Riachy Moussa, Azar Madona
Service de Pneumologie et de Réanimation médicale, CHU Hôtel-Dieu de France, Beyrouth, Liban.
J Med Liban. 2006 Jan-Mar;54(1):17-21.
The goal of this study is to compare three techniques for the measurement of arterial blood pressure (invasive (I), oscillometric (O), and sphygmomanometric (S)) in critically ill patients to determine if the noninvasive techniques can replace the arterial catheterization, and to see whether the relation between these three methods varies over time.
Thiyty-three patients were recruited in the medical critical care unit at Hôtel-Dieu de France hospital. Each patient included had an arterial catheter inserted in the right femoral artery. The cuff of the oscillometer was positioned on the level of the right arm and measurements by sphygmomanometric technique were carried out on the level of the left arm. All measurements were taken at the same time, three times per day, during the patient stay in the critical care unit.
The study period was five days with an overall of fifteen measurements for each technique. At t0, the calculation of the correlation coefficients of Spearman showed a very good correlation between the three measurements techniques for systolic (I/O: r = 0.7258, p < 0.001; I/S: r = 0.8824, p < 0.001; O/S: r = 0.8675, p < 0.001), diastolic (I/O: r = 0.7620, p < 0.001; I/S: r = 0.7910, p < 0.001; O/S: r = 0.7152, p < 0.001) and mean (I/O: r = 0.7725, p < 0.001; I/S: r = 0.8221, p < 0.001; O/S: r = 0.8363, p < 0.001) pressures. Between t1 and t15, analysis of variance (ANOVA) showed that the three methods remained well correlated (systolic p = 0.175; diastolic p = 0.107; mean p = 0.550). The calculation of the limits of agreement between the three techniques showed a lack of agreement between the invasive technique and the sphygmomanometric technique in 25% of the cases, and a good agreement between invasive and oscillometric techniques in 87.5% of the cases.
Oscillometry can replace the direct intra-arterial standard technique for the monitoring of the blood pressure in the intensive care unit. In contrast, the sphygmomanometry in the ICU gives inaccurate results that could lead to inappropriate therapeutic attitudes.
本研究的目的是比较三种测量危重症患者动脉血压的技术（有创（I）、示波法（O）和血压计测量法（S）），以确定无创技术是否可以取代动脉插管，并观察这三种方法之间的关系是否随时间变化。
在法国迪厄医院的医疗重症监护病房招募了33名患者。纳入的每位患者都在右股动脉插入了动脉导管。示波仪的袖带置于右臂水平，血压计测量法在左臂水平进行测量。在患者入住重症监护病房期间，所有测量均在同一时间进行，每天3次。
研究期为5天，每种技术总共进行了15次测量。在t0时，Spearman相关系数计算显示，三种测量技术在收缩压（I/O：r = 0.7258，p < 0.001；I/S：r = 0.8824，p < 0.001；O/S：r = 0.8675，p < 0.001）、舒张压（I/O：r = 0.7620，p < 0.001；I/S：r = 0.7910，p < 0.001；O/S：r = 0.7152，p < 0.001）和平均压（I/O：r = 0.7725，p < 0.001；I/S：r = 0.8221，p < 0.001；O/S：r = 0.8363，p < 0.001）方面具有非常好的相关性。在t1和t15之间，方差分析（ANOVA）表明这三种方法仍具有良好的相关性（收缩压p = 0.175；舒张压p = 0.107；平均压p = 0.550）。三种技术之间一致性界限的计算表明，在25%的病例中，有创技术与血压计测量法之间缺乏一致性，而在87.5%的病例中，有创技术与示波法之间具有良好的一致性。
示波法可替代直接动脉内标准技术用于重症监护病房的血压监测。相比之下，重症监护病房的血压计测量法给出的结果不准确，可能导致不适当的治疗态度。
