Ukuqhathaniswa kwezilinganiso zomfutho wegazi ophezulu naphansi

Ukuqhathaniswa kwezilinganiso zomfutho wegazi emaphethelweni aphezulu naphansi nezilinganiso zomfutho wegazi ezinganeni ezingaphansi kwe-anesthesia jikelele
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 Isibhedlela iColumbus, e-Ohio 43205, eU.SA;2 Umnyango Wezingane, Ohio State University, Columbus, Ohio, 43210, USA;3 Iyunithi Yokunakekelwa Kakhulu Kwezingane, Isibhedlela Sikazwelonke Sezingane, Columbus, Ohio, 43205, USA;4 Department of Anesthesiology and Pain Management, Ohio State University, Columbus, OH 43210, USA Umbhali ohambelanayo: Seth Hayes Department of Anesthesiology and Pain Management, Children's National Hospital, 700 Children's Drive, Columbus, OH 43205, USAtel +1 614 702 Fax420 +1 614 722 4203 Ukufundwa kweshubhu ye-Invasive blood pressure (IBP) ngokumelene nezilinganiso ze-non-invasive blood pressure (NIBP) ezinama-oscillometric cuffs of the upper and lower extremits ezinsaneni nasezinganeni ngaphansi kwe-anesthesia jikelele.IZIGULI KANYE NEZINDLELA.Ucwaningo lwethu lwaluhlanganisa iziguli ezingaphansi kweminyaka engu-10 uma zithola i-anesthesia evamile futhi zihlela i-catheterization ye-radial artery.I-IBP yayilinganiswa njalo ngemizuzu engu-5 nge-transducer ye-hydrodynamic, futhi i-NIBP yayilinganiswa ngama-oscilloscopes amabili anama-cuffs anobukhulu obufanele abekwe engalweni engaphezulu nomlenze ophansi, futhi izilinganiso ze-10 zathathwa esigulini ngasinye.Imiphumela: Ucwaningo lubandakanya abafana abangu-18 namantombazane angu-12 abaneminyaka engu-0 kuya kweyisi-8 ubudala.Emaphoyinti edatha angu-300, umehluko ophelele phakathi kokucindezela kwe-arm mean ye-arterial (MAP) kanye nezilinganiso ezihlaselayo kube ngu-7 ± 7 mmHg.Art.(ububanzi: 0–52 mmHg).Umehluko ophelele phakathi kwesilinganiso se-SBP emlenzeni kanye nendlela yokuhlasela kwaba ngu-8 ± 8 mm Hg.Art.(ububanzi: 0–52 mmHg). Nakuba womabili amasayithi okulinganisa angahlaseli abonise ukuchezuka okuvamile esilinganisweni esihlaselayo, ukuchezuka okukhulu bekuvame kakhulu lapho i-BP ikalwa emlenzeni (okubonwa okungu-81 kokungu-298 (27%) kuchezuka nge->10 mmHg) uma kuqhathaniswa nengalo (60 of 300 observations). (20%) ichezuka ngo>10 mmHg).Isiphetho: Imvamisa yokuchezuka kwe-NIBP okubalulekile emtholampilo ezinganeni ezingaphansi kwe-anesthesia evamile isekela ukubaluleka kokuqapha kwe-IBP lapho ukuguquka kwe-hemodynamic kungenzeka futhi kungaba yingozi kakhulu. Nakuba womabili amasayithi okulinganisa angahlaseli abonise ukuchezuka okuvamile esilinganisweni esihlaselayo, ukuchezuka okukhulu bekuvame kakhulu lapho i-BP ikalwa emlenzeni (okubonwa okungu-81 kokungu-298 (27%) kuchezuka nge->10 mmHg) uma kuqhathaniswa nengalo (60 of 300 observations). (20%) ichezuka ngo>10 mmHg).Isiphetho: Imvamisa yokuchezuka kwe-NIBP okubalulekile emtholampilo ezinganeni ezingaphansi kwe-anesthesia evamile isekela ukubaluleka kokuqapha kwe-IBP lapho ukuguquka kwe-hemodynamic kungenzeka futhi kungaba yingozi kakhulu.Nakuba womabili amasayithi okulinganisa angahlaseli abonise ukuphambuka okuvamile esilinganisweni esihlaselayo, ukuchezuka okukhulu kwakuvame kakhulu ngezilinganiso ze-BP yomlenze (81 wokubonwa okungu-298 (27%), ukuchezuka ngaphezu kuka-10 mmHg) uma kuqhathaniswa nengalo (60 kokubuka okungu-300) .(20%), ichezuka ngaphezu kuka-10 mm Hg.Art.).Isiphetho.Ukuvama kokungajwayelekile okubalulekile emtholampilo kwe-NIBP ezinganeni ezingaphansi kwe-anesthesia ejwayelekile iqinisekisa ukubaluleka kokuqapha i-NIBP lapho ukuguquka kwe-hemodynamic kungenzeka futhi kungaba yingozi kakhulu.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 298 298 298 298 из 300 наблюдений) %), отклонение> 10 мм рт.ст.) чаще (20 % отклонение). Nakuba womabili amasayithi okulinganisa angahlaseli abonise ukuphambuka okuvamile ezilinganisweni ezihlaselayo, i-BP ikalwa emlenzeni (ukubuka okungu-81 kokungu-298 (27) uma kuqhathaniswa nengalo (okuphawulwe okungu-60 kokungu-300) %), ukuphambuka> 10 mmHg) kaningi ( 20% ukuchezuka). > 10 мм рт.ст.). > 10 mmHg).IZIPHETHO.Ukuvama kokungajwayelekile okubalulekile emtholampilo kwe-NIBP ezinganeni ezingaphansi kwe-anesthesia evamile kuqinisekisa ukubaluleka kokuqapha i-NIBP lapho ukuguquka kwe-hemodynamic kungenzeka futhi kuyingozi kakhulu.Uma kuqhathaniswa namanani e-NIBP atholwe engxenyeni engenhla, i-NIBP elinganiswa emlenzeni ongezansi cishe ingase ibangele ukuchezuka okubalulekile emtholampilo kumfutho we-arterial olinganiswa ngokuhlaselayo.Amagama angukhiye: umfutho wegazi ohlaselayo, umfutho wegazi ongahlaseli, i-blood pressure cuff.
