Impact and Measurement of Blood Pressure During Continuous Flow Left Ventricular Assist Device Support: The Pressure Is On!
Impact and Measurement of Blood Pressure During Continuous Flow Left Ventricular Assist Device Support: The Pressure Is On!
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连续流动左心室辅助装置支持期间血压的影响和测量：压力已开启！
DOI：
10.1097/mat.0000000000000960
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Jorde,UlrichP
中科院分区：
文献类型：
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作者：
Saeed,Omar;Jorde,UlrichP
102 SAEED 和 JORDE 研究仅注意到与侵入性 SBP (r= 0.73) 的良好相关性，但未注意到与 MAP (r= 0.53) 的相关性。 17 尽管通过记录可触及的脉搏，多普勒血压可以更准确地解释为 SBP，21 测量仍然存在固有的复杂性，需要经过培训的工作人员，并且可能会被误解为 MAP，这可能会导致过度治疗和发生不良低血压相关事件的风险。与多普勒技术类似，在臂带放气期间恢复手指脉搏血氧饱和度读数时采集的血压记录也对 SBP 和 MAP 之间的区分有限，并且并非在所有患者中都能获得。 18 通过缓慢袖带放气系统（例如 Terumo Elemano）测量血压可以进一步区分 MAP 和 SBP，但只能对 70-80% 的患者产生一致的重复测量结果。 17 Nexfin 装置等指套方法可以在与低 PP 相对应的较高 CF LVAD 速度下提供准确的血压测量，但这些装置尚未在大量患者中得到验证，需要专门的设备，并且在四肢冰冷明显的血管收缩期间可能无法产生测量结果。 19 为了克服 CF LVAD 患者无创血压测量的局限性，Sajgalik 等人。 20 评估了新型肱袖压力实验血压 (ExpBP) 监测仪的有效性、可重复性和测量成功率。该 ExpBP 设备使用标准示波力学，具有低脉动性的定制硬件和软件，并且能够以 2 毫米汞柱/秒的速度测量袖带放气期间的脉动。 MAP 是通过编程算法在最大峰峰值振荡幅度下得出的，SBP 和舒张压 (DBP) 是使用先前验证的基于身高的标准获得的。由一名操作员在 LVAD 植入术后 2.6±3.4 天对 HM II (n= 20) 和 HVAD (n= 11) 患者进行测量，ExpBP
102 SAEED AND JORDE studies have only noted a good correlation with invasive SBP (r= 0.73) but not MAP (r= 0.53). 17 Although Doppler BP can be interpreted more accurately as SBP by noting a palpable pulse, 21 there remain inherent complexities of measurement requiring trained staff and potential for misinterpretation as MAP, which may lead to over treatment and risk of adverse hypotension-related events. Similar to the Doppler technique, BP recordings taken when finger pulse oximetry readings are restored during arm cuff deflation also have limited discrimination between SBP and MAP and are not obtainable in all patients. 18 BP measurement by slow cuff deflation systems such as the Terumo Elemano can further distinguish between MAP and SBP, but only yield consistent repeat measurements in 70–80% of patients. 17 Finger cuff methods such as the Nexfin device have provided accurate BP measurements at higher CF LVAD speeds corresponding to low PP, but these devices have not been validated in a large number of patients, require specialized equipment, and may not yield measurements during vasoconstriction apparent by cold extremities. 19 To surmount limitations of noninvasive BP measurement in CF LVAD patients, Sajgalik et al. 20 assessed the validity, repeatability, and measurement success rate of a novel brachial cuff pressure experimental BP (ExpBP) monitor. This ExpBP device used standard oscillometric mechanics, with customized hardware and software for low pulsatility and an ability to measure pulsations during cuff deflation at 2 mm Hg/second. MAP was derived at maximum peak to peak amplitude of oscillations by a programmed algorithm, and SBP and diastolic blood pressure (DBP) were obtained using previously validated heightbased criteria. Measured in both HM II (n= 20) and HVAD (n= 11) patients during the postoperative period at 2.6±3.4 days after LVAD implantation by a single operator, the ExpBP