脉搏血氧仪测量的灌注指数会影响 ClearSight 与动脉导管血压之间的一致性：一项前瞻性观察研究。

The perfusion index measured by the pulse oximeter affects the agreement between ClearSight and the arterial catheter-based blood pressures: A prospective observational study.

机构信息

Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Education and Training Department, Yokohama City University Hospital, YCU Centre for Novel and Exploratory Clinical Trials, Yokohama, Japan.

出版信息

PLoS One. 2019 Jul 10;14(7):e0219511. doi: 10.1371/journal.pone.0219511. eCollection 2019.

DOI:10.1371/journal.pone.0219511

PMID:31291340

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6619788/

Abstract

BACKGROUND

ClearSight is a noninvasive arterial blood pressure monitor, but it remains unknown whether it is affected by the state of perfusion to the fingers. We investigated whether the lower perfusion index (PI) measured with a pulse oximeter, which reflects finger perfusion, would affect the agreement between arterial pressures measured with ClearSight versus those obtained with an arterial catheter.

METHODS

Paired arterial pressure data (ClearSight and arterial catheter-based pressures) and PI values were prospectively obtained from 30 patients undergoing major abdominal surgery. The primary outcome was standard deviation (SD) of the bias (precision) of blood pressure between ClearSight and arterial catheter. The ratio of the adjusted SD of the bias between PI≤1 and PI>1 was calculated using the linear mixed-effects model. The secondary outcomes were the bias and the limits of agreement (LOA) between the two devices (repeated measures Bland-Altman analysis).

RESULTS

We analyzed 6312 paired data points. The adjusted SD of bias in PI ≤1 compared with those in PI >1 was 1.4-fold (95% confidence interval: 1.3- to 1.4-fold) for systolic arterial pressure, 1.5-fold (95% confidence interval: 1.3- to 1.6-fold) for diastolic arterial pressure, and 1.3-fold (95% confidence interval: 1.2- to 1.5-fold) for mean arterial pressure. The bias (LOA) were as follows: systolic arterial pressure in the PI ≤1 and PI >1 groups, -3.5 (-35.4 to 28.4) mmHg and 2.2 (-19.9 to 24.3) mmHg, respectively; diastolic arterial pressure in the PI ≤1 and PI >1 groups, 13.1 (-5.1 to 31.3) mmHg and 9.0, (-2.6 to 20.6) mmHg, respectively; and mean arterial pressure in the PI ≤1 and PI >1 groups, 8.7 (-11.3 to 28.7) mmHg and 7.6 (-6.2 to 21.3) mmHg, respectively.

CONCLUSIONS

PI ≤1 was associated with a large SD of the bias between the devices. The PI value could be a real-time indicator of ClearSight precision.

摘要

背景

ClearSight 是一种非侵入性动脉血压监测仪，但尚不清楚它是否受到手指灌注状态的影响。我们研究了脉搏血氧仪测量的较低灌注指数（PI）是否会影响 ClearSight 测量的动脉压与动脉导管获得的动脉压之间的一致性。

方法

前瞻性地从 30 例接受大腹部手术的患者中获得了动脉压数据（ClearSight 和基于动脉导管的压力）和 PI 值的配对数据。主要结局是 ClearSight 和动脉导管之间血压的偏差（精度）的标准偏差（SD）。使用线性混合效应模型计算 PI≤1 和 PI>1 时调整的偏差 SD 比。次要结局是两种设备之间的偏差和一致性限（LOA）（重复测量 Bland-Altman 分析）。

结果

我们分析了 6312 对数据点。PI≤1 时的偏差调整 SD 是 PI>1 时的 1.4 倍（95%置信区间：1.3 至 1.4 倍），收缩压为 1.5 倍（95%置信区间：1.3 至 1.6 倍），舒张压为 1.3 倍（95%置信区间：1.2 至 1.5 倍），平均动脉压为 1.3 倍（95%置信区间：1.2 至 1.5 倍）。偏差（LOA）如下：PI≤1 和 PI>1 组的收缩压分别为-3.5（-35.4 至 28.4）mmHg 和 2.2（-19.9 至 24.3）mmHg；PI≤1 和 PI>1 组的舒张压分别为 13.1（-5.1 至 31.3）mmHg 和 9.0（-2.6 至 20.6）mmHg；PI≤1 和 PI>1 组的平均动脉压分别为 8.7（-11.3 至 28.7）mmHg 和 7.6（-6.2 至 21.3）mmHg。