ukuqikelela okanye ukujongela phantsi uxinzelelo lwegazi, kunokunika amaxabiso aqinisekisa ngobuxoki kwizigulana ezingazinzanga kwi-hemodynamically.Xa ufunda amaxabiso e-NIBP ebantwaneni phantsi kwe-anesthesia jikelele, iintshukumo kunye nezenzo zezifundo azifakwanga, ezinokukhokelela kwimilinganiselo echanekileyo.Ke ngoko, senze olu phononongo olulindelekileyo lokujonga ukuthelekisa i-IBP ye-arterial cannulation kunye ne-NIBP elinganiswe ngamacufu e-oscillometric angaphezulu nasezantsi kubantwana abaphantsi kwe-anesthesia jikelele.I-hypothesis yethu ephambili kukuba ukufundwa kwe-NIBP kugqithise i-BP xa kuthelekiswa nezixhobo ezihlaselayo.Kukho idatha encinci yokuthelekisa ukufundwa kwe-NIBP ephezulu nasezantsi, ngoko ke isigqibo sokusebenzisa ilungu elithile sihlala siyinto ephathekayo esekelwe ekufikeleleni ngokulula kunye nesidingo sokuphepha i-peripheral IV catheters.Ngoko ke, injongo yethu yesibini yayikukuphanda ulungelelwaniso kunye nokungakhethi phakathi kwemilinganiselo ye-NIBP yegxalaba kunye nomlenze ophantsi.
Uphononongo luvunyiwe yiBhodi yokuHlola yeZiko (IRB) yeSibhedlele saBantwana seSizwe (iColumbus, Ohio, USA) kwaye lwenziwa ngokuhambelana neSibhengezo saseHelsinki.Uphononongo lubhaliswe kunye neClinicaltrials.gov (NCT03220906).Ngokuxhomekeke ekufumanekeni komphandi, izigulane ze-30 zaqeshwa ukugqiba isifundo.Imvume yolwazi yomlomo yafunyanwa kubazali besigulane ngaphambi kokuthatha inxaxheba kwisifundo (ukukhutshwa kwemvume ebhaliweyo kufunyenwe kwi-IRB).Izigulane ezingaphantsi kweminyaka eyi-10 ubudala, i-American Society of Anesthesiologists (ASA) udidi lwe-1-3, lufakwe kwisifundo sethu ukuba babeza kufumana i-anesthesia jikelele kunye ne-elective radial artery cannulation.I-IBP yalinganiswa ngokusebenzisa i-hydrodynamic transducer yoxinzelelo (i-Edward Lifesciences TruWave) kunye nomboniso we-BP oqhubekayo (Philips Intellivue).I-NIBP yalinganiswa ngokusebenzisa i-oscilloscopes ezimbini ezihlukeneyo zohlobo olufanayo (i-Philips Intellivue) kunye ne-cuffs efanelekileyo ngokufanelekileyo (ngokwezikhokelo ze-AHA) ezisetyenziswe kwingalo ephezulu kunye nomlenze ophantsi.
I-Systolic, i-diastolic kunye ne-arterial pressure (MAP) kumanqaku e-3 (i-radial artery, i-arm cuff kunye ne-leg cuff) ibhalwe kwii-5 zemizuzu kunye nemilinganiselo ye-10 ngesigulane.Kwizigulane ezithatha i-intraoperative cardiopulmonary bypass (CPB), izibonakaliso ze-5 zifunyenwe ngaphambi kokuqala kwe-CPB kunye nezibonakaliso ze-5 zifunyenwe emva kokugqitywa kwe-bypass.Uhlalutyo lwamandla lokuqala lwenziwa kwisampulu yovavanyo lomlinganiselo omnye.Sabala ukuba uphando luya kufuna amandla e-80% kwiimeko ze-185 ukubonisa izinga lephutha elikhulu kune-10% yemilinganiselo engabonakaliyo, enezinga eliphezulu lephutha le-5% kunye nenqanaba lokubaluleka kwezibalo ze-95%.Ukubhaliswa kwancitshiswa emva kokuba izigulane ze-30 ziqeshwe kwi-300 ye-BP yoqwalaselo.
