Blood Pressure measurements are site dependent in a cohort of patients with neurological illness
Blood Pressure measurements are site dependent in a cohort of patients with neurological illness
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DOI：
10.1038/s41598-020-60414-7
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发表时间：
2020-02-25
影响因子：
4.6
通讯作者：
Olson, DaiWai M.
中科院分区：
文献类型：
--
作者：
Siaron, Kathrina B.;Cortes, Michaela X.;Olson, DaiWai M.
血压（BP）管理是重症监护的重要组成部分，直接影响发病率和死亡率。虽然BP已成为患者护理的支柱，但在常用部位（左上臂、右上臂等）测量BP的准确性和精确度仍有待提高。方法尚未建立。本研究通过检验血压测量值不因研究中心而异的零假设来填补文献中的这一空白。这是一项对80名神经重症监护病房患者进行的前瞻性、非随机、横断面研究。包括4个不同位置（双侧上臂、双侧手腕）的近同时无创血压（NIBP）读数，以及动脉内血压读数（IABP）（如可用）。采用Pearson相关系数和单因素重复测量方差分析观察收缩压、舒张压和平均动脉压（MAP）的相关性。在四个最常见部位（左上臂、左手腕、右上臂、右手腕）测量的BP具有足够的相关系数，但具有统计学显著性差异且高度不可预测。中心间收缩压变异性中位数为10 mmHg（IQR 2 - 10 mmHg）。中心间MAP变异性中位数为6 mmHg，四分位距（IQR）为3 - 9 mmHg。正如预期的那样，这些值相关，表明一个部位血压高的患者往往在另一个部位血压高。然而，不可预测的部位间变异性在临床环境中是令人担忧的，在临床环境中，BP测量部位通常未标准化，但所得值仍用于治疗。在4个最常见的测量部位测量的BP存在显著的部位间变异性。非侵入性（NIBP）和侵入性（IABP）评估方法之间的差异性持续存在。
Blood pressure (BP) management is a crucial part of critical care that directly affects morbidity and mortality. While BP has become a mainstay in patient care, the accuracy and precision of BP measures across commonly used sites (left upper arm, right upper arm, etc.) and methods have not been established. This study begins to fill this gap in literature by testing the null hypothesis that BP measurement does not vary according to site. This is a prospective, non-randomized, cross-sectional study of 80 neurocritical care unit patients. Near simultaneous non-invasive blood pressure (NIBP) readings from 4 different locations (bilateral upper arm, bilateral wrist) and, when available, intra-arterial blood pressure readings (IABP) were included. Pearson correlation coefficients and one-way repeated measures ANOVA were used to observe the systolic, diastolic, and mean arterial pressure (MAP) correlations. The BP measured at the four most common sites (left upper arm, left wrist, right upper arm, right wrist) had adequate correlation coefficients but were statistically significantly different and highly unpredictable. The median inter-site systolic variability was 10 mmHg (IQR 2 to 10 mmHg). The median inter-site MAP variability was 6mmHg with an interquartile range (IQR) of 3 to 9 mmHg. As expected, the values correlated to show that patients with high BP in one site tended to have high BP in another site. However, the unpredictable inter-site variability is concerning within the clinical setting where oftentimes BP measurement site is not standardized but resulting values are nevertheless used for treatment. There is prominent inter-site variability of BP measured across the 4 most common measurement sites. The variability persists across non-invasive (NIBP) and invasive (IABP) methods of assessment.