Hayes Seth, Miller Rebecca, Patel Ambrish, Tumin Dmitry, Walia Hina, Hakim Mohammed, Syed Faizaan, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA.
Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA.
Med Devices (Auckl). 2019 Aug 22;12:297-303. doi: 10.2147/MDER.S209629. eCollection 2019.
To compare invasive blood pressure (IBP) readings obtained from an arterial cannula with non-invasive blood pressure (NIBP) measurements from oscillometric cuffs on the upper and lower extremities of infants and children under general anesthesia.
Patients under 10 years of age were enrolled in our study if they were to receive general anesthesia with planned placement of a radial arterial cannula. At 5 mins intervals, IBP was measured using a fluid-coupled pressure transducer and NIBP was measured with two oscillometers with appropriately sized cuffs placed on the upper arm and lower leg, for 10 readings per patient.
The study enrolled 18 boys and 12 girls, ranging in age from 0 to 8 years. Across 300 data points, the absolute difference between the arm and invasive mean arterial pressure (MAP) measurements was 7±7 mmHg (range: 0-52 mmHg). The absolute difference between the leg and invasive MAP measurements was 8±8 mmHg (range: 0-52 mmHg). Although both non-invasive measurement sites demonstrated frequent deviation from invasive measurement, large deviations were more common when BP was measured at the leg (81 of 298 observations (27%) deviating by >10 mmHg) compared to the arm (60 of 300 observations (20%) deviating by >10 mmHg).
The frequency of clinically significant NIBP deviation in children under general anesthesia supports the importance of IBP monitoring when hemodynamic fluctuations are likely and would be particularly detrimental. NIBP measured at the lower leg is more likely to result in clinically significant deviation from invasively measured MAP than NIBP values obtained from an upper arm.
比较在全身麻醉下，从动脉套管获得的有创血压（IBP）读数与采用示波法袖带分别在上肢和下肢测量的婴幼儿无创血压（NIBP）。
10岁以下拟接受全身麻醉并计划放置桡动脉套管的患者纳入本研究。每隔5分钟，使用液耦压力传感器测量IBP，并用两台示波仪测量NIBP，在上臂和小腿放置尺寸合适的袖带，每位患者测量10次。
本研究纳入18名男孩和12名女孩，年龄范围为0至8岁。在300个数据点中，上臂测量值与有创平均动脉压（MAP）之间的绝对差值为7±7 mmHg（范围：0至52 mmHg）。小腿测量值与有创MAP之间的绝对差值为8±8 mmHg（范围：0至52 mmHg）。尽管两个无创测量部位的测量值均频繁偏离有创测量值，但与上臂相比，在小腿测量血压时出现较大偏差更为常见（298次观察中有81次（27%）偏差>10 mmHg），而上臂为300次观察中有60次（20%）偏差>10 mmHg）。
全身麻醉下儿童临床上显著的NIBP偏差频率表明，在血流动力学波动可能发生且可能造成特别不利影响时，IBP监测非常重要。与上臂获得的NIBP值相比，小腿测量的NIBP更有可能导致与有创测量的MAP出现临床上显著的偏差。