Isiphumo esiphambili sasiyi-bias ebalulekileyo yeklinikhi njengoko kuchazwe ngokuphambuka kwe-BP> 5 mmHg phakathi kwe-IBP kunye ne-NIBP. Isiphumo esiphambili sasiyi-bias ebalulekileyo yeklinikhi njengoko kuchazwe ngokuphambuka kwe-BP> 5 mmHg phakathi kwe-IBP kunye ne-NIBP. Первичным исходом была клинически значимая систематическая ошибка, определяемая отклонением АД> 5 мм рт. Isiphumo esiphambili sasiyi-bias ebalulekileyo yeklinikhi, echazwa njenge-BP deviation> 5 mmHg.Ubugcisa.phakathi kwe-IBP kunye ne-NIBP.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Первичной конечной точкой было клинически значимое отклонение, определяемое как отклонение АД> 5 мм рт. Isiphelo esiphambili sasikuntlukwano okubalulekileyo kweklinikhi, okuchazwa njenge-BP deviation> 5 mmHg.Ubugcisa.phakathi kwe-IBP kunye ne-NIBP.Siphinde saphanda ngesehlo sokutenxa ngaphezulu kwe-10 mmHg.Idatha eqhubekayo phakathi kweesayithi yathelekiswa kusetyenziswa uhlalutyo lwe-Bland-Altman.I-15 kuhlalutyo lwama-multivariate, sasebenzisa iziphumo ezixubileyo ukulinganisa ulwahlulo olupheleleyo phakathi kwe-NIBP kunye ne-IBP njengomsebenzi we-NIBP, ubudala, ubulili, ubunzima, kunye nesigxina sesigulane (i-prone or supine) ngokulandelelana ngokuphindaphindiweyo ngokuphindaphindiweyo kwinqanaba lesigulane. I-intercept ye-random-level-level intercept isetyenziselwa ukulandelela izinto zesigulane ezingabandakanywanga ngokucacileyo kumzekelo, kodwa eziye zahluka phakathi kwezigulane.16 Uhlalutyo lwedatha lwenziwa kusetyenziswa i-Stata / IC 14.2 (Isikhululo seKholeji, TX: StataCorp, LP), kwaye p<0.05 yathathwa njengebalulekile ngokweenkcukacha-manani. I-intercept ye-random-level-level intercept isetyenziselwa ukulandelela izinto zesigulane ezingabandakanywanga ngokucacileyo kumzekelo, kodwa eziye zahluka phakathi kwezigulane.16 Uhlalutyo lwedatha lwenziwa kusetyenziswa i-Stata / IC 14.2 (Isikhululo seKholeji, TX: StataCorp, LP), kwaye p<0.05 yathathwa njengebalulekile ngokweenkcukacha-manani. 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 (Isikhululo saseKholeji, TX: StataCorp, LP), kunye p <0,05 считалось статистически значимым. Isigulane esine-random intercept esetyenzisiweyo kwi-akhawunti yezigulane ezingabandakanywanga ngokucacileyo kumzekelo kodwa zahluke phakathi kwezigulane.16 Uhlalutyo lwedatha lwenziwa kusetyenziswa i-Stata / IC 14.2 (Isikhululo seKholeji, TX: StataCorp, LP), kunye p < I-0.05 yayithathwa njengebalulekileyo ngokwezibalo.Izithintelo ezingakhethiyo zenqanaba lesigulana zisetyenziselwe ukunika ingxelo malunga neemeko zesigulane ezingabandakanywanga ngokucacileyo kumzekelo kodwa zisahluka ngesigulane. 16 使用Stata/IC 14.2（Isikhululo saseKholeji,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（Isikhululo saseKholeji,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 (Isikhululo saseKholeji, TX: StataCorp, LP), p<0,05 считалось статистически значимым. I-16 Uhlalutyo lwedatha lwenziwa kusetyenziswa i-Stata / IC 14.2 (Isikhululo seKholeji, i-TX: i-StataCorp, i-LP), i-p <0.05 ithathwa njengebalulekileyo.Abaphandi / ababhali abayi kwabelana ngedatha yomntu yabathathi-nxaxheba.