Ukuqapha umfutho wegazi (BP) bekubalulekile ekuphepheni kokubulala izinzwa okuvamile kusukela i-sphygmomanometer yagunyazwa uDkt. Harvey Cushing ekuqaleni kwawo-1900.Kusukela ngo-1986, lokhu bekuyindinganiso edingwa yi-American Society of Anesthesiologists (ASA) phakathi nanoma yisiphi isikhathi sokulaliswa kwezinzwa okuvamile.Ngenxa yokuthi izilinganiso zomfutho wegazi ziqhuba izinqumo ezibalulekile mayelana nokuphathwa kwe-perioperative, ukunemba kungenza kube nzima ukuxilonga okufika ngesikhathi kanye nokwelashwa kokungazinzi kwe-hemodynamic.Odokotela ababulala izinzwa bezingane bavame ukunquma ukunikeza uketshezi, imikhiqizo yegazi, nama-inotropes ngokusekelwe ekuphambukeni ku-BP "evamile".1 Ngenxa yokuthi umfutho wegazi ophakeme we-intraoperative kanye ne-hypotension kuboniswe ukuthi kuhlotshaniswa nezinkinga zangemva kokuhlinzwa, okuhlanganisa ukuhluleka kwe-renal acute, i-encephalopathy, i-myocardial infarction, unhlangothi, nokwanda kokushona kwezinsuku ezingu-30, izilinganiso ze-BP ezingalungile zingaholela ekuziphatheni okuyingozi, okungabonakali kwe-BP.2-5
Ngesikhathi sokuhlinzwa, umfutho wegazi ungakalwa ngokungewona ohlaselayo nge-oscillometric blood pressure cuff (NIBP) noma ngokuhlasela nge-cannula ye-arterial indwelling (IBP).I-cuff ye-oscillometric ivala umthambo wesiguli ngokuwuvuthela umfutho ongaphezu komfutho wegazi wesiguli we-systolic (SBP) bese ikala ukuguquguquka kwengcindezi njengoba i-cuff iyancipha kancane kancane.Iphuzu lapho ingcindezi ishintsha kakhulu khona i- mean arterial pressure (MAP).I-SBP kanye nomfutho wegazi we-diastolic (DBP) bese kubalwa ngokusekelwe kumfutho omaphakathi we-arterial namamodeli we-oscillometric.Ama-algorithms alezi zibalo angobunikazi futhi ancike kumkhiqizi wekhafu we-NIBP.6 Ngokuphambene, ukukhanselwa kwe-arterial okuhlaselayo kulinganisa i-SBP ne-DBP ngokuqondile kusuka kumagagasi okushaya kwenhliziyo.I-MAP isuselwa kulawa manani.7
Ucwaningo oluningana luphenye ukuhlotshaniswa kwe-VBP ne-NIBP ezinganeni ezinemiphumela exubile. Ngo-2010, u-Meyer et al wenza ucwaningo olubonisa ukuchema okuphansi (<1 mmHg) ekuhlaziyweni kwe-Bland-Altman kwengcindezi ye-arterial engalinganisiwe engahlaseli ezinganeni ezisanda kuzalwa futhi waphakamisa ukuthi ukuhlobana phakathi kwe-IBP ne-NIBP kuye kwathuthuka njengoba ubuchwepheshe be-NIBP buthuthukile. .8 Nokho, u-O'Shea et al waphawula ukuthambekela kumanani e-NIBP anyuswe ngokungekho emthethweni kulesi sibalo sesiguli naphezu kokuthuthukiswa kwamadivayisi e-NIBP amasha, athuthuke kakhulu, ngisho nalapho izici ezididayo ezingase zibe khona njengosayizi we-cuff kanye nezinga lomsebenzi zisusiwe.9 Ucwaningo olwengeziwe baye bahlola izilinganiso ze-BP ezigulini zezingane ezigula kakhulu. Ngo-2010, uMeyer et al wenza ucwaningo olubonisa ukuchema okuphansi (<1 mmHg) ekuhlaziyweni kwe-Bland-Altman kwengcindezi ye-arterial engalinganisiwe engahlaseli ezinganeni ezisanda kuzalwa futhi waphakamisa ukuthi ukuhlobana phakathi kwe-IBP ne-NIBP kuye kwathuthuka njengobuchwepheshe be-NIBP. ithuthukile .8 Nokho, u-O'Shea et al waphawula ukuthambekela emananini aphakeme e-NIBP aphakeme ngokungeyikho kulesi sibalo sabantu abagulayo naphezu kokuthuthukiswa kwamadivayisi e-NIBP amasha, athuthuke kakhulu, ngisho nalapho izici ezididayo ezingaba khona njengosayizi we-cuff kanye nezinga lomsebenzi zisusiwe. .9 Ucwaningo olwengeziwe luye lwahlola izilinganiso ze-BP ezigulini zezingane ezigula kakhulu. Ngo-2010 g.Meyer and соавторы провели исследование, показывающее низкую погрешность (<1 мм рт. с.) доношенных детей и предположили, что корреляция между ИАД ne-НИАД улучшилась по мере того, как технология НИАД .8 Тем не менее, O'Shea et