Gevers M, van Genderingen H R, Lafeber H N, Hack W W
Department of Pediatrics-neonatology, Free University Hospital, Amsterdam, The Netherlands.
Intensive Care Med. 1996 Mar;22(3):242-8. doi: 10.1007/BF01712244.
To perform further evaluation of the oscillometric device for neonatal arterial blood pressure (ABP) measurement, using a catheter-manometer system (CMS) for accurate intraarterial measurement. We aimed to describe the influence of the radial artery wave shape on oscillometric ABP determination, as pressure wave-shape influences the relationships between systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) in the wave. These relationships are part of the algorithms contributing to the final ABP determination in the oscillometric device.
Intra-patient comparison of two blood pressure measurement systems.
Neonatal intensive care unit.
In 51 critically ill newborn infants, ABP was determined oscillometrically in the brachial artery and, simultaneously, invasively in the radial artery using a high-fidelity CMS. Clinical data of the infants were: gestational age: 29 (25-41) weeks; birthweight: 1200 (500-3675) g, postnatal age: 6 (2-46) h.
Statistical analysis was performed with the paired Student's t-test. Multiple regression analysis was used to determine the influence of birthweight and height of the blood pressure on the results.
In 51 infants, 255 paired values of SAP, DAP and MAP were recorded. In all recordings, we determined the relationship between SAP, DAP and MAP, using the equation: MAP = alpha%(SAP - DAP) + DAP. For SAP, DAP, MAP and alpha, we computed mean differences (bias) and the limits of agreement (precision). Biases for SAP, DAP, MAP and alpha were significantly different from zero (P < 0.001) and the limits of agreement for SAP, DAP and MAP were wide: 18.8 mmHg, 17.2 mmHg and 15.2 mmHg respectively. The relationship between invasive and noninvasive values is only partly (7-19%) influenced by the height of the blood pressure; low values of SAP, DAP and MAP tend to give overestimated oscillometric values. In the relationship between SAP, DAP and MAP, alpha was found to be 47% invasively (as generally found in the radial artery in newborns) and 34% noninvasively (as generally found in the brachial/radial artery in adults).
Inaccuracy of the oscillometric device may be partly explained by the incorporation of an inappropriately fixed algorithm for final ABP determination in newborns. Care should be taken when interpreting the oscillometrically derived values in critically ill newborn infants.
使用导管 - 压力计系统（CMS）进行准确的动脉内血压测量，对用于新生儿动脉血压（ABP）测量的示波测量装置进行进一步评估。我们旨在描述桡动脉波形对示波法测定ABP的影响，因为压力波形会影响动脉收缩压（SAP）、舒张压（DAP）和平均动脉压（MAP）在波形中的关系。这些关系是示波测量装置最终ABP测定算法的一部分。
两种血压测量系统的患者内比较。
新生儿重症监护病房。
在51例危重新生儿中，采用示波法测定肱动脉ABP，并同时使用高保真CMS侵入性测定桡动脉ABP。婴儿的临床数据为：胎龄：29（25 - 41）周；出生体重：1200（500 - 3675）g，出生后年龄：6（2 - 46）小时。
采用配对t检验进行统计分析。多元回归分析用于确定出生体重和血压高度对结果的影响。
在51例婴儿中，记录了255对SAP、DAP和MAP值。在所有记录中，我们使用公式：MAP =α%（SAP - DAP）+ DAP确定SAP、DAP和MAP之间的关系。对于SAP、DAP、MAP和α，我们计算了平均差异（偏差）和一致性界限（精密度）。SAP、DAP、MAP和α的偏差显著不同于零（P < 0.001），SAP、DAP和MAP的一致性界限较宽：分别为18.8 mmHg、17.2 mmHg和15.2 mmHg。有创和无创值之间的关系仅部分（7 - 19%）受血压高度影响；较低的SAP、DAP和MAP值往往会使示波测量值被高估。在SAP、DAP和MAP之间的关系中，有创测量时α为47%（如新生儿桡动脉中通常所见），无创测量时α为34%（如成人肱动脉/桡动脉中通常所见）。
示波测量装置的不准确可能部分归因于在新生儿最终ABP测定中采用了不合适的固定算法。在解释危重新生儿示波测量得出的值时应谨慎。
