Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children
Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children
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DOI：
10.1097/01.pcc.0000257039.32593.dc
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发表时间：
2007-03-01
影响因子：
4.1
通讯作者：
Zaritsky, Arno L.
中科院分区：
文献类型：
--
作者：
Haque, Ikram U.;Zaritsky, Arno L.
目的：收缩压（SBP）和平均动脉压（MAP）是儿童收缩期低血压的重要评价指标，但不同来源的收缩压低血压定义差异较大，且MAP无正常参考值。我们的目标是计算第5百分位数的SBP和MAP值的儿童最近更新的数据公布的工作组的国家高血压教育计划，并比较这些值与最低限度的可接受的SBP和MAP定义的不同sources.Design：临床database. Methods数学分析。来自工作组数据的第50和第95百分位数SBP值用于推导按身高比例分层的1 - 17岁儿童的第5百分位数值。使用标准数学公式计算MAP值。将计算的SBP值与其他来源的收缩期低血压定义进行比较。应用线性回归分析建立简单的公式，以估计不同年龄组在第50次身高测试时的第5百分位数SBP和第5百分位数MAP。在相同年龄组中，不同身高组的SBP和MAP值范围为9-21%。用于定义不同来源低血压的第5百分位数SBP值高于我们在儿童中的计算值，但低于我们在青少年中的计算值。正常儿童SBP和MAP（mmHg）的临床计算公式为：SBP（50 th身高百分位数）= 2 ×年龄（岁）+ 65，MAP（50 th身高百分位数）= 1.5 ×年龄（岁）+ 40，MAP（50 th身高百分位数）= 1.5 ×年龄（岁）+55。我们开发了第5百分位数SBP值的新估计值，并创建了正常MAP值表供参考。SBP受身高的显著影响，这在以前没有考虑过。尽管SBP的估计下限低于目前用于定义低血压的值，但这些值来自正常健康儿童，可能不适用于危重病儿童。我们的数据表明，目前的低血压值是没有证据的，可能需要调整患者的身高，最重要的是，临床条件。具体来说，我们建议不应使用正常儿童的低血压定义来定义SBP目标;在许多危重和受伤儿童中，更高的目标SBP可能是合适的。需要进一步的研究来评估确定低血压的适当SBP阈值。
Objective: Systolic blood pressure (SBP) and mean arterial pressure (MAP) are essential evaluation elements in ill children, but there is wide variation among different sources defining systolic hypotension in children, and there are no normal reference values for MAP. Our goal was to calculate the 5th percentile SBP and MAP values in children from recently updated data published by the task force working group of the National High Blood Pressure Education Program and compare these values with the lowest limit of acceptable SBP and MAP defined by different sources.Design: Mathematical analysis of clinical database.Methods. The 50th and 95th percentile SBP values from task force data were used to derive the 5th percentile value for children from 1 to 17 yrs of age stratified by height percentiles. MAP values were calculated using a standard mathematical formula. Calculated SBP values were compared with systolic hypotension definitions from other sources. Linear regression analysis was applied to create simple formulas to estimate 5th percentile SBP and 5th and 50th percentile MAP for different age groups at the 50th height percentile.Results. A 9-21% range in both SBP and MAP values was noted for different height percentiles in the same age groups. The 5th percentile SBP values used to define hypotension by different sources are higher than our calculated values in children but are lower than our calculated values in adolescents. Clinical formulas for calculation of SBP and MAP (mm Hg) in normal children are as follows: SBP (5th percentile at 50th height percentile) = 2 x age in years + 65, MAP (5th percentile at 50th height percentile) = 1.5 x age in years + 40, and MAP (50th percentile at 50th height percentile) = 1.5 x age in years + 55.Conclusion. We developed new estimates for values of 5th percentile SBP and created a table of normal MAP values for reference. SBP is significantly affected by height, which has not been considered previously. Although the estimated lower limits of SBP are lower than currently used to define hypotension, these values are derived from normal healthy children and are likely not appropriate for critically, ill children. Our data suggest that the current values for hypotension are not evidence-based and may need to be adjusted for patient height and, most important, for clinical condition. Specifically, we suggest that the definition of hypotension derived from normal children should not be used to define the SBP goal; a higher target SBP is likely appropriate in many critically ill and injured children. Further studies are needed to evaluate the appropriate threshold values of SBP for determining hypotension.