危重患者无创血压测量的准确性及对临床决策的影响  

Accuracy of noninvasive blood pressure measurement in critically ill patients and and its impact on clinical decision-making

作　　者：颜铭 徐颖 顾勤[1] YAN Ming;XU Ying;GU Qin(Department of Critical Care Medicine,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing Jiangsu 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院重症医学科,江苏南京210008

出　　处：《江苏大学学报（医学版）》2023年第2期99-106,111,共9页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:研究危重患者无创血压测量的准确性及对临床决策的影响。方法:采用前瞻性观察性研究方法,纳入2021年3月至12月南京鼓楼医院ICU已建立有创动脉血压监测的133例危重患者,入室后1 h内同时测量无创血压和有创血压,记录无创与有创收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)。将患者分为应用血管活性药物的休克组和未应用血管活性药物的非休克组。应用Spearman、Bland-Altman相关性分析、组内相关系数(ICC)验证两种测量方法的一致性,采用误差网格法分析无创血压对临床决策的影响,采用多因素Logistic回归分析影响无创血压测量准确性的危险因素。结果:①Spearman相关性结果显示,非休克组患者,有创与无创血压呈显著正相关(SBP有创-SBP无创、DBP有创-DBP无创、MAP有创-MAP无创r分别为0.69、0.72、0.70,P均<0.001);休克组患者,SBP有创-SBP无创呈一定正相关(r=0.34,P<0.05),但DBP有创-DBP无创、MAP有创-MAP无创无明显相关性(P均>0.05)。②简单线性回归分析显示,非休克组患者,有创与无创血压呈正相关(SBP有创-SBP无创、DBP有创-DBP无创、MAP有创-MAP无创相关系数R 2分别为0.56、0.58、0.43,P均<0.05);休克组患者,有创与无创SBP、MAP成一定正相关(SBP有创-SBP无创、MAP有创-MAP无创相关系数R 2分别为0.20、0.10,P均<0.05),但DBP有创-DBP无创线性回归方程无统计学意义(P>0.05)。③Bland-Altman结果显示,非休克组与休克组患者,有创与无创血压在平均差值区间±10 mmHg的数据点占比均不满足美国医疗仪器促进协会(AAMI)无创血压测量标准,一致性差(SBP有创-SBP无创、DBP有创-DBP无创、MAP有创-MAP无创在平均差值区间±10 mmHg的数据点占比:非休克组患者分别为63%、73%、76%,休克组患者分别为35%、50%、52%,P均<0.05)。④ICC结果显示,非休克组患者,DBP有创-DBP无创一致性�Objective:To investigate the accuracy of noninvasive blood pressure measurement and the impact on clinical decision-making in critically ill patients.Methods:Using a prospective observational study,a total of 133 critically ill patients with established invasive blood pressure monitoring in the ICU of Nanjing Drum tower Hospital from March to December 2021 were included.Non-invasive and invasive blood pressure were measured and recorded simultaneously within 1 h after admission.The patients were divided into shock group with vasoactive drugs and non-shock group without vasoactive drugs.Spearman,Bland-Altman correlation analysis and interclass correlation coefficient(ICC)were applied to verify the consistency of the two monitoring methods,and the error grid method was used to analyze the effect of non-invasive blood pressure on guiding clinical decision-making.Results:①Spearman correlation results showed that in non-shock patients,there were significant positive correlation between invasive and the non-invasive blood pressure(r of SBP,DBP,MAP were 0.69,0.72,0.70,all P<0.001).In shock patients,there was a significant positive correlation between SBP invasive-SBP noninvasive(r=0.34,P<0.05),while DBP invasive-DBP noninvasive,MAP invasive-MAP noninvasive without significant correlation(both P>0.05).②Simple linear regression analysis revealed that in non-shock patients,there was a significant positive correlation between invasive and non-invasive blood pressure(R^(2) of SBP,DBP,MAP were 0.56,0.58,0.43,all P<0.05).In shock patients,invasive and non-invasive SBP and MAP were significantly positively correlated(R^(2) of SBP,MAP were 0.20,0.10,P<0.05).DBP invasive and DBP noninvasive linear regression equation was not statistically significant(P>0.05).③The Bland-Altman analysis results showed that patients in the non-shock and shock groups,the proportion of data points between invasive and noninvasive blood pressure in the mean difference interval±10 mmHg did not meet the non-invasive blood pressure measurement crit

关 键 词：有创血压 无创血压 休克 血管活性药物 平均动脉压 重症监护室 

分 类 号：R544[医药卫生—心血管疾病]