危重症患者床旁无创与有创血压监测的一致性评价及相关性分析

Evaluation of consistency and correlation between non-invasive and invasive blood pressure monitoring among critically illed patients

摘要:

目的：评价危重症患者床旁有创血压（invasive blood pressure，IBP）与无创血压（non-invasive blood pressure，NIBP）监测的一致性及相关性。方法：随机选择2010年3月-2012年3月宁夏医科大学总医院重症医学科收治的500例危重患者，同步进行右侧桡动脉IBP和双侧肱动脉NIBP监测。依据IBP水平分为3组：A组，收缩压（systolic blood pressure，SBP）＜90 mmHg，116例；B组，SBP 90～140 mmHg，172例；C组，SBP≥140 mmHg，212例。采用Bland-Altman分析、Spearman分析评价NIBP与IBP监测的一致性及相关性。结果：（１）一致性分析显示A组患者有创SBP值与无创SBP值间差值平均水平为-2.9 mmHg（左肱动脉）及-5.6 mmHg（右肱动脉），B组为4.5 mmHg及1.9 mmHg，C组达20.0 mmHg及17.3 mmHg。A组超一致性上限、下限范围发生率为0%、3.4%（左肱动脉）及0.0%、4.3%（右肱动脉），B组为1.7%、3.5%及1.7%、2.3%，C组达2.0%、0.0%及2.0%、0.0%。（２）一致性分析显示A组患者有创舒张压（diastolic blood pressure，DBP）值与无创DBP值间差值平均水平为-3.5 mmHg（左肱动脉）及-5.8 mmHg（右肱动脉），B组为-3.2 mmHg及-3.5 mmHg，C组达0.3 mmHg及1.2 mmHg。A组超一致性上限、下限范围发生率为6.0%、1.7%（左肱动脉）及3.4%、2.6%（右肱动脉），B组为1.2%、2.9%及1.7%、3.5%，C组达2.4%、4.2%及3.3%、2.8%。（３）相关分析显示A组患者无创SBP与有创SBP间rs为0.105～0.108，B组达0.417～0.444，而C组降至0.144～0.166。DBP间比较，A组为0.409～0.427，B组达0.598～0.617，C组为0.546～0.596。结论：危重症患者低血压及高血压状态下IBP与NIBP间相关性显著下降，低血压状态下NIBP监测值易高估患者实际血压水平，而高血压状态下表现低估患者血压水平。

Abstract:

Objective：To evaluate the consistency and correlation between invasive blood pressure（IBP） and non-invasive blood pressure（NIBP） in critically illed patients. Methods：Five hundred critically illed patients in department of critical care medicine in General Hospital of NingXia Medical University from March 2010 to March 2012 were randomly enrolled. Right radial artery IBP monitoring and bilateral brachial artery NIBP monitoring were conducted synchronistically. According to IBP level，patients were divided into three groups：group A，systolic blood pressure（SBP）< 90 mmHg，n=116；group B，SBP 90-140 mmHg，n=172；group C，SBP≥140 mmHg，n=212. Methods of correlation coefficient and Bland-Altman analysis were employed to assess the correlation and consistency of NIBP and IBP. Results：（１）Consistency analysis showed that the average difference levels for invasive SBP and non-invasive SBP in group A were accordingly -2.9 mmHg（left brachial artery） and -5.6 mmHg（right brachial artery），in group B（4.5 mmHg and 1.9 mmHg），in group C（20 mmHg and 17.3 mmHg），respectively. Incidences beyond the consistency zone of upper and lower limit in group A were 0.0%，3.4%（left brachial artery） and 0.0%，4.3%（right brachial artery），in group B（1.7%，3.5% and 1.7%，2.3%），in group C（2.0%，0.0% and 2.0%，0.0%），respectively. （２）Consistency analysis showed that average difference levels for invasive diastolic blood pressure（DBP） and non-invasive DBP in group A were accordingly -3.5 mmHg（left brachial artery） and -5.8 mmHg（right brachial artery），in group B（-3.2 mmHg and -3.5 mmHg），in group C（0.3 mmHg and 1.2 mmHg），respectively. Incidences beyond the consistency zone of upper and lower limit in group B were 6.0%，1.7%（left brachial artery） and 3.4%，2.6%（right brachial artery），in group B（1.2%，2.9% and 1.7%，3.5%），in group C（2.4%，4.2% and 3.3%，2.8%），respectively. ③Correlation coefficients between invasive and non-invasive SBP of three groups were accordingly 0.105-0.108（group A），0.417-0.444（group B） and 0.144-0.166（group C）. As to DBP，they were 0.409-0.427（group A），0.598-0.617（group B） and 0.546-0.596（group C）. Conclusions：During hypotension and hypertension in critically illed patients，consistency between IBP and NIBP is obviously decreased. NIBP monitoring tends to overestimate or underestimate patient’s real blood pressure.