Imholz B P, Wieling W, van Montfrans G A, Wesseling K H
Department of Internal Medicine, Academic Medical Center, Amsterdam, Netherlands.
Cardiovasc Res. 1998 Jun;38(3):605-16. doi: 10.1016/s0008-6363(98)00067-4.
We review the Finapres technology, embodied in several TNO-prototypes and in the Ohmeda 2300 and 2300e Finapres NIBP. Finapres is an acronym for FINger Arterial PRESsure, the device delivers a continuous finger arterial pressure waveform. Many papers report on the accuracy of the device in comparison with intra-arterial or with noninvasive but intermittent blood pressure measurements. We compiled the results of 43 such papers and found systolic, diastolic and mean accuracies, in this order, ranging from -48 to 30 mmHg, from -20 to 18 mmHg, and from -13 to 25 mmHg. Weighted for the number of subjects included pooled accuracies were -0.8 (SD 11.9), -1.6 (8.3) and -1.6 (7.6) mmHg respectively. Subdividing the pooled group according to criteria such as reference blood pressure, place of application, and prototype or commercial device we found no significant differences in mean differences or SD. Measurement at the finger allows uninterrupted recordings of long duration. The transmission of the pressure pulse along the arm arteries, however, causes distortion of the pulse waveform and depression of the mean blood pressure level. These effects can be reduced by appropriate filtering, and upper arm 'return-to-flow' calibration to bring accuracy and precision within AAMI limits. For the assessment of beat-to-beat changes in blood pressure and assessment of blood pressure variability Finapres proved a reliable alternative for invasive measurements when mean and diastolic pressures are concerned. Differences in systolic pressure are larger and reach statistical significance but are not of clinical relevance. Finger arteries are affected by contraction and dilatation in relation to psychological and physical (heat, cold, blood loss, orthostasis) stress. Effects of these phenomena are reduced by the built-in Physiocal algorithm. However, full smooth muscle contraction should be avoided in the awake patient by comforting the patient, and covering the hand. Arterial state can be monitored by observing the behaviour of the Physiocal algorithm. We conclude that Finapres accuracy and precision usually suffice for reliable tracking of changes in blood pressure. Diagnostic accuracy may be achieved with future application of corrective measures.
我们回顾了Finapres技术，该技术体现在多个TNO原型以及Ohmeda 2300和2300e Finapres无创血压测量仪中。Finapres是手指动脉压力（FINger Arterial PRESsure）的首字母缩写，该设备可提供连续的手指动脉压力波形。许多论文报道了该设备与有创动脉血压测量或无创但间歇性血压测量相比的准确性。我们汇总了43篇此类论文的结果，发现收缩压、舒张压和平均压的准确性依次为-48至30 mmHg、-20至18 mmHg和-13至25 mmHg。根据纳入的受试者数量加权后，汇总的准确性分别为-0.8（标准差11.9）、-1.6（8.3）和-1.6（7.6）mmHg。根据参考血压、应用部位以及原型或商用设备等标准对汇总组进行细分后，我们发现平均差异或标准差没有显著差异。在手指处进行测量可实现长时间的不间断记录。然而，压力脉冲沿臂动脉的传输会导致脉搏波形失真和平均血压水平降低。通过适当的滤波以及上臂“回流”校准可减少这些影响，使准确性和精密度符合AAMI标准。对于评估逐搏血压变化和血压变异性，当涉及平均压和舒张压时，Finapres被证明是一种可靠的有创测量替代方法。收缩压的差异更大且具有统计学意义，但不具有临床相关性。手指动脉会因心理和身体（热、冷、失血、体位性低血压）应激而发生收缩和扩张。内置的Physiocal算法可减少这些现象的影响。然而，在清醒患者中，应通过安抚患者并覆盖手部来避免完全的平滑肌收缩。通过观察Physiocal算法的行为可监测动脉状态。我们得出结论，Finapres的准确性和精密度通常足以可靠地跟踪血压变化。未来应用纠正措施可能会实现诊断准确性。
