Automated blood pressure measurement may not improve efficiency if manual technique was suboptimal.
Automated blood pressure measurement may not improve efficiency if manual technique was suboptimal.
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如果手动技术不理想，自动血压测量可能不会提高效率。
DOI：
10.1111/jch.13263
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Cooper,LisaA
中科院分区：
文献类型：
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作者：
Boonyasai,RomsaiT;Dietz,KatherineB;McCannon,ErikaL;Cooper,LisaA
致编辑：亚罗斯博士提出了一个令人信服的理由，即初级保健办公室应该用自动化设备取代手动血压计。 1 我们同意这一目标，但认为他可能夸大了自动化设备降低血压读数的可能性，或者医疗办公室实现节省时间的可能性。他的案例基于两个原则：(1) 示波血压读数通常低于手动获得的血压读数，(2) 医护人员使用自动化设备获得的血压读数比使用听诊技术更快。示波血压读数低于用听诊技术测量的血压读数是有据可查的，但应该指出的是，研究经常将自动化设备与研究质量的手动技术进行比较。 2 如果执行正确，自动化设备也明显比听诊技术更快。 3 因此，人们可能期望初级保健办公室只需使用自动化设备即可提高高血压控制率和患者流量。然而，在我们正在进行的涉及 30 个初级保健办公室的研究中，4 我们发现现实世界的卫生保健工作者常常无法正确执行听诊技术；具体来说，许多人对血压袖带放气过快。因此，一些采用自动化设备的办公室的高血压控制率下降，但对效率没有影响或产生负面影响。指南建议血压袖带放气速度不超过 2-3 毫米汞柱/秒。 5 其根本原因是，当血压计上的指针下降时，它所经过的每个抽动标记都必须与心跳相关联，以确保当第 1 次和第 5 次柯氏音出现和消失时，指针指向正确的血压。如果患者的真实血压为 140/70 毫米汞柱，脉搏为 60 次/分钟，医护人员必须花费 60 秒的时间将血压袖带从推荐的高于最低充气水平 30 毫米汞柱的压力降至确保医生不会错过听诊间隙 (170-50 毫米汞柱) 的水平。血压袖带放气速度超过此速度会显着增加低估患者“真实”血压的可能性。 6 Yarows 博士报告称，执行一次手动测量的所有方面（包括袖带充气和放气）平均需要 58.6 秒。因此，我们毫不惊讶地发现，在他的实践中，使用示波技术测量的血压测量结果高出 10/6 mm Hg。在我们的工作中，我们发现医护人员对血压袖带放气的速度要快得多，从袖带最大充气到放气的平均时间为 13.2 秒。因此，我们研究中的几位 PCP 抱怨说，
To the Editor: Dr. Yarows makes a compelling case that primary care offices should replace manual sphygmomanometers with automated devices. 1 We agree with this goal, but believe that he may overstate the likelihood that automated devices will lead to lower BP readings, or that medical offices will realize the time savings. His case is based on two principles:(1) oscillometric BP readings are often lower than those obtained manually, and (2) a health-care worker can obtain BP readings faster with automated devices than he or she could using auscultatory technique. That oscillometric BP readings are lower than those measured with auscultatory technique is well-documented, but it should be noted that studies often compare automated devices with research-quality manual techniques. 2 Automated devices are also clearly faster than the auscultatory technique when performed correctly. 3 Thus, one might expect primary care offices would improve hypertension control rates and patient flow simply by using automated devices. However, in our ongoing study involving 30 primary care offices, 4 we have found that realworld health-care workers often do not perform the auscultatory technique correctly; specifically, many deflate the BP cuff too quickly. Therefore, some offices that adopt automated devices have seen hypertension control rates worsen, and experienced no or negative effect on efficiency.Guidelines recommend deflating BP cuffs no faster than 2-3 mm Hg/s. 5 The underlying reason for this is, as the needle on the sphygmomanometer gauge descends, each tic mark it passes must be linked with a heartbeat in order to ensure that the needle is pointing at the correct BP when the 1st and 5th Korotkoff sounds appear and disappear. If a patient has a true BP of 140/70 mm Hg and pulse of 60 bpm, a health-care worker would have to allocate 60 seconds simply to deflate the blood pressure cuff from the recommended 30 mm Hg above the minimum inflation level to a level that ensures the physician does not miss an auscultatory gap (170-50 mm Hg). Deflating a BP cuff faster than this significantly increases the potential that one underestimates a patient’s “true” BP. 6 Dr. Yarows reported needing an average 58.6 seconds to perform all aspects of a single manual measurement, including cuff inflation and deflation. Thus, we were unsurprised to read that BP measurements in his practice were 10/6 mm Hg higher with the oscillometric technique. In our work, we have found that healthcare workers deflate BP cuffs far faster, with average time from maximum cuff inflation to deflation completed in 13.2 seconds. As a result, several PCPs in our study have complained that the