Schimanski Karen, Jull Andrew, Mitchell Nancy, McLay Jessica
Emergency Department, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand.
School of Nursing, University of Auckland, New Zealand.
Int J Nurs Stud. 2014 Dec;51(12):1575-84. doi: 10.1016/j.ijnurstu.2014.03.008. Epub 2014 Apr 8.
Forearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution.
To determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity.
Single centre comparison study.
Adult Emergency Department, Tertiary Trauma Centre.
Forty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board.
A random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland-Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg.
The forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p=0.002, F-statistic=11.09). Blood pressure disparity was not associated with participant characteristics.
Forearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg.
当无法测量上臂血压时，有人建议测量前臂血压作为替代方法。然而，几乎没有利用临床人群的证据来支持这种替代。
使用单一示波无创设备，确定成年急诊科患者左上臂和前臂测量的血压之间的一致性。次要目的是探讨血压差异与年龄、性别、种族、吸烟史和肥胖之间的关系。
单中心比较研究。
三级创伤中心的成人急诊科。
从急诊科就诊名单中按顺序选取的44名符合纳入/排除标准的参与者。
采用随机分配测量左上臂和前臂血压顺序的方法。参与者年龄在18岁及以上、澳大利亚分诊量表代码为2、3、4或5、能够同意且能够在以45°角卧位时测量左臂血压即为合格。采用Bland-Altman统计分析方法，收缩压、舒张压和平均动脉压临床可接受的一致性水平定义为±10 mmHg。
前臂测量值高估了收缩压（平均差异2.2 mmHg，95%一致性界限±19 mmHg）、舒张压（平均差异3.4 mmHg，95%一致性界限±14.4 mmHg）和平均动脉压（平均差异4.1 mmHg，95%一致性界限±13.7 mmHg）。收缩压测量值与零无显著差异。使用Levene检验发现，与收缩压高于140 mmHg相比，收缩压低于140 mmHg时，上臂/前臂收缩压测量的一致性更好（p = 0.002，F统计量 = 11.09）。血压差异与参与者特征无关。
前臂测量不能常规替代上臂测量血压。如果临床情况需要使用前臂血压，收缩压与上臂测量值的潜在差异为±19 mmHg，不过如果收缩压低于140 mmHg，变异性可能接近±10 mmHg。
