Watson Sheri, Aguas Marita, Colegrove Pat, Foisy Nancy, Jondahl Bonnie, Anastas Zoe
J Perianesth Nurs. 2017 Feb;32(1):15-21. doi: 10.1016/j.jopan.2014.08.145. Epub 2016 May 20.
The purpose of the study was to determine if forearm blood pressures (BPs) measured in three different locations agree with the recommended upper arm location for noninvasive BP measurement.
A method-comparison design was used.
In a convenience sample of postanesthesia care unit patients with large upper arm circumference, BP's were obtained in three different forearm locations (lower forearm, middle forearm, and upper forearm) and compared to upper arm BP using an automated BP measuring device. The level of agreement (bias ± precision) between each forearm location and the upper arm BP was calculated using standard formulas. Acceptable levels of agreement based on expert opinion were set a priori at bias and precision values of less than ±5 mm Hg (bias) and ±8 mm Hg (precision).
Forty-eight postanesthesia patients participated in the study. Bias and precision values were found to exceed the acceptable level of agreement for all but one of the systolic and diastolic BP comparisons in the three forearm BP locations. Fifty-six percent of all patients studied had one or more BP difference of at least 10 mm Hg in each of the three forearm locations, with 10% having one or more differences of at least 20 mm Hg.
The differences in forearm BP measurements observed in this study indicate that the clinical practice of using a forearm BP with a regular-sized BP cuff in place of a larger sized BP cuff placed on the upper arm in postanesthesia care unit patients with large arm circumferences is inappropriate. The BPs obtained at the forearm location are not equivalent to the BPs obtained at the upper arm location.
本研究的目的是确定在三个不同位置测量的前臂血压（BP）是否与推荐的用于无创血压测量的上臂位置一致。
采用方法比较设计。
在一个便利样本中，选取了上臂围较大的麻醉后护理单元患者，使用自动血压测量设备在三个不同的前臂位置（前臂下部、前臂中部和前臂上部）测量血压，并与上臂血压进行比较。使用标准公式计算每个前臂位置与上臂血压之间的一致性水平（偏差±精密度）。根据专家意见，预先设定的可接受一致性水平为偏差值小于±5 mmHg（偏差）和精密度值小于±8 mmHg（精密度）。
48名麻醉后患者参与了本研究。在三个前臂血压位置的收缩压和舒张压比较中，除了一项比较外，偏差和精密度值均超过了可接受的一致性水平。在所有研究患者中，56%的患者在三个前臂位置中的每个位置都有一个或多个血压差值至少为10 mmHg，10%的患者有一个或多个差值至少为20 mmHg。
本研究中观察到的前臂血压测量差异表明，对于上臂围较大的麻醉后护理单元患者，临床实践中使用常规尺寸血压袖带在前臂测量血压以替代在上臂使用较大尺寸血压袖带是不合适的。在前臂位置获得的血压与在上臂位置获得的血压不相等。
