Marouane Abderrahim, Cornelissen Elisabeth A M, Nusmeier Anneliese, Bootsma-Robroeks Charlotte M H H T
Pediatric Nephrology Department, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
Pediatric Intensive Care Unit, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
Pediatr Transplant. 2019 Feb;23(1):e13309. doi: 10.1111/petr.13309. Epub 2018 Oct 25.
Blood pressure (BP) monitoring in children immediately after kidney transplantation is ideally performed with an arterial line. Accurate measurement of BP is necessary for optimal management. However, during the first days postoperative, the arterial line is removed and BP measurement is switched to a non-invasive device. The aim of this study was to determine the accuracy and reliability of the automated oscillometric device compared to invasive arterial BP (IBP) monitoring in patients after renal transplantation in pediatric intensive care unit (PICU).
We analyzed all simultaneously measured BPs in children with a kidney transplant in the Amalia Children's Hospital Radboud University Medical Center between January 1, 2012, and January 1, 2016. BP measurements were performed according to the hospital protocol. Agreement between invasive and non-invasive methods was assessed using Bland-Altman plots.
A total of 29 patients were included in this retrospective study. The majority of children were male (59%), and median age was 11 years (range 1-17 years). Totally, 80 BP measurements were recorded during the first days post-kidney transplantation. The correlation coefficients (R) of systolic, diastolic, and MAP of non-invasive (NIBP) and IBP measurements were 0.84, 0.76, and 0.77, respectively (P < 0.01). Overall, the average MAP (7.5 ± 1.2 mm Hg; P < 0.05) NIBP values were lower compared to IBP. In hypertensive patients, MAP (10.4 ± 10.0 mm Hg; P < 0.05) BP values were significantly lower using the NIBP device. Clinically relevant difference of >10 mm Hg was found in 51% (41/80) of measurements and mainly observed in hypertensive measurements.
IBP measurement is considered the golden standard for monitoring BP in patients immediately after kidney transplantation. NIBP values showed a good agreement with invasive reading, but the variability of NIBP mainly in hypertensive patients is high as it is the number of clinically relevant differences to IBP. We conclude that IBP remains the golden standard to monitor BP in children directly postoperatively.
肾移植术后即刻对儿童进行血压（BP）监测，理想情况下应使用动脉导管。准确测量血压对于优化管理至关重要。然而，在术后最初几天，动脉导管会被移除，血压测量会改用无创设备。本研究的目的是确定在儿科重症监护病房（PICU）中，与有创动脉血压（IBP）监测相比，自动示波装置在肾移植患者中的准确性和可靠性。
我们分析了2012年1月1日至2016年1月1日期间在拉德堡大学医学中心阿玛利亚儿童医院接受肾移植的儿童同时测量的所有血压值。血压测量按照医院方案进行。使用Bland - Altman图评估有创和无创方法之间的一致性。
本回顾性研究共纳入29例患者。大多数儿童为男性（59%），中位年龄为11岁（范围1 - 17岁）。肾移植术后最初几天共记录了80次血压测量值。无创（NIBP）和有创血压测量的收缩压、舒张压和平均动脉压（MAP）的相关系数（R）分别为0.84、0.76和0.77（P < 0.01）。总体而言，NIBP的平均MAP值（7.5 ± 1.2 mmHg；P < 0.05）低于IBP。在高血压患者中，使用NIBP装置时MAP（10.4 ± 10.0 mmHg；P < 0.05）血压值显著更低。在51%（41/80）的测量中发现临床相关差异>10 mmHg，且主要出现在高血压测量中。
IBP测量被认为是肾移植术后即刻患者血压监测的金标准。NIBP值与有创读数显示出良好的一致性，但NIBP的变异性主要在高血压患者中较高，因为与IBP存在临床相关差异的数量较多。我们得出结论，IBP仍然是术后直接监测儿童血压的金标准。