al. Ngo-2010, u-Meyer et al wenza ucwaningo olubonisa iphutha eliphansi (<1 mmHg) ekuhlaziyweni kwe-Bland-Altman kwengcindezi ye-arterial engalinganisiwe engahlaseli ezinganeni ezisanda kuzalwa futhi waphakamisa ukuthi ukuhlobana phakathi kwe-IBP ne-NIBP kuthuthuke njengobuchwepheshe be-NIBP .8 Nokho. , O'Shea et al.iphawule ukuthambekela okuya kumanani e-NIBP aphezulu ngokungelona iqiniso kulesi sibalo sesiguli naphezu kokuthuthukiswa kwamadivayisi e-NIBP amasha, athuthuke kakhulu, ngisho nalapho izici ezididayo ezingaba khona njengosayizi we-cuff kanye nezinga lomsebenzi sezisusiwe..9 Ucwaningo olwengeziwe luye lwahlola izilinganiso ze-BP ezinganeni ezigula 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 设备，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 nibp 之间的 相关性 有所 改善 .8 出然而 ， o'She A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 值 nibp 值 nibp 值 值 nibp高的趋势. Ngo-2010 g.Мейер kanye 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. Ngo-2010, uMeyer et al.yenze ucwaningo olubonisa ukuthi ukuhlaziywa kwe-Bland-Altman kunikeza iphutha eliphansi (<1 mmHg) ngenxa yokucindezela okungenakulinganiswa okulinganiselwe kwe-arterial ezinganeni ezisanda kuzalwa futhi kubonise ukuthi ngokuthuthukiswa kobuchwepheshe be-NIBP, kukhona umehluko omkhulu phakathi kwe-IAD.kanye ne-NIBP, ukuhlobana kwaba ngcono.sabantu Ukuthambekela ekwandeni kwenani lamaphutha kuyaqhubeka.9 Olunye ucwaningo lwahlola umfutho wegazi ezinganeni ezigula kakhulu.Ababili babo bathola "umehluko omkhulu" phakathi kwezindlela zokuqapha ezihlaselayo nezingezona ezihlaselayo futhi baphetha ngokuthi ukubukela phansi umfutho wegazi ophakeme kanye ne-hypotension ezigulini ze-PICU kungaholela ekwelapheni kancane.10,11 Ngokuphambene, uRay et al.ifunde amanani omfutho wegazi ezikhungweni ezimbili zokunakekela izingane kakhulu futhi, ngokususelwa kumkhuba obheke kumanani aphansi we-NIBP ye-diastolic ne-diastolic, yaphetha ngokuthi ukweqiwa kwe-hypotension kungaba sebangeni elingafika ku-40% wesikhathi.12
Kuyaziwa ukuthi i-cuff enosayizi ofanele kufanele isetshenziselwe ukuthola ukufundwa okunembe kakhulu okungahlaseli.I-American Heart Association (AHA) incoma ukuthi ububanzi nobude besinye esifakwe amakhafu kube ngu-40% kanye no-80% we-circumference emaphakathi nengalo, ngokulandelana.I-13 Kuyaziwa ukuthi i-NIBP ithintwa ukunyakaza nokusebenza kwesihloko, njengoba izisusa zangaphandle zingathinta ukunemba kwezilinganiso ze-BP.13,14 Nakuba le mithombo yephutha engaba khona ekulinganisweni kwe-NIBP ibonakala kahle, izinga lokuchema ezilinganisweni ze-NIBP ezinganeni alikacaciswanga kahle.Uma ukuqapha okungahlaseli kuvame ukulinganisa ngokweqile noma ukubukela phansi umfutho wegazi, kungase kunikeze amanani aqinisekisa amanga ezigulini ezingazinzile ngokwe-hemodynamically.Lapho ufunda amanani e-NIBP ezinganeni ngaphansi kwe-anesthesia ejwayelekile, ukunyakaza nezenzo zezifundo azifakwa, okungaholela ekulinganisweni okunembe kakhudlwana.Ngakho-ke, senze lolu cwaningo lokubheka okulindelekile ukuze siqhathanise ukukhanselwa kwe-arterial i-IBP ne-NIBP elinganiswa ngamakhafu e-oscillometric emilenzeni ephezulu nangaphansi ezinganeni ngaphansi kwe-anesthesia ejwayelekile.I-hypothesis yethu eyinhloko ukuthi ukufundwa kwe-NIBP kulinganisa i-BP ngokweqile uma kuqhathaniswa namadivayisi ahlaselayo.Kukhona idatha encane yokuqhathanisa ukufundwa kwe-NIBP ephezulu nephansi, ngakho-ke isinqumo sokusebenzisa isitho esithile ngokuvamile sisebenza ngokusekelwe ekufinyeleleni kalula kanye nesidingo sokugwema ama-catheter e-peripheral IV.Ngakho-ke, umgomo wethu wesibili kwakuwukuphenya ukuhlobana nokuchema phakathi kwezilinganiso ze-NIBP zehlombe kanye nomlenze ophansi.
