心房颤动血压测量方法的改进

发布时间：2018-04-28 05:38

本文选题：血压 + 桡动脉　；参考：《南昌大学》2016年博士论文

【摘要】：血压是人体的最重要的生理参数之一,是反应人体血流动力学状态的最主要的指标,合适的血压是维持正常血液循环的基础。血压过低过高都会对机体造成严重损害,需要进行及时有效干预,避免严重后果的产生。因而准确测量血压对于评价机体状况及临床疾病的诊断及治疗具有十分重要的意义。血压的测量包括直接测量和间接测量,间接测压就是无创血压测量,是临床应用最为广泛的测量血压的方法,目前无创血压测量最主要方法为:柯氏音听诊法和示波法电子血压计。最常用的示波法电子血压计采用的是“计算血压”的方式。任何机械的、电磁的干扰都会影响振荡波的图像,血压计自身滤波器不能完全排除这些混杂信号,所以环境因素对示波法电子血压计测值影响较大。高血压伴有心房颤动的患者十分常见,高血压增加心房颤动患者血栓事件发生率,尤其是脑卒中的发生率,心房颤动患者中血压的管理是一个十分重要问题,迄今为止无创血压测量方法在心房颤动时血压测值的准确性仍受到强烈质疑,因此提高心房颤动患者无创血压测量的准确性是一个重要的现实问题。基于上述原因,本研究将从以下三部分进行第一部分:脉搏波法血压计血压测量的研究目的:通过有创血压对比,观察新型脉搏波血压计血压测量的准确性。方法:本研究纳入2013年5月以来南昌大学第二附属医院收治的的择期经皮冠状动脉介入治疗(percutaneous coronary intervention PCI)患者45例,研究使用两种类型的自动血压测量装置,一个是示波法血压计(Microlife BP 3AC1-1),另一种是脉搏波法血压计(RGBP11,瑞光医疗设备有限公司,深圳,中国)。以有创桡动脉腔内血压为标准,比较两种无创血压计血压测值差别。结果:桡动脉腔内压在两组测量数值相似(145.1±27.7 vs 145.8±24.2mm Hg),但是示波法测量的收缩压值显著低于脉搏波法测得值(127.7±20.5 vs130.3±22.7 mm Hg,P0.05),示波法测量的差值要高于脉搏波法的差值(18.1±11.8 vs 14.8±12.8 mm Hg,P0.05)。肱-桡动脉差值的平均值为12.4mmhg,与示波法血压计所测得收缩压相比,脉博波血压计所测得的收缩压更接近肱动脉收缩压,二者差值为3.3 mm Hg。通过Bland-Altman图显示,以桡动脉内血压相比较,脉搏波法测量的收缩压95%的可信区间一致性界线比示波法测得值一致性界线要窄(12.0-17.5 vs 15.5-20.6 mm Hg)。然而,舒张压及平均动脉压二者95%的可信区间相近。结论:用桡动脉腔内压对照,同示波法血压计比较,脉搏波血压计能提供更准确的收缩压,相似的舒张压及平均动脉压。第二部分脉搏波血压计在心房颤动患者血压测量的研究目的:以水银柱血压计为对照,比较新型的脉搏波电子血压计与通用的示波法电子血压计在心房颤动患者血压测量的准确性。方法:选取40例心房颤动患者(22~83岁)。使用水银柱血压计、示波法电子血压计(Omron HEM7101)和脉搏波电子血压计(RG-BP11型,深圳瑞光康泰)为每一患者进行血压测量。电子血压计和水银柱血压计血压测量分别由2位医生负责。血压计使用顺序1为:示波法-水银柱-脉搏波-脉搏波-水银柱-示波法;顺序2为脉搏波-水银柱-示波法-示波法-水银柱-脉搏波。每一患者行6次血压测量,间隔2分钟。分别取2次水银柱、示波法和脉搏波法的数据的均值为各自的最终值。分别计算示波法和脉搏波法血压与水银柱法血压的差值。同时计算两次示波法(示波-示波)和两次脉搏波法(脉搏-脉搏)血压测值之间的差值。顺序1和2交叉应用。血压袖带均使用脉搏波血压计所配备的上臂带,连接三种血压计。结果:在心房颤动患者,研究发现示波法和脉搏波法收缩压相似,但均明显低于水银柱法收缩压(122.2±21.8和123.4±24.2比127.0±22.0 mm Hg,二组P值0.05)。示波法舒张压明显低于水银柱法的测值(68.0±10.3比72.2±11.9mm Hg,P0.05);而脉搏波法舒张压与水银柱法舒张压更为接近(70.3±14.8mm Hg);通过Bland-Altman图显示示波法-水银柱法收缩压差值与脉搏波法-水银柱法收缩压差值一致性界值要窄(9.0—-18.7 vs 15.5—-22.9);示波法-水银柱法舒张压差值与脉搏波法-水银柱法舒张压差值一致性界值要窄(11.4—-19.7 vs 22.4—-20.7)。结论:在心房颤动患者示波法电子血压计测值较脉搏波血压计测值更接近水银柱血压计测值。第三部分心房颤动患者血压测量方法的改进研究目的:探讨一种新的相对准确的心房颤动患者血压测量方法。方法:入选251例心房颤动患者与154例窦性节律患者作为对照组。分别应用示波法血压计测量脉率(PR),血压3次。3次测值之间的最大值和最小值差分别为△PR,△SBP和△DBP。根据△PR值分为0-5,6-10,11-15和15等4个亚组。结果:二组患者收缩压水平(120.8±20.6和122.6±11.4 mm Hg,NS)、舒张压(71.3±11.2和71.7±10.3 mm Hg,NS)相近;但收缩压差值(11.45±7.75和8.45±5.25mm Hg,P0.001),舒张压差值(8.48±6.75和5.27±5.77 mm Hg,P0.001)和脉率差值(12.1±8.6和4.10±3.21次/分,P0.001),房颤组显著大于窦性心律组;心房颤动组有更大的ΔPR(12.1±8.6 vs.4.10±3.21次/分,P0.001),在心房颤动组ΔPR和ΔSBP呈正相关(r=0.255,P0.001),但在窦性心律组二者无正相关。ΔSBP在0-5和6-10亚组同窦性心律组相似(9.58±5.61和10.67±6.77 vs.8.45±5.25 mm Hg,NS),而在ΔSBP 11-15和15亚组则明显比窦性心律组高。结论:应用示波血压计测量房颤患者血压,收缩压测值与脉率差具有紧密的联系。较大脉率变异的房颤患者,其血压测值也将有更大的变化。如果脉率差在0-10次/分中,房颤病人收缩压的测量是准确的。
[Abstract]:Blood pressure is one of the most important physiological parameters of the human body. It is the most important indicator of the hemodynamic state of the human body. The appropriate blood pressure is the basis for maintaining the normal blood circulation. Too low blood pressure will cause serious damage to the body. It is necessary to intervene in time and effectively to avoid serious consequences. Therefore, the accurate measurement of blood pressure is necessary. It is of great significance to evaluate the status of the body and the diagnosis and treatment of clinical diseases. The measurement of blood pressure includes direct measurement and indirect measurement. Indirect pressure measurement is noninvasive blood pressure measurement. It is the most widely used method for measuring blood pressure. The most important method of non-invasive blood pressure measurement is: Coriolis sound auscultation and oscillographic method. Sphygmomanometer. The most commonly used oscillographic sphygmomanometer is the "calculation of blood pressure". Any mechanical, electromagnetic interference will affect the image of the oscillating wave. The self filter of the sphygmomanometer can not completely eliminate these mixed signals, so the environmental