Uphononongo lubandakanya izigulane ezingama-30, amakhwenkwe angama-18 kunye namantombazana angama-12 aneminyaka eyi-0 ukuya kwe-8.Utyando lubandakanya i-28 (93%) yotyando lwe-thoracic, i-1 (3%) i-neurosurgery, kunye ne-1 (3%) yotyando lwamathambo.Iitheyibhile 1 kunye ne-2 zishwankathela amanani abantu abafundayo kunye nentsingiselo ye-SBP, i-DBP, kunye ne-SBP kwindawo nganye.Imilinganiselo elishumi ye-BP okanye malunga nemizuzu ye-50 yahlalutywa kwisigulane ngasinye, kwimilinganiselo ye-300 iyonke okanye i-15,000 imizuzu yokubeka iliso.
Kwiplani ye-Bland-Altman (umzobo 1), impazamo kunye nokuchaneka kwe-NIBP (SBP) ilinganiswe kwingalo, ngokubhekiselele kwi-IBP, yayiyi-2 kunye ne-10 mm Hg.Ubugcisa.ngokulandelanayo (i-95% yokuthotyelwa kwemida: -21, + 17 mmHg).I-bias kunye nokuchaneka kwengcinezelo ye-arterial ye-arterial ehambelana nomlenze we-IBP yayingu-5 kunye ne-11 mmHg.Ubugcisa.ngokulandelanayo (i-95% yemida yesivumelwano: -26, + 16 mmHg). Xa uthelekisa i-IBP ne-NIBP engalweni, umahluko opheleleyo kwi-MAP wawuyi-7 ± 7 mmHg (uluhlu: 0-52 mmHg) kunye ne-143 ye-300 yokuqwalaselwa (48%) ephambuka ngu> 5 mmHg kunye ne-60 ye-300 yokuqwalaselwa (20%). itenxa nge->10 mmHg. Xa uthelekisa i-IBP ne-NIBP engalweni, umahluko opheleleyo kwi-MAP wawuyi-7 ± 7 mmHg (uluhlu: 0-52 mmHg) kunye ne-143 ye-300 yokuqwalaselwa (48%) ephambuka ngu> 5 mmHg kunye ne-60 ye-300 yokuqwalaselwa (20%). itenxa nge->10 mmHg.Xa uthelekisa i-IBP kunye ne-NIBP engalweni, umahluko opheleleyo kwi-SBP wawuyi-7±7 mm Hg.Ubugcisa.(диапазон: 0–52 мм рт. ст.) при 143 наблюдениях из 300 (48%) с отклонением > 5 мм рт. (uluhlu: 0-52 mmHg) kunye nokuqwalaselwa kwe-143 ngaphandle kwe-300 (48%) ngokuphambuka> 5 mmHg.Ubugcisa.kunye nemigqaliselo engama-60 kuma-300 (20%).отклонение >10 мм рт.ст. ukutenxa>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 次观察中的143 次次（07777770（07777777）察中的60 次（20%）偏差> 10 mmHg.比较 手臂 上的 IBP 和 nibp 时 , imephu 的 差异 為 為為為 7 mmHG （范围 : 0-52 mmhg） 300 次 中家 8 mm ） 300 次 ） 143 mm 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 次 20 %Xa uthelekisa i-IBP kunye ne-NIBP engalweni, umahluko opheleleyo kwi-SBP wawuyi-7±7 mm Hg.(диапазон: 0-52 мм рт.ст.), с отклонениями >5 мм рт.ст. (uluhlu: 0-52 mmHg), kunye nokunxaxha> 5 mmHg. в 143 из 300 наблюдений (48%) и 60 из 300 наблюдений (20% ) Отклонение > 10 мм рт.