袖带法测量血压时前臂肌肉的血流和氧代谢:基于近红外光谱的初步研究  

Blood flow and oxygen metabolism in forearm muscle during cuff-based blood pressure measurement:a pilot study based on near-infrared spectroscopy

作　　者：宫双 刘志涛 唐敏 苏海[2] GONG Shuang;LIU Zhitao;TANG Min;SU Hai(Department of Neurology,Ningbo Rehabilitation Hospital,Ningbo,Zhejiang 315040,China;Department of Cardiovascular Medicine,Second Affiliated Hospital,Nanchang University)

机构地区：[1]浙江省宁波市康复医院神经康复科,浙江宁波315040 [2]南昌大学第二附属医院心内科

出　　处：《中华高血压杂志(中英文)》2024年第12期1156-1160,共5页Chinese Journal of Hypertension

基　　金：浙江省中医药科技计划项目(2024ZL954);宁波市自然科学基金(2022J035);宁波市鄞州区农业与社会发展类项目(2021AS0038)。

摘　　要：目的评估袖带法测量血压时前臂肌肉血流和氧代谢的变化。方法2021年6—8月于浙江省宁波市康复医院神经康复科病房与门诊招募20名健康受试者。在右前臂放置近红外光极探头支架,记录血压测量过程中连续近红外光谱曲线,观察氧合血红蛋白/肌红蛋白(oxy-Hb/Mb),脱氧血红蛋白/肌红蛋白(deoxy-Hb/Mb)和总血红蛋白/肌红蛋白(tHb/Mb)的变化。其中5名受试者进行了两次血压测量,测量间隔2 min。基于oxy-Hb/Mb波形和目前的血流动力学知识,分析三条波形的特征。结果依据oxy-Hb/Mb波形,可见清晰双峰波形,并分为四个阶段:第一阶段为第一峰前的上升支迅速增加到第一个峰值,原因为静脉阻塞,前臂血液快速积聚;第二阶段为第一峰后下降支,提示为静脉和动脉均阻塞,由于肌肉耗氧使oxy-Hb/Mb下降;第二峰前的上升支为第三阶段,提示动脉再度开放导致oxy-Hb/Mb积聚;第四阶段为第二峰后的下降支,波形迅速下降到基线水平,提示静脉完全开放,血液回流心脏。5名受试者第1次和第2次血压测量的波形相似。结论近红外光谱技术可以敏感地反映袖带血压测量时前臂血流和肌肉氧代谢的复杂变化。Objective To evaluate the changes of blood flow and oxygen metabolism in the forearm muscle during cuff-based blood pressure measurement.Methods Twenty healthy subjects were recruited in the Neurorehabilitation Ward and Outpatient Department of Ningbo Rehabilitation Hospital,Zhejiang Province from June 2021 to August 2021.A near-infrared probe was placed on the right forearm,and continuous near-infrared spectral waveforms during blood pressure measurement,including oxygenated hemoglobin/myoglobin(oxy-Hb/Mb),deoxygenated hemoglobin/myoglobin(deoxy-Hb/Mb),and total hemoglobin/myoglobin(tHb/Mb),were recorded.Five of the subjects had two blood pressure measurements,with an interval of 2 minutes.Based on the oxy-Hb/Mb waveform and current knowledge of hemodynamics,the characteristics of the three waveforms were analyzed.Results According to the oxy-Hb/Mb curve,a clear double-peak waveform could be observed,which was divided into four stages:in the first stage,the rising branch before the first peak increased rapidly to the first peak,which was due to venous occlusion and rapid accumulation of blood in the forearm;the second stage was the descending branch after the first peak,which indicated venous and arterial occlusion,with a decrease in oxy-Hb/Mb due to muscle oxygen consumption;the rising branch before the second peak was the third stage,suggesting that the reopening of the artery led to accumulation of oxy-Hb/Mb;the fourth stage was the descending branch after the second peak,with the curve rapidly falling to the baseline level due to complete venous opening and blood refluxing to the heart.The curves of the first and second blood pressure measurements were similar for the five subjects.Conclusion The technology of near-infrared spectroscopy can sensitively reflect the complex changes of blood flow and oxygen metabolism in forearm muscle during cuff-based blood pressure measurement.

关 键 词：近红外光谱 血压 袖带 测量 前臂 肌肉 血流 氧代谢 

分 类 号：R544.1[医药卫生—心血管疾病] O657.33[医药卫生—内科学]