發(fā)布時間：2018-04-28 05:38

  本文選題：血壓 + 橈動脈�。� 參考：《南昌大學(xué)》2016年博士論文

【摘要】：血壓是人體的最重要的生理參數(shù)之一,是反應(yīng)人體血流動力學(xué)狀態(tài)的最主要的指標(biāo),合適的血壓是維持正常血液循環(huán)的基礎(chǔ)。血壓過低過高都會對機(jī)體造成嚴(yán)重?fù)p害,需要進(jìn)行及時有效干預(yù),避免嚴(yán)重后果的產(chǎn)生。因而準(zhǔn)確測量血壓對于評價機(jī)體狀況及臨床疾病的診斷及治療具有十分重要的意義。血壓的測量包括直接測量和間接測量,間接測壓就是無創(chuàng)血壓測量,是臨床應(yīng)用最為廣泛的測量血壓的方法,目前無創(chuàng)血壓測量最主要方法為:柯氏音聽診法和示波法電子血壓計。最常用的示波法電子血壓計采用的是“計算血壓”的方式。任何機(jī)械的、電磁的干擾都會影響振蕩波的圖像,血壓計自身濾波器不能完全排除這些混雜信號,所以環(huán)境因素對示波法電子血壓計測值影響較大。高血壓伴有心房顫動的患者十分常見,高血壓增加心房顫動患者血栓事件發(fā)生率,尤其是腦卒中的發(fā)生率,心房顫動患者中血壓的管理是一個十分重要問題,迄今為止無創(chuàng)血壓測量方法在心房顫動時血壓測值的準(zhǔn)確性仍受到強(qiáng)烈質(zhì)疑,因此提高心房顫動患者無創(chuàng)血壓測量的準(zhǔn)確性是一個重要的現(xiàn)實問題�；谏鲜鲈�,本研究將從以下三部分進(jìn)行第一部分:脈搏波法血壓計血壓測量的研究目的:通過有創(chuàng)血壓對比,觀察新型脈搏波血壓計血壓測量的準(zhǔn)確性。方法:本研究納入2013年5月以來南昌大學(xué)第二附屬醫(yī)院收治的的擇期經(jīng)皮冠狀動脈介入治療(percutaneous coronary intervention PCI)患者45例,研究使用兩種類型的自動血壓測量裝置,一個是示波法血壓計(Microlife BP 3AC1-1),另一種是脈搏波法血壓計(RGBP11,瑞光醫(yī)療設(shè)備有限公司,深圳,中國)。以有創(chuàng)橈動脈腔內(nèi)血壓為標(biāo)準(zhǔn),比較兩種無創(chuàng)血壓計血壓測值差別。結(jié)果:橈動脈腔內(nèi)壓在兩組測量數(shù)值相似(145.1±27.7 vs 145.8±24.2mm Hg),但是示波法測量的收縮壓值顯著低于脈搏波法測得值(127.7±20.5 vs130.3±22.7 mm Hg,P0.05),示波法測量的差值要高于脈搏波法的差值(18.1±11.8 vs 14.8±12.8 mm Hg,P0.05)。肱-橈動脈差值的平均值為12.4mmhg,與示波法血壓計所測得收縮壓相比,脈博波血壓計所測得的收縮壓更接近肱動脈收縮壓,二者差值為3.3 mm Hg。通過Bland-Altman圖顯示,以橈動脈內(nèi)血壓相比較,脈搏波法測量的收縮壓95%的可信區(qū)間一致性界線比示波法測得值一致性界線要窄(12.0-17.5 vs 15.5-20.6 mm Hg)。然而,舒張壓及平均動脈壓二者95%的可信區(qū)間相近。結(jié)論:用橈動脈腔內(nèi)壓對照,同示波法血壓計比較,脈搏波血壓計能提供更準(zhǔn)確的收縮壓,相似的舒張壓及平均動脈壓。第二部分脈搏波血壓計在心房顫動患者血壓測量的研究目的:以水銀柱血壓計為對照,比較新型的脈搏波電子血壓計與通用的示波法電子血壓計在心房顫動患者血壓測量的準(zhǔn)確性。方法:選取40例心房顫動患者(22~83歲)。