四肢动脉粥样硬化老年高血压患者围术期有创血压与无创血压的比较  

Comparison of invasive and non-invasive blood pressure in perioperative elderly hypertensive patients with atherosclerosis of the extremities

作　　者：刘文君 李红[1] 郭利永 赵丽云[1] 马骏[1] Liu Wenjun;Li Hong;Guo Liyong;Zhao Liyun;Ma Jun(Center for Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,北京100029

出　　处：《中华老年医学杂志》2023年第5期552-556,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划(2018YFC2001900);国家自然科学基金(81871592)。

摘　　要：目的通过比较围手术麻醉期四肢动脉粥样硬化的老年高血压患者有创血压(IBP)和无创血压(NBP)监测在收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)3个水平的相关性和差异,为围术期四肢动脉粥样硬化老年高血压患者的血压管理提供依据。方法前瞻性观察首都医科大学附属北京安贞医院2018年12月至2021年12月收治的血管外科行外周血管狭窄介入手术的老年患者,在围手术麻醉期同时进行IBP与NBP的测量,应用Pearson、Bland-Altman、受试者工作特征(ROC)曲线等方法分析IBP与NBP的相关性、一致性等。结果共纳入156例老年患者,其中男性108例(69.2%)、女性48例(30.8%),年龄(72.2±7.6)岁。Pearson相关性分析结果显示,IBP与NBP存在显著正相关,其中有创收缩压(ISBP)和无创收缩压(NSBP)、有创舒张压(IDBP)和无创舒张压(NDBP)、有创平均压(IMAP)和无创平均压(NMAP)的相关系数分别0.993、0.808、0.853(均P<0.001)。Bland-Altman分析结果显示,ISBP和NSBP平均偏差(20.3±6.5)mmHg(95%CI:19.18~21.38)(1 mmHg=0.133 kPa);IDBP和NDBP平均偏差(3.8±9.7)mmHg(95%CI:2.13~5.41);IMAP和NMAP平均偏差(12.7±11.0)mmHg(95%CI:10.83~14.55)。ISBP-NSBP偏差与ISBP的相关系数、IDBP-NDBP偏差与IDBP的相关系数、IMAP-NMAP偏差与IMAP的相关系数分别为0.856、0.206、0.583(均P<0.05)。当ISBP≥137 mmHg时,预测ISBP-NSBP偏差≥20 mmHg的敏感性为96.3%、特异性为96.4%,ROC曲线下面积为0.970(95%CI:0.934~1.000);当ISBP≥158 mmHg时,预测ISBP-NSBP偏差≥25 mmHg的敏感性为97.4%、特异性为78.8%,ROC曲线下面积为0.876(95%CI:0.820~0.933);当ISBP≥208 mmHg时,预测ISBP-NSBP偏差≥30 mmHg的敏感性为100.0%、特异性为98.5%,ROC曲线下面积为0.985(95%CI:0.964~1.000)。结论四肢动脉粥样硬化老年高血压患者在围手术麻醉期IBP与NBP具有较好的一致性,两者偏差的大小与血压数值高低呈显著正相关,提示我们在围术期合理选择测血压的方式,正确评估�Objective To compare the correlation and differences between invasive blood pressure(IBP)and noninvasive blood pressure(NBP)monitoring at three different levels of systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)in elderly hypertensive patients with atherosclerosis of the extremities during perioperative anesthesia.Methods 156 elderly patients were prospectively admitted to the Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University,for peripheral vascular stenosis interventions between December 2018 and December 2021.Their IBP and NBP were measured simultaneously during the perioperative anesthesia period.Then the correlation and consistency between IBP and NBP were analyzed via the Pearson correlation coefficient,Bland-Altman plots,and the receiver operating characteristic curve(ROC curve).Results A total of 156 elderly patients were enrolled,including 108 men(69.2%)and 48 women(30.8%),with a mean age of 72.2±7.6.Pearson correlation analysis revealed that there was a significant positive correlation between IBP and NBP.The correlation coefficient was 0.993 for invasive systolic blood pressure(ISBP)and non-invasive systolic blood pressure(NSBP),0.808 for invasive diastolic blood pressure(IDBP)and non-invasive diastolic blood pressure(NDBP),and 0.853 for invasive mean arterial pressure(IMAP)and non-invasive mean arterial pressure(NMAP)(P<0.001 for all).Bland-Altman analysis showed that the mean deviation of ISBP and NSBP was(20.3±6.5)mmHg(95%CI:19.18-21.38)(1 mmHg=0.133 kPa),the mean deviation of IDBP and NDBP was(3.8±9.7)mmHg(95%CI:2.13-5.41),and the mean deviation of IMAP and NMAP was(12.7±11.0)mmHg(95%CI:10.83-14.55).The correlation coefficient of ISBP-NSBP deviation with ISBP was 0.856,the correlation coefficient of IDBP-NDBP deviation with IDBP was 0.206,and the correlation coefficient of IMAP-NMAP deviation with IMAP was 0.583(P<0.05 for all).When ISBP≥137 mmHg,the sensitivity of an ISBP-NSBP deviation≥20 mmHg was 96.3%,the specifici

关 键 词：动脉粥样硬化 血压测定 手术期间 

分 类 号：R614[医药卫生—麻醉学]