Gillman M W, Cook N R
Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass, USA.
Circulation. 1995 Aug 15;92(4):1049-57. doi: 10.1161/01.cir.92.4.1049.
Accurate measurement of blood pressure in childhood epidemiological studies requires standardized conditions, valid instruments, and multiple measurements.
We used published literature and our own data to make recommendations on the reduction of biases caused by various technical factors, to discuss the advantages and disadvantages of selected measurement devices, and to evaluate the optimal number of visits and measurements per visit for accurate estimation of a child's blood pressure level. The conditions under which blood pressure is measured should be standardized. This includes training and certification to minimize observer biases; equipment factors such as use of an appropriate cuff bladder size, subject factors such as minimizing activities before and during the reading, environmental factors such as accounting for the time of day and ambient temperature, and technique factors such as recording both the fourth and fifth Korotkoff sounds. The choice of instrument for measuring blood pressure depends on the goals of the study and the resources available to the investigators.
Although relatively economical and easy to use, the standard mercury sphygmomanometer is subject to the bias resulting from knowledge of earlier readings. The random-zero sphygmomanometer overcomes this bias, but it is more expensive and difficult to use and may underestimate blood pressure levels. In contrast to auscultatory devices, automated oscillometric devices are not subject to observer biases. They are gaining wider use and may be especially appropriate for younger children. However, they are expensive, and each model requires validation before use in epidemiological studies. Ambulatory blood pressure monitoring represents a potentially useful technique for future epidemiological studies. Multiple measurements are vital in estimating a child's blood pressure, and the number of visits, days or weeks apart, is at least as important as the number of measurements per visit.
在儿童流行病学研究中，准确测量血压需要标准化的条件、有效的仪器以及多次测量。
我们利用已发表的文献和我们自己的数据，就减少各种技术因素导致的偏差提出建议，讨论所选测量设备的优缺点，并评估为准确估计儿童血压水平所需的就诊次数和每次就诊的测量次数。测量血压的条件应标准化。这包括培训和认证以尽量减少观察者偏差；设备因素，如使用合适的袖带气囊尺寸；受试者因素，如在测量前和测量期间尽量减少活动；环境因素，如考虑一天中的时间和环境温度；以及技术因素，如记录柯氏音的第四音和第五音。测量血压仪器的选择取决于研究目标和研究者可用的资源。
标准汞柱式血压计虽然相对经济且易于使用，但会受到因知晓先前读数而产生的偏差影响。随机零位血压计克服了这种偏差，但更昂贵且使用困难，可能会低估血压水平。与听诊设备不同，自动振荡式设备不受观察者偏差影响。它们的使用越来越广泛，可能特别适用于年幼儿童。然而，它们价格昂贵，每种型号在用于流行病学研究之前都需要进行验证。动态血压监测是未来流行病学研究中一种潜在有用的技术。多次测量对于估计儿童血压至关重要，就诊间隔的天数或周数至少与每次就诊的测量次数一样重要。
