Biomedical Systems Research Laboratory, University of New South Wales.
Concord Repatriation Hospital, Cardiology, University of Sydney.
J Hypertens. 2024 Jun 1;42(6):968-976. doi: 10.1097/HJH.0000000000003659. Epub 2024 Jan 15.
Conventional sphygmomanometry with cuff deflation is used to calibrate all noninvasive BP (NIBP) instruments and the International Standard makes no mention of calibrating methods specifically for NIBP instruments, which estimate systolic and diastolic pressure during cuff inflation rather than cuff deflation. There is however increasing interest in inflation-based NIBP (iNIBP) instruments on the basis of shorter measurement time, reduction in maximal inflation pressure and improvement in patient comfort and outcomes. However, we have previously demonstrated that SBP estimates based on the occurrence of the first K1 Korotkoff sounds during cuff deflation can underestimate intra-arterial SBP (IA-SBP) by an average of 14 ± 10 mmHg. In this study, we compare the dynamics of intra-arterial blood pressure (IABP) measurements with sequential measurement of Korotkoff sounds during both cuff inflation and cuff deflation in the same individual. In 40 individuals aged 64.1 ± 9.6 years (range 36-86 years), the overall dynamic responses below the cuff were similar, but the underestimation error was significantly larger during inflation than deflation, increasing from 14 ± 10 to 19 ± 12 mmHg ( P < 0.0001). No statistical models were found which could compensate for this error as were found for cuff deflation. The statistically significant BP differences between inflation and deflation protocols reported in this study suggest different behaviour of the arterial and venous vasculature between arterial opening and closing which warrant further investigation, particularly for iNIBP devices reporting estimates during cuff inflation. In addition, measuring Korotkoff sounds during cuff inflation represents significant technical difficulties because of increasing pump motor noise.
传统的袖带放气法用于校准所有非侵入性血压（NIBP）仪器，国际标准并未特别提及专门用于 NIBP 仪器的校准方法，这些仪器在袖带充气期间而不是袖带放气期间估计收缩压和舒张压。然而，基于测量时间更短、最大充气压力降低以及改善患者舒适度和结果，基于充气的 NIBP（iNIBP）仪器越来越受到关注。然而，我们之前已经证明，基于袖带放气期间第一声 K1 柯氏音出现来估计收缩压（SBP）可能会使动脉内 SBP（IA-SBP）平均低估 14±10mmHg。在这项研究中，我们比较了在同一个体中同时进行袖带充气和袖带放气时连续测量柯氏音的动脉内血压（IABP）测量的动力学。在 40 名年龄为 64.1±9.6 岁（36-86 岁）的个体中，袖带下方的总体动态反应相似，但充气时的低估误差明显大于放气时，从 14±10mmHg 增加到 19±12mmHg（P<0.0001）。与我们在袖带放气中发现的一样，没有找到可以补偿这种误差的统计模型。本研究报告的充气与放气方案之间存在统计学显著的血压差异表明，在动脉开放和关闭之间，动脉和静脉血管系统的行为不同，这需要进一步研究，特别是对于报告在袖带充气期间估计值的 iNIBP 设备。此外，由于泵马达噪声增加，在袖带充气期间测量柯氏音代表着重大的技术困难。