ст. kwi-143 kuma-300 oqwalaselo (48%) kunye nama-60 kuma-300 oqwalaselo (20%) ukutenxa > 10 mm Hg. Xa kuthelekiswa ne-IBP kunye ne-NIBP emlenzeni, umahluko opheleleyo kwi-MAP wawuyi-8 ± 8 mmHg (uluhlu: 0-52 mmHg) kunye ne-169 ye-298 yokujonga (57%) ephambuka nge-> 5 mmHg kunye ne-81 ye-298 yokuqwalaselwa (27%). itenxa nge->10 mmHg. Xa kuthelekiswa ne-IBP kunye ne-NIBP emlenzeni, umahluko opheleleyo kwi-MAP wawuyi-8 ± 8 mmHg (uluhlu: 0-52 mmHg) kunye ne-169 ye-298 yokujonga (57%) ephambuka nge-> 5 mmHg kunye ne-81 ye-298 yokuqwalaselwa (27%). itenxa nge->10 mmHg.Xa kuthelekiswa ne-VBP kunye ne-NIBP emlenzeni, umahluko opheleleyo kwi-SBP wawuyi-8 ± 8 mm Hg.Ubugcisa.(uluhlu: 0-52 mmHg), kunye ne-169 ye-298 yokuqwalaselwa (57%) ephambuka ngaphezu kwe-5 mmHg.Ubugcisa.kunye 81 из 298 наблюдений (27%) отклонение >10 мм рт.ст. kunye ne-81 kwii-298 zokuqwalaselwa (27%) ukutenxa > 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次观察察中的169 277 98 次观察中的81 次 (27%) 偏差> 10 mmHg.将 IBP 与 腿部 nibp 进行时 ， , imephu 的差异 為为 8 ± 8 mmhg （范围 : 0-52 mmhg） ， 298次 16 （ 52 mmhg）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（27%）偏差> 10mmHg.Xa kuthelekiswa ne-VBP kunye ne-NIBP emlenzeni, umahluko opheleleyo kwi-SBP wawuyi-8 ± 8 mm Hg.Ubugcisa.(диапазон: 0–52 мм рт. ст.), при этом 169 из 298 наблюдений (57%) имели отклонение > 5 мм рт. (uluhlu: 0-52 mmHg), kunye ne-169 ye-298 yokuqwalaselwa (57%) enokutenxa> 5 mmHg.Ubugcisa.kunye 1 из 298 наблюдений 81 (27%) отклонения > 10 мм рт.ст. kunye ne-1 ye-298 ukujonga i-81 (27%) ukuphambuka> 10 mmHg.
Irayisi.1. Isicwangciso se-Bland-Altman sembalelwano phakathi kwemilinganiselo ye-invasive ye-arterial pressure (MAP) kunye nemilinganiselo ye-SBP engekho.
Itheyibhile 3 ibonisa iziphumo zokuthelekisa i-SBP kunye ne-DBP phakathi kweesayithi.Nangona zombini iindawo ze-NIBP zibonise ukuphambuka kwi-NIBP, ukuphambuka okukhulu kwakuxhaphake kakhulu xa i-NIBP ifunyenwe emilenzeni.Itheyibhile ye-4 ibonisa imodeli ye-multivariate echaza inani lokuphambuka kwe-SBP ukusuka kumaxabiso e-IBP usebenzisa imilinganiselo ye-NIBP kwiingalo nasemilenzeni.Isini, ubudala, ubunzima, kunye nendawo yesigulana ayizange idityaniswe necala kwimilinganiselo ye-MAP engenelelayo.Xa kuthelekiswa nemilinganiselo ye-NIBP yengalo, ukutenxa ngokupheleleyo kwe-SBP kwimilinganiselo ye-IBP yayiyi-1.5 mmHg.Ubugcisa.ngaphezulu emilenzeni (95% CI: 0.4, 2.6; p = 0.009).Ukuqhathaniswa ngokuthe ngqo kwengalo ye-NIBP kunye nomlenze we-NIBP (umzobo 2) ubonise ulwahlulo olupheleleyo kwi-SBP ye-2.5 ± 10 mmHg.Ubugcisa.(95% imida yesivumelwano: -17.1, +22.0 mmHg).