factors have great influence on the measured values of the oscilloscope electronic blood pressure meter. Hypertension accompanied by atrial fibrillation. The incidence of thrombotic events in patients with atrial fibrillation, especially the incidence of cerebral apoplexy, is very common. The management of blood pressure in patients with atrial fibrillation is a very important problem. The accuracy of the measurement of blood pressure in atrial fibrillation by non invasive blood pressure measurement is still strongly questioned so far, thus improving atrial fibrillation. The accuracy of the patient's noninvasive blood pressure measurement is an important practical problem. Based on the above reasons, this study will take part in the first part of the three part: the purpose of the study of the blood pressure measurement of the pulse wave sphygmomanometer: To observe the accuracy of the new type of pulse wave sphygmomanometer by the contrast of invasive blood pressure. Methods: This study was included in May 2013. Since the Second Affiliated Hospital of Nanchang University, 45 patients with percutaneous coronary intervention PCI were treated with two types of automatic blood pressure measuring devices, one is the oscillographic sphygmomanometer (Microlife BP 3AC1-1), and the other is the pulse wave sphygmomanometer (RGBP11, REIA medical equipment). Limited company, Shenzhen, China). Compared the blood pressure difference between the two noninvasive blood pressure gauges with the standard of the intraluminal blood pressure in the radial artery. Results: the measured values of the two groups were similar (145.1 + 27.7 vs 145.8 + 24.2mm Hg), but the systolic pressure measured by the oscillographic method was significantly lower than that of the pulse wave method (127.7 + 20.5 vs130.3 + 22.7 mm Hg, P0.05) the difference between the oscilloscope and the pulse wave method was higher than the difference between the pulse wave method (18.1 + 11.8 vs 14.8 + 12.8 mm Hg, P0.05). The mean value of the difference value of the brachial radial artery was 12.4mmhg. The systolic pressure measured by the pulse wave sphygmomanometer was closer to the brachial systolic pressure compared with the oscillographic sphygmomanometer, and the difference value of the two was 3.3 mm Hg. through Bland-Altman. The map shows that the conformance boundary of the confidence interval of 95% of systolic blood pressure measured by pulse wave method is narrower than that measured by Oscillographic method (12.0-17.5 vs 15.5-20.6 mm Hg). However, the confidence interval of 95% of the diastolic pressure and mean arterial pressure of two is similar. Comparison, pulse wave sphygmomanometer can provide more accurate systolic pressure, similar diastolic pressure and mean arterial pressure. The purpose of the second part pulse wave sphygmomanometer in patients with atrial fibrillation: compared with the mercury sphygmomanometer, compared with the new pulse wave electronic sphygmomanometer and the universal oscillographic sphygmomanometer in patients with atrial fibrillation. Methods: the accuracy of blood pressure measurement. Methods: 40 patients with atrial fibrillation (22~83 years old) were measured by the mercury sphygmomanometer, Omron HEM7101 and pulse wave electronic sphygmomanometer (RG-BP11 type, Shenzhen ray Kangtai) for each patient's blood pressure measurement. The blood pressure meter and the mercury sphygmomanometer were measured by 2 doctors, respectively. Responsibility. The order of the use of the sphygmomanometer is 1: oscilloscope - mercury column pulse wave pulse wave - mercury column - oscilloscope; sequence 2 is pulse wave - mercury column - oscilloscope - oscilloscope - mercury column pulse wave. 6 times of blood pressure measurement in each patient, interval of 2 minutes, 2 times of mercury column, and the mean value of the data of oscilloscope