Ucwaningo lugunyazwe Ibhodi Lokubuyekeza Isikhungo (i-IRB) LeSibhedlela Sezingane Sikazwelonke (i-Columbus, Ohio, USA) futhi lwenziwa ngokuvumelana Nesimemezelo Sase-Helsinki.Ucwaningo lubhaliswe ne-Clinicaltrials.gov (NCT03220906).Ngokuya ngokutholakala komseshi, kwaqashwa iziguli ezingu-30 ukuze ziqedele ucwaningo.Imvume yokwaziswa ngomlomo yatholwa kubazali besiguli ngaphambi kokubamba iqhaza ocwaningweni (ukuyekwa kwemvume ebhaliwe kutholwe ku-IRB).Iziguli ezingaphansi kweminyaka engu-10 ubudala, i-American Society of Anesthesiologists (ASA) isigaba 1-3, zafakwa ocwaningweni lwethu uma zizothola izinzwa ezivamile ngokukhanselwa komthambo we-radial okhethekile.I-IBP ikalwe kusetshenziswa i-hydrodynamic pressure transducer (Edward Lifesciences TruWave) ene-BP display eqhubekayo (Philips Intellivue).I-NIBP ikalwe kusetshenziswa ama-oscilloscopes amabili ahlukene omkhiqizo ofanayo (Philips Intellivue) anama-cuffs anosayizi ofanele (ngokweziqondiso ze-AHA) asetshenziswa engalweni engaphezulu nomlenze ophansi.
I-Systolic, i-diastolic kanye ne-arterial pressure (MAP) emaphoyinti angu-3 (i-radial artery, i-arm cuff kanye ne-leg cuff) ibhalwe ngezikhathi ze-5-minute ngezilinganiso ze-10 ngesiguli ngasinye.Ezigulini ezibhekene ne-intraoperative cardiopulmonary bypass (CPB), izinkomba ze-5 zitholwe ngaphambi kokuqala kwe-CPB kanye nezinkomba ze-5 zitholwe ngemuva kokuqedwa kwe-bypass.Ukuhlaziywa kwamandla okuqala kwenziwe kuhlolo lwengxenye yesampula eyodwa.Sibale ukuthi ucwaningo luzodinga amandla angu-80% ezimweni ezingu-185 ukuze kuboniswe izinga lephutha elikhulu kuno-10% ezilinganisweni ezingahlaseli, ngesilinganiso samaphutha esiphezulu esingu-5% kanye nezinga lezibalo lokubaluleka elingu-95%.Ukubhaliswa kwehlisiwe ngemva kokuba iziguli ezingu-30 ziqashelwe inani eliphelele lama-300 okubuka i-BP.
Umphumela oyinhloko wawuwukuchema okubalulekile emtholampilo njengoba kuchazwe ukuchezuka kwe-BP>5 mmHg phakathi kwe-IBP ne-NIBP. Umphumela oyinhloko wawuwukuchema okubalulekile emtholampilo njengoba kuchazwe ukuchezuka kwe-BP>5 mmHg phakathi kwe-IBP ne-NIBP. Первичным исходом была клинически значимая систематическая ошибка, определяемая отклонением АД> 5 мм рт. Umphumela oyinhloko kwaba ukuchema okubalulekile emtholampilo, okuchazwa njengokuphambuka kweBP>5 mmHg.Art.phakathi kwe-IBP 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. Isiphetho esiyinhloko kwaba ukuchezuka okubalulekile emtholampilo, okuchazwa njengokuchezuka kwe-BP>5 mmHg.Art.phakathi kwe-IBP ne-NIBP.Siphinde saphenya nokwenzeka kokuchezuka okukhulu kuno-10 mmHg.Idatha eqhubekayo phakathi kwamasayithi iqhathaniswe kusetshenziswa ukuhlaziya kwe-Bland-Altman.15 Ekuhlaziyweni okuhlukahlukene, sasebenzisa imiphumela exubile ukuze sibonise umehluko ophelele phakathi kwe-NIBP ne-IBP njengomsebenzi we-NIBP, ubudala, ubulili, isisindo, kanye nesimo sesiguli (esithambekele noma esiphansi) ngokuhambisana nokuphindaphinda okungahleliwe ezingeni lesiguli. I-intercept engahleliwe yezinga lesiguli yayisetshenziselwa ukulandisa ngezici zesiguli ezingafakwanga ngokucacile kumodeli, kodwa ezazisahluka phakathi kweziguli.16 Ukuhlaziywa kwedatha kwenziwa kusetshenziswa i-Stata/IC 14.2 (College Station, TX: StataCorp, LP), futhi i-p<0.05 ibhekwe njengebalulekile ngokwezibalo. I-intercept engahleliwe yezinga lesiguli yayisetshenziselwa ukulandisa ngezici zesiguli ezingafakwanga ngokucacile kumodeli, kodwa ezazisahluka phakathi kweziguli.16 Ukuhlaziywa kwedatha kwenziwa kusetshenziswa i-Stata/IC 14.2 (College Station, TX: StataCorp, LP), futhi i-p<0.05 ibhekwe njengebalulekile ngokwezibalo. Случайный перехват на уровне пациента использовался для учета факторов пациента, которые не были явно включены включены в ключены в ключены ж пациентами.16 I-Анализ данных был выполнен с использованием Stata/IC 14.2 (College Station, TX: StataCorp, LP), kanye p <0,05 считалось статистически значимым. Ukungena okungahleliwe kwezinga lesiguli kwakusetshenziselwa ukulandisa ngezici zesiguli ezingafakwanga ngokucacile kumodeli kodwa zisahluka phakathi kweziguli.16 Ukuhlaziywa kwedatha kwenziwa kusetshenziswa i-Stata/IC 14.2 (College Station, TX: StataCorp, LP), kanye ne-p < 0.05 ibhekwe njengebalulekile ngokwezibalo.Ukungena okungahleliwe kwezinga lesiguli kwasetshenziselwa ukulandisa ngezici zesiguli ezazingafakwanga ngokucacile kumodeli kodwa zisahluka ngesiguli. 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 статистически значимым. 16 Ukuhlaziywa kwedatha kwenziwa kusetshenziswa i-Stata/IC 14.2 (College Station, TX: StataCorp, LP), p<0.05 ibhekwe njengebalulekile ngokwezibalo.Abacwaningi/ababhali ngeke babelane ngedatha yomuntu siqu yabahlanganyeli.
