Karlsson Jonas, Linde Joacim, Svensen Christer, Gellerfors Mikael
1Department of Anaesthesia and Intensive Care,Södersjukhuset,Stockholm,Sweden.
2Department of Anaesthesia and Intensive Care,Södra Älvsborg Hospital,Borås,Sweden.
Prehosp Disaster Med. 2018 Oct;33(5):490-494. doi: 10.1017/S1049023X18000729. Epub 2018 Aug 31.
IntroductionInvasive blood pressure (IBP) monitoring could be of benefit for certain prehospital patient groups such as trauma and cardiac arrest patients. However, there are disadvantages with using conventional IBP devices. These include time to prepare the transducer kit and flush system as well as the addition of long tubing connected to the patient. It has been suggested to simplify the IBP equipment by replacing the continuous flush system with a syringe and a short stopcock.HypothesisIn this study, blood pressures measured by a standard IBP (sIBP) transducer kit with continuous flush was compared to a transducer kit connected to a simplified and minimized flush system IBP (mIBP) using only a syringe.
A mechanical, experimental model was used to create arterial pressure pulsations. Measurements were made simultaneously using a sIBP and mIBP device, respectively. This was repeated four times using different mean arterial pressure (MAP): 40, 70, 110, and 140mm Hg. For each series, 16 measurements were taken during 20 minutes. Data were analyzed using Bland-Altman plots. Measurement error greater than five percent was regarded as clinically significant.
Mean bias and standard deviation (SD) for systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP was -3.05 (SD = 2.07), 0.2 (SD = 0.48), and -0.3 (SD = 0.55) mmHg, respectively. Bland-Altman plots revealed that the bias and SD for systolic pressures was mainly due to an increased under-estimation of pressures in lower ranges. All MAP and 98.4% of diastolic pressure measurements had an error of less than five percent. Systolic pressures in the MAP 40 series all had an error of greater than five percent. All other systolic pressures had an error of less than five percent.
Thus, IBP with the mIBP flush system provides accurate measurement of MAP and DBP in a wide range of physiological pressures. For SBP, there was a tendency to under-estimate pressures, with larger error in lower pressures. Implementation of a simplified flush system could allow further development and potentially simplify the use of IBP for prehospital critical care teams. KarlssonJ, LindeJ, SvensenC, GellerforsM. Prehospital invasive arterial pressure: use of a minimized flush system. Prehosp Disaster Med. 2018;33(5):490-494.
引言
有创血压（IBP）监测可能对某些院前患者群体有益，如创伤和心脏骤停患者。然而，使用传统的IBP设备存在缺点。这些缺点包括准备换能器套件和冲洗系统的时间，以及连接到患者的长管路。有人建议通过用注射器和短旋塞替换连续冲洗系统来简化IBP设备。
假设
在本研究中，将使用带连续冲洗的标准IBP（sIBP）换能器套件测量的血压与仅使用注射器连接到简化和最小化冲洗系统IBP（mIBP）的换能器套件测量的血压进行比较。
使用机械实验模型产生动脉压搏动。分别使用sIBP和mIBP设备同时进行测量。使用不同的平均动脉压（MAP）：40、70、110和140mmHg重复此操作四次。对于每个系列，在20分钟内进行16次测量。使用布兰德 - 奥特曼图分析数据。测量误差大于5%被视为具有临床意义。
收缩压（SBP）、舒张压（DBP）和MAP的平均偏差和标准差（SD）分别为-3.05（SD = 2.07）、0.2（SD = 0.48）和-0.3（SD = 0.55）mmHg。布兰德 - 奥特曼图显示，收缩压的偏差和SD主要是由于在较低范围内压力估计不足增加。所有MAP和98.4%的舒张压测量误差小于5%。MAP 40系列中的收缩压测量误差均大于5%。所有其他收缩压测量误差小于5%。
因此，采用mIBP冲洗系统的IBP在广泛的生理压力范围内能准确测量MAP和DBP。对于SBP，存在低估压力的趋势，在较低压力下误差更大。实施简化冲洗系统可促进进一步发展，并可能简化院前重症护理团队对IBP的使用。卡尔松J、林德J、斯文森C、盖勒福斯M。院前有创动脉压：最小化冲洗系统的应用。院前灾难医学。2018；33（5）：490 - 494。
