Gore Payton, Liu Hong, Bohringer Christian
Anesthesiology, University of California Davis Medical Center, Sacramento, USA.
Cureus. 2024 Feb 22;16(2):e54707. doi: 10.7759/cureus.54707. eCollection 2024 Feb.
Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients.
全身麻醉期间血压（BP）偏离正常水平已被明确与多种不良后果相关联。因此，准确测量血压对于在医疗保健中取得良好效果至关重要。然而，正常血压并不一定保证器官灌注充足，即使血压看似充足时也会发生不良事件。侵入性血压监测最近已不仅仅局限于测量血压。现在，利用动脉导管获得的脉搏轮廓分析来评估心输出量和每搏量变化，作为血管内容量充足的指标。在管理高危患者时，通过侵入性动脉导管获得的数据来确认可接受的心输出量变得非常重要。通过手指袖带在指动脉中连续、无创测量血压的新型设备也已问世。现在许多临床医生在思考这些新设备是否准备好取代动脉导管进行侵入性监测。与无创设备不同，动脉导管允许频繁采血。这使得能够频繁评估诸如pH值、血红蛋白浓度、离子钙、钾、葡萄糖以及动脉血氧分压和二氧化碳分压等重要参数。已发现无创连续血压测量在重症患者、老年人以及动脉钙化患者中不可靠。与新型手指袖带监测仪相比，通过动脉导管获得的数据能更好地验证基于脉搏轮廓的心输出量和每搏量变化估计值。无创连续血压监测仪最近取得了重大进展。然而，对于重症患者，动脉导管侵入性监测仍然是测量血压和评估基于脉搏轮廓分析的血流动力学变量的金标准。未来，无创连续血压监测仪可能会在手术室和术后取代间歇性示波仪。然而，它们并不能消除重症患者进行动脉插管的必要性。