and pulse wave method are the final values respectively. The difference between the blood pressure of the blood pressure and the mercury column method was calculated by the oscilloscope and pulse wave method. The difference between the two oscilloscope (oscillographic wave) and the two pulse wave method (pulse pulse) was calculated. The sequence 1 and the 2 cross application. The blood pressure cuff used the upper arm of the pulse wave sphygmomanometer and connected three kinds of sphygmomanometer. Results: in the atrial fibrillation. The study found that the systolic pressure of the oscilloscope and pulse wave method was similar, but obviously lower than the systolic pressure of the mercury column method (122.2 + 21.8 and 123.4 + 24.2 to 127 + 22 mm Hg, two P values 0.05). The diastolic pressure of the oscillographic method was significantly lower than that of the mercury column method (68 + 10.3 to 72.2 + 11.9mm Hg, P0.05), while the diastolic pressure of the pulse wave method and the mercury column method diastolic The pressure was closer (70.3 + 14.8mm Hg); the boundary value of the difference between the systolic pressure difference between the oscilloscope and the pulse wave method and the mercury column method was narrower (9 - -18.7 vs 15.5 - -22.9) by the Bland-Altman diagram; the difference between the diastolic pressure difference of the oscilloscope - mercury column method and the pulse wave method - the diastolic pressure difference between the pulse wave method and the mercury column method was narrow (11.4 -19.7 vs 22.4 - -20.7) conclusion: the measured values of the oscilloscope electronic sphygmomanometer in the patients with atrial fibrillation are closer to the value of the mercury sphygmomanometer than the pulse wave sphygmomanometer. Third the improvement of the blood pressure measurement method for the patients with atrial fibrillation: a new relatively accurate method of measuring the blood pressure of the patients with atrial fibrillation. Method: 2 51 patients with atrial fibrillation and 154 patients with sinus rhythm were used as the control group. The pulse rate (PR) was measured with the oscillographic sphygmomanometer. The maximum and minimum difference between the 3 times of blood pressure 3 times.3 and the delta SBP and delta DBP. were divided into 4 subgroups of 0-5,6-10,11-15 and 15 according to the delta P value. The results showed that the systolic pressure level of the two groups was 120.8 + 20.6. With 122.6 + 11.4 mm Hg, NS), diastolic pressure (71.3 + 11.2 and 71.7 + 10.3 mm Hg, NS) was similar, but systolic pressure difference (11.45 + 7.75 and 8.45 + 5.25mm Hg, P0.001), diastolic pressure difference (8.48 + 6.75 and 5.27 + 5.77 mm Hg, P0.001) and pulse rate difference was significantly greater than that in sinus rhythm group; atrial fibrillation group was more The large delta PR (12.1 + 8.6 vs.4.10 + 3.21 / min, P0.001) was positively correlated in the atrial fibrillation group Delta PR and delta SBP (r=0.255, P0.001), but there was no positive correlation in the sinus rhythm group. The delta SBP in the 0-5 and 6-10 subgroups was similar to the sinus rhythm group (9.58 + 5.61 and 10.67 + 6.77 vs.8.45 + 5.25 mm Hg, NS), while the delta 11-15 and 15 subgroups were significantly more than the sinus rhythm. Conclusion: the measurement of systolic blood pressure is closely related to the measurement of blood pressure in patients with atrial fibrillation using a oscillographic sphygmomanometer. The measurement of blood pressure in patients with atrial fibrillation with large pulse rate variation will also have a greater change. If the pulse rate difference is in the 0-10 / sub, the measurement of systolic pressure in patients with atrial fibrillation is accurate.

【学位授予单位】：南昌大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R541.75;R443.5

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