Division of Nephrology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
J Pediatr. 2020 Jun;221:23-31.e5. doi: 10.1016/j.jpeds.2020.02.072.
To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the literature regarding proper BP cuff size and measurement location and method.
A literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library, and CINAHL from 1946 to 2017 on BP in neonates <3 months of age (PROSPERO ID CRD42018092886). Study data were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods.
Of 3587 nonduplicate publications identified, 34 were appropriate for inclusion in the analysis. Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of approximately 0.5. Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement. Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg.
Proper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long-term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.
通过系统分析有关适当血压袖带尺寸和测量位置及方法的文献，确定新生儿推荐的血压（BP）测量方法。
对 1946 年至 2017 年间 MEDLINE、PubMed、Embase、Cochrane 图书馆和 CINAHL 中关于 <3 个月龄新生儿 BP 的文献进行了检索（PROSPERO ID CRD42018092886）。使用 Bland-Altman 研究的单独分析对测量方法进行了数据提取和分析。
在 3587 篇非重复出版物中，有 34 篇适合纳入分析。四项评估 BP 袖带尺寸的研究支持建议袖带宽度与臂围比约为 0.5。研究测量位置的研究确定上臂是最准确和最稳定的位置，用于测量振动脉压。使用 Bland-Altman 方法比较动脉内血压与振动脉压测量的研究分析表明，2 种方法的相关性最好，平均动脉压，而振动脉压测量的收缩压往往高估了动脉内收缩压。与动脉内方法相比，振动脉压测量的收缩压、舒张压和平均动脉压准确性和精密度较低，尤其是在平均动脉压 <30mmHg 的新生儿中。
在自然血压较低的新生儿中，正确的血压测量至关重要，注意 BP 袖带尺寸、位置和测量方法是必不可少的。随着新生儿长期动脉内血压监测中动脉内导管使用的减少，迫切需要进一步研究验证和开发具有增强准确性的振动脉压测量方法。
