Sugimachi Masaru, Sunagawa Kenji, Okamoto Hirotsugu, Hoka Sumio
Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita 565-8565.
Masui. 2002 Jul;51(7):784-90.
Oscillometric noninvasive arterial pressure monitoring devices frequently fail to measure pressure precisely in patients with arrhythmia, such as atrial fibrillation, because beat-by-beat changes in pulse pressure and mean pressure level distort the relation between cuff pressure and oscillometric wave amplitude. To overcome this problem, we developed a new algorithm for oscillometric measurement in which oscillometric wave amplitude is corrected according to changes in pulse pressure and mean arterial pressure level. In 7 patients with atrial fibrillation, we compared systolic pressure thus estimated with that simultaneously measured invasively in the radial artery and averaged during oscillometric measurement. Correction based on invasively obtained beat-by-beat pulse pressure and mean pressure level decreased the ratio of unmeasurable cases from 11 to 4%. Correction based on plethysmographically estimated pulse pressure decreased unmeasurable cases to 6% (P < 0.01). Standard error of systolic pressure estimates was 6.44 +/- 1.83, 4.10 +/- 0.85, and 4.75 +/- 1.26 mmHg with no, invasive, and plethysmographical correction in this order (P < 0.01). We conclude that oscillometric wave amplitude correction based on beat-by-beat pulse pressure and mean arterial pressure level lessened the number of unmeasurable cases and improved measurement precision in patients with atrial fibrillation.
示波法无创动脉压监测设备在心律失常患者（如心房颤动患者）中常常无法精确测量血压，这是因为脉压和平均压力水平的逐搏变化会扭曲袖带压力与示波幅度之间的关系。为克服这一问题，我们开发了一种新的示波测量算法，根据脉压和平均动脉压水平的变化对示波幅度进行校正。在7例心房颤动患者中，我们将如此估算的收缩压与同时经桡动脉有创测量并在示波测量期间取平均值的收缩压进行了比较。基于有创获取的逐搏脉压和平均压力水平进行校正，使不可测量病例的比例从11%降至4%。基于体积描记法估算的脉压进行校正，将不可测量病例减少至6%（P<0.01）。收缩压估算值的标准误差依次为6.44±1.83、4.10±0.85和4.75±1.26 mmHg，分别对应无校正、有创校正和体积描记法校正（P<0.01）。我们得出结论，基于逐搏脉压和平均动脉压水平的示波幅度校正减少了不可测量病例的数量，并提高了心房颤动患者的测量精度。