Lolu cwaningo beluhlanganisa iziguli ezingu-30, abafana abangu-18 namantombazane angu-12 abaneminyaka engu-0 kuya kweyisi-8.Ukuhlinzwa kwakuhlanganisa ukuhlinzwa kwe-28 (93%) kwe-thoracic, i-1 (3%) i-neurosurgery, kanye ne-1 (3%) yokuhlinzwa kwamathambo.Amathebula 1 kanye no-2 afingqa izibalo zabantu bocwaningo futhi asho amanani e-SBP, DBP, kanye ne-SBP endaweni ngayinye.Izilinganiso eziyishumi ze-BP noma cishe imizuzu engu-50 zahlaziywa esigulini ngasinye, ngenani eliphelele lezilinganiso ze-300 noma imizuzu ye-15,000 yokuqapha.
Kusakhiwo se-Bland-Altman (Umfanekiso 1), iphutha nokunemba kwe-NIBP (SBP) kulinganiswa engalweni, ngokuhlobene ne-IBP, bekuyi- -2 kanye ne-10 mm Hg.Art.ngokulandelana (95% imikhawulo yokuhambisana: -21, +17 mmHg).Ukuchema nokunemba komfutho we-arterial omaphakathi ohlobene nomlenze we-IBP wawungu -5 no-11 mmHg.Art.ngokulandelana (95% wemingcele yesivumelwano: -26, +16 mmHg). Uma kuqhathaniswa i-IBP ne-NIBP engalweni, umehluko ophelele ku-MAP ubungu-7±7 mmHg (ububanzi: 0–52 mmHg) nokubonwa okungu-143 kokungu-300 (48%) kuchezuka ngu> 5 mmHg kanye nokubonwa okungu-60 kokungu-300 (20%). ukuchezuka ngo>10 mmHg. Uma kuqhathaniswa i-IBP ne-NIBP engalweni, umehluko ophelele ku-MAP ubungu-7±7 mmHg (ububanzi: 0–52 mmHg) nokubonwa okungu-143 kokungu-300 (48%) kuchezuka ngu> 5 mmHg kanye nokubonwa okungu-60 kokungu-300 (20%). ukuchezuka ngo>10 mmHg.Uma kuqhathaniswa i-IBP ne-NIBP engalweni, umehluko ophelele ku-SBP ubungu-7±7 mm Hg.Art.(диапазон: 0–52 мм рт. ст.) при 143 наблюдениях из 300 (48 %) с отклонением > 5 мм рт. (ububanzi: 0–52 mmHg) ngokubhekwa okungu-143 kokungu-300 (48%) ngokuchezuka> 5 mmHg.Art.kanye nokubhekwa okungu-60 kokungu-300 (20%).отклонение >10 мм рт.ст. ukuchezuka>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 次差异为7±7 mmHg（范围:0-52 mmHg），300次观察中的143 次次（587977777（0777799）察中的60 次（20%）偏差> 10 mmHg.比较 手臂 上的 IBP 和 nibp 时 , imephu 的 差异 为 为為 為 7 mmhg （范围 : 0-52 mmhg） 300 次 差异 中 ） 143 ） 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 %Uma kuqhathaniswa i-IBP ne-NIBP engalweni, umehluko ophelele ku-SBP ubungu-7±7 mm Hg.(диапазон: 0-52 мм рт.ст.), с отклонениями >5 мм рт.ст. (ububanzi: 0-52 mmHg), ngokuchezuka >5 mmHg. в 143 из 300 наблюдений (48%) и 60 из 300 наблюдений (20% ) Отклонение > 10 мм рт.ст. ekubonweni okungu-143 kokungu-300 (48%) kanye nokubhekwa okungu-60 kokungu-300 (20%) Ukuphambuka > 10 mm Hg. Uma uqhathanisa i-IBP ne-NIBP emlenzeni, umehluko ophelele ku-MAP wawungu-8±8 mmHg (ububanzi: 0–52 mmHg) ngokubona okungu-169 kokungu-298 (57%) kuchezuka ngu> 5 mmHg kanye ne-81 yokubonwa kwe-298 (27%). ukuchezuka ngo>10 mmHg. Uma uqhathanisa i-IBP ne-NIBP emlenzeni, umehluko ophelele ku-MAP wawungu-8±8 mmHg (ububanzi: 0–52 mmHg) ngokubona okungu-169 kokungu-298 (57%) kuchezuka ngu> 5 mmHg kanye ne-81 yokubonwa kwe-298 (27%). ukuchezuka ngo>10 mmHg.Uma uqhathanisa i-VBP ne-NIBP emlenzeni, umehluko ophelele ku-SBP wawungu-8±8 mm Hg.Art.(ububanzi: 0–52 mmHg), nokubonwa okungu-169 kokungu-298 (57%) kuchezuka ngaphezu kuka-5 mmHg.Art.и 81 из 298 наблюдений (27%) отклонение >10 мм рт.ст. kanye nokuphambuka okungu-81 kokungu-298 (27%) >10 mmHg.将 IbP 与 腿部腿部 的 Nibp 进行 比较 比较 时, Imephu 的 绝对 差异 为 8 ± 8 MMHG (范围: 0-52 Mmhg), 298 次 观察 中 的 169 次 (57%) 偏 差> 5 mmHG, 298 次 观察81 次 (27%) 偏差> 10 mmHg.将 IBP 与 腿部 nibp 进行 时 , , imephu 的 差异 为為為 8 ± 8 mmhg （范围 : 0-52 mmhg） , 298 次 16 ） 298 次 16 ）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 HIP 81 次（27%）偏差> 10mmHg.Uma uqhathanisa i-VBP ne-NIBP emlenzeni, umehluko ophelele ku-SBP wawungu-8 ± 8 mm Hg.Art.(диапазон: 0–52 мм рт. ст.), при этом 169 из 298 наблюдений (57%) имели отклонение > 5 мм рт. (ububanzi: 0–52 mmHg), nokubonwa okungu-169 kokungu-298 (57%) kunokuchezuka> 5 mmHg.Art.и 1 из 298 наблюдений 81 (27%) отклонения > 10 мм рт.ст. kanye nokuphawula okungu-1 kokungu-298 okungu-81 (27%) ukuchezuka> 10 mmHg.