Itheyibhile 3 Ukuthelekiswa koxinzelelo lwegazi oluphakathi, i-systolic, kunye ne-diastolic yegazi ezingalweni nasemilenzeni kunye ne-arterial cannulation
Itheyibhile 4 Uluhlu lokutenxa phakathi koxinzelelo oluqikelelweyo lwe-arterial kunye nomlinganiselo ohlaselayo usebenzisa iziphumo ezixubeneyo zemodeli yokubuyisela umva
Irayisi.2. Iploti ye-Bland-Altman yembalelwano phakathi kwemilinganiselo engabonakaliyo yoxinzelelo lwengqondo (MAP) kwiingalo nasemilenzeni.
Izifundo zangaphambili ezithelekisa imilinganiselo ye-NIBP kunye ne-IBP kubantwana abathotyiweyo zilinganiselwe.Nangona idatha kubantwana abasanda kuzalwa iyangqubana, olunye uphando lubonisa umkhwa wokunyuka koxinzelelo lwegazi xa kulinganiswa ngokungeyongozi.UJoffe et al.ifumene ukuba kubantwana ababalulekileyo, ukungafani phakathi kwe-NIBP kunye ne-IBP yokulinganisa kubantwana be-100 babencinci ngokuqhelekileyo, kodwa ukuphambuka okusemgangathweni, i-interquartile ranges, kunye ne-Bland-Altman izicwangciso zineemvumelwano ezininzi.Ezi zifundo azizange zenziwe kwizigulane phantsi kwe-anesthesia jikelele, into enokuba luncedo kwisifundo sethu esinokunciphisa iimpazamo zesigulane ekuhambeni okanye kumsebenzi.Nangona kunjalo, ngokufana neziphumo ze-Ioffe, iziphumo zethu zibonisa ukuba nangona i-IBP kunye ne-NIBP imilinganiselo kubantwana abane-anesthetized ihlala ihambelana, imilinganiselo ye-NIBP yomntu isoloko ingachanekanga, ebonisa kokubili ukuqikelelwa kunye nokunciphisa i-BP.Umahluko obalulekileyo ngokweklinikhi kusetyenziso lwe-NIBP luvela rhoqo ngexesha lokufunda.Oku kuphambuka kwi-IBP efunyenwe kwimilinganiselo ye-NIBP yomlenze ongezantsi yayinkulu kwaye iphindaphinda ngaphezu kokuphambuka okufunyenwe kwimilinganiselo ye-NIBP yegxalaba.
Ukuthelekiswa kwemilinganiselo ye-NIBP kwiingalo nasemilenzeni kubantwana kuye kwaxelwa ngaphambili.Ngo-2000, uMfutshane et al.wafunda i-NIBP kubantwana be-50 phantsi kwe-anesthesia. Kubantwana abaneminyaka eyi-8 ubudala nangaphantsi, i-BP efunyenwe kumlenze ophantsi yayingaphantsi kakhulu kunokulinganisa ukusuka kwingalo ephezulu (p <0.05) .17 Ngokwahlukileyo koku, uphando lwethu lufanisa ingalo kunye nomlenze we-NIBP kwimilinganiselo ye-IBP. Kubantwana abaneminyaka eyi-8 ubudala nangaphantsi, i-BP efunyenwe kumlenze ophantsi yayingaphantsi kakhulu kunokulinganisa ukusuka kwingalo ephezulu (p <0.05) .17 Ngokwahlukileyo koku, uphando lwethu lufanisa ingalo kunye nomlenze we-NIBP kwimilinganiselo ye-IBP. У детей в возрасте 8 лет и младше АД, змеренное на голени, было значительно ниже, чем измеренное на плече (p<0,05).17 ИАД руки и ноги сравнивали с измерениями НИАД. Kubantwana abaneminyaka eyi-8 kunye nangaphantsi, uxinzelelo lwegazi olulinganiswe emlenzeni ophantsi luphantsi kakhulu kunokuba lulinganiswe kwingalo ephezulu (p <0.05) .17 Ngokwahlukileyo, kwisifundo sethu, ingalo kunye nomlenze we-NIBP wathelekiswa nemilinganiselo ye-NIBP.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 У детей 8 лет и младше артериальное давление, измеренное на голени, было значительно ниже, чем на плече (p<0,05). Kubantwana abaneminyaka eyi-8 nangaphantsi, uxinzelelo lwegazi olulinganiswe emlenzeni ophantsi lwaluphantsi kakhulu kunengalo ephezulu (p<0.05).17 Ngokwahlukileyo, uphando lwethu luthelekisa i-NIBP yeengalo kunye nemilenze kunye nemilinganiselo ye-IBP.Iziphumo zethu zibonise ukuba i-BP kunye ne-BP yayixhaphake kakhulu emilenzeni, enokuthi ibonise ukuba ithole i-NIBP ayithembeki kangako kune-NIBP yengalo ephezulu.