使用水銀柱血壓計、示波法電子血壓計(Omron HEM7101)和脈搏波電子血壓計(RG-BP11型,深圳瑞光康泰)為每一患者進(jìn)行血壓測量。電子血壓計和水銀柱血壓計血壓測量分別由2位醫(yī)生負(fù)責(zé)。血壓計使用順序1為:示波法-水銀柱-脈搏波-脈搏波-水銀柱-示波法;順序2為脈搏波-水銀柱-示波法-示波法-水銀柱-脈搏波。每一患者行6次血壓測量,間隔2分鐘。分別取2次水銀柱、示波法和脈搏波法的數(shù)據(jù)的均值為各自的最終值。分別計算示波法和脈搏波法血壓與水銀柱法血壓的差值。同時計算兩次示波法(示波-示波)和兩次脈搏波法(脈搏-脈搏)血壓測值之間的差值。順序1和2交叉應(yīng)用。血壓袖帶均使用脈搏波血壓計所配備的上臂帶,連接三種血壓計。結(jié)果:在心房顫動患者,研究發(fā)現(xiàn)示波法和脈搏波法收縮壓相似,但均明顯低于水銀柱法收縮壓(122.2±21.8和123.4±24.2比127.0±22.0 mm Hg,二組P值0.05)。示波法舒張壓明顯低于水銀柱法的測值(68.0±10.3比72.2±11.9mm Hg,P0.05);而脈搏波法舒張壓與水銀柱法舒張壓更為接近(70.3±14.8mm Hg);通過Bland-Altman圖顯示示波法-水銀柱法收縮壓差值與脈搏波法-水銀柱法收縮壓差值一致性界值要窄(9.0—-18.7 vs 15.5—-22.9);示波法-水銀柱法舒張壓差值與脈搏波法-水銀柱法舒張壓差值一致性界值要窄(11.4—-19.7 vs 22.4—-20.7)。結(jié)論:在心房顫動患者示波法電子血壓計測值較脈搏波血壓計測值更接近水銀柱血壓計測值。第三部分心房顫動患者血壓測量方法的改進(jìn)研究目的:探討一種新的相對準(zhǔn)確的心房顫動患者血壓測量方法。方法:入選251例心房顫動患者與154例竇性節(jié)律患者作為對照組。分別應(yīng)用示波法血壓計測量脈率(PR),血壓3次。3次測值之間的最大值和最小值差分別為△PR,△SBP和△DBP。根據(jù)△PR值分為0-5,6-10,11-15和15等4個亞組。結(jié)果:二組患者收縮壓水平(120.8±20.6和122.6±11.4 mm Hg,NS)、舒張壓(71.3±11.2和71.7±10.3 mm Hg,NS)相近;但收縮壓差值(11.45±7.75和8.45±5.25mm Hg,P0.001),舒張壓差值(8.48±6.75和5.27±5.77 mm Hg,P0.001)和脈率差值(12.1±8.6和4.10±3.21次/分,P0.001),房顫組顯著大于竇性心律組;心房顫動組有更大的ΔPR(12.1±8.6 vs.4.10±3.21次/分,P0.001),在心房顫動組ΔPR和ΔSBP呈正相關(guān)(r=0.255,P0.001),但在竇性心律組二者無正相關(guān)。ΔSBP在0-5和6-10亞組同竇性心律組相似(9.58±5.61和10.67±6.77 vs.8.45±5.25 mm Hg,NS),而在ΔSBP 11-15和15亞組則明顯比竇性心律組高。結(jié)論:應(yīng)用示波血壓計測量房顫患者血壓,收縮壓測值與脈率差具有緊密的聯(lián)系。較大脈率變異的房顫患者,其血壓測值也將有更大的變化。如果脈率差在0-10次/分中,房顫病人收縮壓的測量是準(zhǔn)確的。
[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.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R541.75;R443.5

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