Ilayisi.1. Isiqephu se-Bland-Altman sokuxhumana phakathi kwezilinganiso zomfutho wegazi ohlaselayo (MAP) kanye nezilinganiso ze-SBP ezingahlaseli.
Ithebula lesi-3 libonisa imiphumela yokuqhathanisa i-SBP ne-DBP phakathi kwamasayithi.Nakuba zombili izingosi ze-NIBP zibonise ukuphambuka ku-NIBP, ukuphambuka okukhulu kwakuvame kakhulu lapho i-NIBP itholakala emilenzeni.Ithebula lesi-4 libonisa imodeli ehlukahlukene ebikezela inani lokuchezuka kwe-SBP kusuka kumanani e-IBP kusetshenziswa izilinganiso ze-NIBP ezingalweni nasemilenzeni.Ubulili, ubudala, isisindo, nendawo yesiguli azihlotshaniswanga nokuchema ezilinganisweni ezihlaselayo ze-MAP.Uma kuqhathaniswa nezilinganiso ze-NIBP zengalo, ukuchezuka okuphelele kwe-SBP kusukela kuzilinganiso ze-IBP kube ngu-1.5 mmHg.Art.ngaphezulu emilenzeni (95% CI: 0.4, 2.6; p = 0.009).Ukuqhathaniswa okuqondile kwengalo ye-NIBP nomlenze we-NIBP (Umfanekiso we-2) ubonise umehluko ophelele ku-SBP ye-2.5 ± 10 mmHg.Art.(95% imikhawulo yesivumelwano: -17.1, +22.0 mmHg).
Ithebula 3 Ukuqhathaniswa komfutho wegazi ophakathi, we-systolic, kanye nowe-diastolic ezingalweni nasemilenzeni ngokukhanselwa kwe-arterial
Ithebula 4 Ibanga lokuchezuka phakathi kwengcindezi ye-arterial ebikezelwe kanye nesilinganiso esihlaselayo kusetshenziswa imiphumela exubile yomugqa wokuhlehla imodeli
Ilayisi.2. Isiqephu se-Bland-Altman sokuxhumana phakathi kwezilinganiso ezingahlaseli zomfutho wegazi omaphakathi (MAP) ezingalweni nasemilenzeni.
Izifundo zangaphambilini eziqhathanisa izilinganiso ze-NIBP ne-IBP ezinganeni ezilaliswa izinzwa zilinganiselwe.Nakuba idatha yezingane ezisanda kuzalwa ingqubuzana, olunye ucwaningo lubonisa ithrendi ebheke ekukhuphukeni komfutho wegazi uma kulinganiswa ngokungahlaseli.UJoffe et al.ithole ukuthi esibalweni esibucayi sezingane, umehluko phakathi kwezilinganiso ze-NIBP ne-IBP ezinganeni ze-100 zazincane ngokwesilinganiso, kodwa ukuphambana okujwayelekile, ububanzi be-interquartile, neziqephu ze-Bland-Altman zinezivumelwano eziningi.Lezi zifundo azenziwanga ezigulini ezingaphansi kwe-anesthesia ejwayelekile, isici esingaba usizo socwaningo lwethu esingase sinciphise amaphutha esiguli ekuhambeni noma emsebenzini.Nokho, ngokufana nemiphumela ye-Ioffe, imiphumela yethu ibonisa ukuthi nakuba izilinganiso ze-IBP ne-NIBP ezinganeni ezilaliswa izinzwa zivame ukuhlobana, izilinganiso ze-NIBP zomuntu ngamunye ngokuvamile azinembile, okubonisa kokubili ukulinganisa ngokweqile nokubukelwa phansi kwe-BP.Umehluko obalulekile ngokomtholampilo ekusetshenzisweni kwe-NIBP uvame ukuvela ngesikhathi socwaningo.Lokhu kuchezuka ku-IBP okutholwe ezilinganisweni ze-NIBP zomlenze ongezansi bekukukhulu futhi kuvame kakhulu kunokuchezuka okutholwe ezilinganisweni ze-NIBP yehlombe.