Kuphononongo lwethu, idigri ye-BP shift yavavanywa kusetyenziswa amaxabiso e-threshold ye-5 kunye ne-10 mm Hg.Art., eziye zangaphambili ekuhloleni ukuchaneka kwezixhobo ezizenzekelayo zokulinganisa uxinzelelo lwegazi.18 Ngoxa umahluko kwi-SBP ye-5 okanye i-10 mmHg Art.ifanelekile kubantu abadala abane-BP ye-perfusion, ezi zinto zingaqhelekanga zinokubonakala ngakumbi kubantwana, ngakumbi abo bane-borderline ephezulu okanye ephantsi, njengoko i-BP yabo eqhelekileyo iphantsi.Ukuvusa uxinzelelo lwegazi kubantwana abaneminyaka emi-2 ubudala (iminyaka yobudala ephakathi kwabantu abafundayo) yayingu-90-105 / 55-70.Uxinzelelo lwegazi oluqhelekileyo kwiintsana ezineminyaka eyi-0-3 iinyanga ngu-65-85 / 45-55.Ubugcisa.kwizigulane zokugqibela kunokukhokelela kwi-hyperperfusion enzima okanye i-hypoperfusion, ingxaki enokuthi ibangele umonakalo kunye nokungasebenzi kakuhle kwamalungu ekujoliswe kuwo.Ukongeza, la maxabiso aqhelekileyo oxinzelelo lwegazi aya kuthotywa ngakumbi phantsi kwe-anesthesia jikelele.Amashumi amabini
Nangona kungekho zindlela ezihambelanayo kwi-MAP ngaphezulu okanye ngaphantsi komlinganiselo kwiindawo ezimbini zokulinganisa i-NIBP, iziphumo zethu zandisa ukufunyaniswa kwezifundo zangaphambili ngokuthelekisa imilinganiselo ye-BP ephazamisayo kunye nengathinteliyo kubantwana, ephawula ukuba ukungafani phakathi kwe-NIBP kunye ne-IBP kuqhelekileyo.Okubalulekileyo, isifundo sethu saphelisa iimpazamo zokulinganisa i-NIBP ezibangelwa ukunyakaza kwesigulane okanye umsebenzi ngelixa izigulane zethu ziphantsi kwe-anesthesia jikelele.Iziphumo zethu zigxininisa imfuno yophuhliso oluthe kratya oluchanekileyo, olungena-invasive lwe-blood monitors kunye nemisebenzi ye-hemodynamic.Ubuninzi beenguqu eziphawulekayo zeklinikhi nazo ziqinisekisa ukubaluleka kokuhlolwa kwe-invasive xa ukungazinzi kwe-hemodynamic okanye i-hypertension encinci okanye i-hypotension kulindeleke ukuba ibe yinkxalabo ethile kwizigulane.
