神经放射学检查期间连续无创与有创动脉血压监测的比较、前瞻性、单中心观察性研究

Continuous non-invasive vs. invasive arterial blood pressure monitoring during neuroradiological procedure: a comparative, prospective, monocentric, observational study.

作者信息

Chapalain Xavier, Morvan Thomas, Gentric Jean-Christophe, Subileau Aurélie, Jacob Christophe, Cadic Anna, Caillard Anaïs, Huet Olivier

机构信息

Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France.

Laboratoire ORPHY, Université de Bretagne Occidentale, Brest, France.

出版信息

Perioper Med (Lond). 2024 Jul 22;13(1):77. doi: 10.1186/s13741-024-00442-3.

DOI:10.1186/s13741-024-00442-3

PMID:39034414

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11265173/

Abstract

BACKGROUND

In the perioperative setting, the most accurate way to continuously measure arterial blood pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developed to allow non-invasive measurements and are increasingly used, but need further evaluation. The aim of this study is to evaluate the accuracy and clinical concordance between two devices for the measurement of ABP during neuroradiological procedure.

METHODS

This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuroradiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with two different technologies: radial artery catheter and Nexfin. Bland-Altman and error grid analyses were performed to evaluate the accuracy and clinical concordance between devices.

RESULTS

From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin were located in the risk zone A or B. However, 65.7% of hypertension events and 41% of hypotensive events were respectively not detected by Nexfin. Compared to the artery catheter, a significant relationship was found for SAP (r = 0.78) and MAP (r = 0.80) with the Nexfin (p < 0.001). Bias and limits of agreement (LOA) were respectively 9.6 mmHg (- 15.6 to 34.8 mmHg) and - 0.8 mmHg (- 17.2 to 15.6 mmHg), for SAP and MAP.

CONCLUSIONS

Nexfin is not strictly interchangeable with artery catheter for ABP measuring. Further studies are needed to define its clinical use during neuroradiological procedure.

TRIAL REGISTRATION

Clinicaltrials.gov, registration number: NCT05283824.

摘要

背景

在围手术期，连续测量动脉血压（ABP）的最准确方法是使用动脉导管。已经开发出如指套袖带等替代方法以进行无创测量，并且其使用越来越广泛，但仍需要进一步评估。本研究的目的是评估两种用于神经放射学检查过程中ABP测量设备的准确性和临床一致性。

方法

这是一项前瞻性、单中心、观察性研究。所有连续接受神经放射学检查的患者均符合条件。纳入需要使用动脉导管测量血压的患者。在神经放射学检查过程中，使用两种不同技术测量ABP（收缩压、平均压和舒张压）：桡动脉导管和Nexfin。进行Bland-Altman分析和误差网格分析以评估设备之间的准确性和临床一致性。

结果

2022年3月至2022年11月，我们纳入了50例患者，大多数为美国麻醉医师协会（ASA）3级（60%），且在全身麻醉（96%）下需要进行脑栓塞术（94%）。误差网格分析显示，使用Nexfin获得的99%的无创ABP测量值位于风险区域A或B。然而，Nexfin分别未检测到65.7%的高血压事件和41%的低血压事件。与动脉导管相比，发现Nexfin与收缩压（r = 0.78）和平均动脉压（r = 0.80）存在显著相关性（p < 0.001）。收缩压和平均动脉压的偏差和一致性界限（LOA）分别为9.6 mmHg（-15.6至34.8 mmHg）和-0.8 mmHg（-17.2至15.6 mmHg）。