Ukuqhathaniswa kwezilinganiso ze-NIBP ezingalweni nasemilenzeni ezinganeni kuye kwabikwa ngaphambilini.Ngo-2000, i-Short et al.ufunde i-NIBP ezinganeni ze-50 ngaphansi kwe-anesthesia. Ezinganeni ezineminyaka engu-8 nangaphansi, i-BP etholwe emlenzeni ophansi yayiphansi kakhulu kunaleyo elinganiswa nengalo engaphezulu (p<0.05) .17 Ngokuphambene nalokhu, ucwaningo lwethu luqhathanise izingalo nomlenze we-NIBP nezilinganiso ze-IBP. Ezinganeni ezineminyaka engu-8 nangaphansi, i-BP etholwe emlenzeni ophansi yayiphansi kakhulu kunaleyo elinganiswa nengalo engaphezulu (p<0.05) .17 Ngokuphambene nalokhu, ucwaningo lwethu luqhathanise izingalo nomlenze we-NIBP nezilinganiso ze-IBP. 8 лет и младше АД, змеренное на голени, было значительно ниже, чем измеренное на плече (p<0,05).17 I-ИАД руки ne-ноги сравнивали с измерениями НИАД. Ezinganeni ezineminyaka engu-8 nangaphansi, umfutho wegazi okalwa emlenzeni ophansi wawuphansi kakhulu kunalokho okalwe engalweni engaphezulu (p<0.05) .17 Ngokuphambene nalokho, esifundweni sethu, ingalo nomlenze we-NIBP wawuqhathaniswa nezilinganiso ze-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 Kusukela ku-8 kuya ku-8 kuya ku-8 kuya ku-2000 kuya ku-1, было значительно ниже, чем на плече (p<0,05). Ezinganeni ezineminyaka engu-8 nangaphansi, umfutho wegazi okalwa emlenzeni ophansi wawuphansi kakhulu kunengalo engenhla (p<0.05).17 Ngokuphambene, ucwaningo lwethu lwaqhathanisa i-NIBP yezingalo nemilenze nezilinganiso ze-IBP.Imiphumela yethu ibonise ukuthi i-BP ne-BP yayivame kakhulu emilenzeni, okungase kubonise ukuthi ithole i-NIBP ayithembeki kangako kune-NIBP yengalo engenhla.
Ocwaningweni lwethu, izinga lokushintshwa kwe-BP lihlolwe kusetshenziswa amanani omkhawulo we-5 no-10 mm Hg.I-Art., enesandulela ekuhloleni ukunemba kwemishini ezenzakalelayo yokukala umfutho wegazi.18 Ngenkathi umehluko ku-SBP ye-5 noma 10 mmHg Art.yanele kubantu abadala abane-perfusion BP, lokhu okungavamile kungase kubonakale kakhudlwana ezinganeni, ikakhulukazi lezo ezine-BP esemnceleni ephakeme noma ephansi, njengoba i-BP yazo evamile iphansi.Ukuvusa umfutho wegazi ezinganeni ezineminyaka engu-2 ubudala (iminyaka yobudala emaphakathi yenani locwaningo) kwaba ngu-90-105/55-70.Umfutho wegazi ojwayelekile ezinganeni ezineminyaka engu-0-3 izinyanga ngu-65-85/45-55.Art.ezigulini zokugcina zingaholela ekucindezelekeni okukhulu noma i-hypoperfusion, inkinga engabangela ukulimala nokungasebenzi kwezitho ezihlosiwe.Ngaphezu kwalokho, lezi zindinganiso zomfutho wegazi ovukayo zizophinde zehliswe ngaphansi kwe-anesthesia ejwayelekile.amashumi amabili
Nakuba zingekho izitayela ezingaguquguquki ku-MAP ngaphezulu noma ngaphansi kokukalwa kumasayithi amabili wokulinganisa we-NIBP, imiphumela yethu inweba okutholwe yizifundo zangaphambilini ngokuqhathanisa nezilinganiso ze-BP ezihlaselayo nezingahlaseli ezinganeni, eziphawule ukuthi umehluko phakathi kwe-NIBP ne-IBP uvamile.Okubalulekile, ucwaningo lwethu lususe amaphutha okulinganisa e-NIBP abangelwa ukunyakaza kwesiguli noma umsebenzi ngenkathi iziguli zethu zingaphansi kwe-anesthesia evamile.Imiphumela yethu igqamisa isidingo sokuqhubeka nokuthuthukiswa kweziqaphi zomfutho wegazi ezinembile, ezingavaleli kanye nemisebenzi ye-hemodynamic.Imvamisa yezinguquko ezibalulekile emitholampilo iphinde iqinisekise ukubaluleka kokuqapha okuhlaselayo lapho ukungazinzi kwe-hemodynamic noma umfutho wegazi ophakeme noma i-hypotension kulindeleke ukuthi ikhathazeke ngokukhethekile ezigulini.
Imiphumela yocwaningo lwamanje ingase ikhawulelwe yimithombo yamaphutha engaba khona.Sibheka i-IBP indinganiso yethu yegolide yokuqhathanisa izilinganiso ze-NIBP.Lapho kukalwa umfutho wegazi ohlaselayo nge-transducer ehlanganiswe uketshezi, ukunemba ngokweqile noma ngaphansi kwesilinganiso kungase kwenzeke kuye ngosayizi we-catheter engaphakathi kwe-arterial, amabhamuza omoya ohlelweni, ishubhu elicindezelwe noma elicindezelwe, noma i-cannula ye-arterial displaced.9 Ukulinganiswa Kokuqala Noma amaphutha angenzeka uma ubeka i-transducer ezingeni le-atrium yangakwesokudla yesiguli.Izilinganiso ze-NIBP zingathintwa usayizi ongalungile we-BP cuff noma isisusa sangaphandle.Nakuba kunconywa ukulandela izincomo zokukhethwa kwe-cuff ye-AHA, ukukhethwa kosayizi we-cuff ekugcineni kungokokubona kodokotela obulala izinzwa.Le ndlela idala inqubo yokukhetha i-cuff ehambisana nokusebenza kwethu okujwayelekile komtholampilo.Ukuchema okuwumphumela wengcindezi kuwukuchema okubalulekile ngokomtholampilo okulindeleke ukuthi kwenzeke ngaphandle kobubanzi balolu cwaningo.Ngaphezu kwalokho, asikho isincomo se-AHA sokulinganisa i-colf blood pressure cuff, ngakho-ke abahlinzeki baye babhekisela ezincomweni zesayizi yengalo ye-AHA uma usebenzisa ama-calf cuffs.Izinga lomsebenzi wesiguli cishe ngeke lishintshe ngaphansi kwe-anesthesia evamile, kodwa ukucindezelwa kwangaphandle kwe-cuff ngudokotela ohlinzayo, imishini, noma izisebenzi NOMA kungenzeka.