Iziphumo zophononongo lwangoku zinokuthintelwa yimithombo enokubakho yempazamo.Siqwalasela i-IBP umgangatho wethu wegolide wokuthelekisa imilinganiselo ye-NIBP.Xa ulinganisa uxinzelelo lwegazi oluhlaselayo kunye ne-transducer edibeneyo yamanzi, ukungachaneki okungaphezulu okanye ngaphantsi komlinganiselo kunokwenzeka ngokuxhomekeke kubukhulu be-catheter ye-intra-arterial, amaqamza omoya kwinkqubo, i-kinked okanye i-compressed tubing, okanye i-cannula ye-arterial egxothiweyo.9 Ulungelelwaniso lokuqala Okanye iimpazamo zinokuthi zenzeke xa kubekwa i-transducer kwinqanaba le-atrium yasekunene yesigulana.Imilinganiselo ye-NIBP inokuchatshazelwa yi-cuff ye-BP engafanelekanga okanye i-stimuli yangaphandle.Nangona kucetyiswa ukuba ulandele iingcebiso zokukhethwa kwe-cuff ye-AHA, ukhetho lwesayizi ye-cuff ekugqibeleni ngokwengqiqo yabasebenzi be-anesthetist.Le ndlela idala inkqubo yokukhetha i-cuff ehambelana nokusebenza kwethu okuqhelekileyo kweklinikhi.Iziphumo zoxinzelelo zoxinzelelo zilucalucalulo olubalulekileyo ngokwezonyango ekulindeleke ukuba lwenzeke ngaphandle kolu phononongo.Ukongeza, akukho ncomo ye-AHA yokulinganisa ithole loxinzelelo lwegazi, ngoko ke ababoneleli baye babhekisela kwiingcebiso zobungakanani bengalo ye-AHA xa usebenzisa i-calf cuffs.Inqanaba lomsebenzi wesigulane akunakwenzeka ukuba utshintshe phantsi kwe-anesthesia jikelele, kodwa ukunyanzeliswa kwangaphandle kwe-cuff ngugqirha, izixhobo, okanye abasebenzi base-OR kunokwenzeka.
Uphononongo lwethu luthelekisa imilinganiselo yoxinzelelo lwe-arterial efunyenwe ngokuthe ngqo kwimilinganiso ye-cuff oscillation kunye nezo zifunyenwe kwi-invasive pressure pulse waveforms.Ngokukwanjalo, i-SBP efunyenweyo kunye ne-DBP ye-oscillating cuff yafaniswa namaxabiso alinganiswe ngokuthe ngqo kwi-pulse pressure wave.Asizange siphendule ngezinto ezinokuthi zidibanise ezifana nokusetyenziswa kwe-vasopressors, kunye ne-radial vasoconstriction inokunyusa impazamo phakathi kwe-IBP kunye ne-NIBP.Kwakhona kubalulekile ukuqaphela ukuba uxinzelelo lwegazi lunokwahluka kwiindawo ezahlukeneyo zomzimba.Ukuphambuka okufunyenwe phakathi kwe-NIBP emilenzeni kunye ne-BP kwiingalo (i-invasive okanye i-non-invasive) inokubonisa ukungafani kokwenene kwixinzelelo lwegazi kwezi ndawo.Ukongezelela, ezininzi zezigulane zethu zenza utyando lwe-thoracic, olunokuthi lube nefuthe elikhulu kwixinzelelo lwegazi kwiingalo kunemilenze.Nangona asizange silawule ngokucacileyo ukuba imilinganiselo ye-NIBP kunye ne-IBP yenziwa kwiindawo ezifanayo okanye ezahlukeneyo zezigulane, sisebenzise ukuguqulwa kwemiphumo edibeneyo kwi-akhawunti yemigangatho yesigulane engabandakanywanga ngokucacileyo kwimodeli yethu.Ngaloo ndlela, iziphumo ezingalindelekanga zifunxa lo mahluko wenqanaba lesigulane, owawuhlala rhoqo phakathi kokuqwalaselwa kwesigulane esifanayo.Nangona iikhrayitheriya zethu zokufakwa kuphononongo zazingabantwana abangaphantsi kweminyaka eyi-10, enyanisweni uninzi lwezigulane zethu zazincinci kakhulu.Ke ngoko, iziphumo zethu azinakwenzeka ngokubanzi kubantwana abadala.Iziphumo zethu zikwathintelwe zizixhobo zokubeka iliso ezisetyenzisiweyo.Kukho iiyantlukwano ekufundweni koxinzelelo lwegazi phakathi kwabavelisi beemonitha ezahlukeneyo.Abavelisi be-cuff ye-Oscillometric basebenzisa ii-algorithms ezahlukeneyo zobunikazi kwaye iziphumo zethu zisebenza kuphela kwizixhobo ezisetyenziswa kwisifundo sethu.13:21–24