Ucwaningo lwethu luqhathanise izilinganiso zomfutho we-arterial omaphakathi ezitholwe ngokuqondile ezilinganisweni ze-cuff oscillation kanye nalezo ezitholwe kumagagasi omfutho we-pulse ohlaselayo.Ngokufanayo, i-SBP etholiwe kanye ne-DBP ye-oscillating cuff iqhathaniswe namanani akalwe ngokuqondile wegagasi lomfutho we-pulse.Asizange siphendule ngezici ezingase zidideke ezifana nokusetshenziswa kwama-vasopressors, futhi i-radial vasoconstriction ingase ikhulise iphutha phakathi kwe-IBP ne-NIBP.Kubalulekile futhi ukuqaphela ukuthi umfutho wegazi ungahluka ezingxenyeni ezihlukene zomzimba.Ukuchezuka okutholakala phakathi kwe-NIBP emilenzeni kanye ne-BP ezingalweni (okuhlaselayo noma okungahlaseli) kungase kubonise umehluko wangempela womfutho wegazi kulezi zindawo.Ngaphezu kwalokho, iziguli zethu eziningi zenza ukuhlinzwa kwe-thoracic, okungaba nomthelela omkhulu ekucindezelweni kwegazi ezingalweni kunasemilenzeni.Nakuba singazange silawule ngokusobala ukuthi izilinganiso ze-NIBP neze-IBP zenziwe kumasayithi esiguli afanayo noma ahlukene, sisebenzise ukuhlehla kwemiphumela exubile ukuze siphendule ngezici zezinga lesiguli ezingafakiwe ngokusobala kumodeli yethu.Ngakho, imiphumela engahleliwe yamunca lo mehluko wezinga lesiguli, owawungashintshi phakathi kokubhekwa kwesiguli esifanayo.Nakuba indlela yethu yokufakwa kwalolu cwaningo kwakuyizingane ezingaphansi kweminyaka engu-10, empeleni iningi leziguli zethu zazincane kakhulu.Ngakho-ke, imiphumela yethu ingase ingahlanganisi izingane ezindala.Imiphumela yethu iphinde yanqunywa yimishini yokuqapha esetshenzisiwe.Kunomehluko ekufundweni komfutho wegazi phakathi kwabakhiqizi abahlukene bokuqapha.Abakhiqizi be-cuff ye-Oscillometric basebenzisa ama-algorithms obunikazi ahlukahlukene futhi imiphumela yethu isebenza kuphela kumadivayisi asetshenziswe ocwaningweni lwethu.13:21–24
Iqiniso lokuthi amanye amanani ahluka ekufundweni kwe-IBP ngaphezu kuka-30-40 mmHg akhomba ukuthi kungenzeka umthombo onjalo wephutha.Ngenxa yokuthi idatha yabhalwa abacwaningi, kwakungenakwenzeka ukucacisa ukuthi yini eyabangela ushintsho olukhulu kangaka futhi inqume ukuthi ukufundwa kunembile yini.Ukuze kugcinwe ubuqotho bocwaningo, lawa manani aqoshwa futhi afakwa eqenjini locwaningo.Ngaphezu kwalokho, sirekhode mathupha idatha ye-BP ngezikhathi zemizuzu engu-5, kodwa sisola ukuthi ukuhlaziywa kwedatha yokuqapha eqhubekayo ye-NIBP eqoqwe ngekhompuyutha kungase kwembule ukungqubuzana okuvamile phakathi kwezilinganiso ze-IBP ne-NIBP.
Idatha yethu yintsha njengoba ivela ezigulini ezingaphansi kwe-anesthesia ejwayelekile, kodwa ihambisana nezifundo zangaphambilini eziqhathanisa ukuhlobana kwezilinganiso zomfutho wegazi okuhlaselayo nokungahlaseli.Ukuvama kokungajwayelekile kwe-NIBP okubalulekile emtholampilo kuqinisekisa ukubaluleka kokuqapha i-NIBP lapho ukushintshashintsha kwe-hemodynamic kungenzeka noma lapho lokhu kushintsha kuyingozi kakhulu.Ukwengeza, i-NIBP yomlenze ophansi kungenzeka ukuthi ibangele ukuchezuka okuphawulekayo emtholampilo kusuka ku-invasively isilinganiso somfutho we-arterial kune-NIBP yengalo engenhla.Uma kubhekwa imiphumela yethu, izinqumo ezimayelana nokubekwa kwekhafu akufanele zibe ngokunganaki, kodwa kunalokho sincoma ukuthi usebenzise ingalo noma nini lapho kunokwenzeka ngesikhathi sokuhlolwa komfutho wegazi ongaphakathi kokuhlinzwa.
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24. Izinhlelo zezokwelapha ze-Philips.510(k) Isaziso sokuthengiswa kwangaphambili kwesofthiwe ye-Intellivue Information Center.Silver Springs, MD: Umnyango Wezempilo Nezinsizakalo Zabantu wase-US Ukuphatha Ukudla Nezidakamizwa; 2019. Itholakala kokuthi: 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. Itholakala kokuthi: 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. Umthombo wolwazi: 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. Itholakala ku-: 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. 2019. Umthombo wolwazi: 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. Itholakala ku-: 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.Kusukela ngo-Agasti 14, 2019