Inyaniso yokuba amanye amaxabiso ahluke kufundo lwe-IBP ngaphezu kwe-30-40 mmHg ikhomba ukuba kunokwenzeka ukuba loo mthombo wempazamo.Ngenxa yokuba idatha yabhalwa ngabaphandi, kwakungenakwenzeka ukufumanisa oko kubangele utshintsho olukhulu kangaka kwaye unqume ukuba ukufundwa kuchanekile.Ukugcina imfezeko yophononongo, la maxabiso arekhodwa kwaye abandakanywa kwiqela lokufunda.Ukongezelela, sibhale ngesandla idatha ye-BP kwii-5-minute intervals, kodwa siyakrokra ukuba uhlalutyo lwedatha ye-NIBP eqokelelweyo eqhubekayo yokubeka iliso ingabonisa ukungahambelani okuqhelekileyo phakathi kwe-IBP kunye ne-NIBP yokulinganisa.
Iinkcukacha zethu zintsha njengoko zivela kwizigulane eziphantsi kwe-anesthesia jikelele, kodwa zihambelana nezifundo zangaphambili ezithelekisa ukulungelelaniswa kwemilinganiselo yoxinzelelo lwegazi olungenayo kunye ne-non-invasive.Ubuninzi bezinto ezingaqhelekanga ze-NIBP ezibalulekileyo ngokweklinikhi kuqinisekisa ukubaluleka kokubeka iliso kwi-NIBP xa ukuguquguquka kwe-hemodynamic kunokwenzeka okanye xa oku kuguquguquka kuyingozi kakhulu.Ukongeza, i-NIBP yomlenze osezantsi yayinokuthi ibangele ukutenxa okubalulekileyo kwekliniki ukusuka ekulinganisweni okuhlaselweyo kumlinganiselo woxinzelelo lwe-arterial kune-NIBP yengalo ephezulu.Ukunikezelwa kweziphumo zethu, izigqibo malunga nokubekwa kwe-cuff akufuneki zibe ngqongqo, kodwa endaweni yoko sincoma ukusebenzisa ingalo xa kunokwenzeka ngexesha lokujonga uxinzelelo lwegazi.
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24. Iinkqubo zonyango ze-Philips.510(k) Isaziso sokuthengisa kwangaphambili kwisoftware yeIntellivue Information Centre.Silver Springs, MD: iSebe lezeMpilo lase-US kunye neeNkonzo zoLuntu kuLawulo lokuTya kunye neziyobisi; 2019. Ifumaneka apha: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&TypeNavice=TypeReview =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. 2019. Ifumaneka apha: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL%20SYSTEMS&TypeNavice=TypeReview =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5Fdesc. Ngo-2019. Uncedo olufumanekayo: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL&Type&Type &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5F 2019. Ifumaneka apha: 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. 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. Ngo-2019. Uncedo olufumanekayo: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?start_search=1&Center=&Panel=&ProductCode=DSI&KNumber=&Applicant=PHILIPS%20MEDICAL&Type&Type &ThirdPartyReviewed =&ClinicalTrials=&Decision=&DecisionDateFrom=&DecisionDateTo=07%2F24%2F2019&IVDProducts=&Redact510K=&CombinationProducts=&ZNumber=&PAGENUM=10&SortColumn=dd%5F 2019. Ifumaneka apha: 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.Ukusukela nge-14 ka-Agasti 2019