102例危重病患者有创血压和无创血压的对比

doi:10.3877/cma.j.issn.2096-1537.2019.01.004

目的

比较102例危重病患者有创血压（IBP）和无创血压（NBP）测量结果的一致性。

方法

收集2016年3~9月在西安交通大学第二附属医院重症医学科住院治疗的102例危重病患者的尺/桡动脉IBP和同侧上臂NBP数据1072对，先对所有数据分别按收缩压、舒张压、脉压（PP）和平均动脉压（MAP）进行配对t检验；再将数据分为高血压组（MAP≥107 mmHg）（1 mmHg=0.133 kPa）、正常血压组（70 mmHg≤MAP<107 mmHg）和低血压组（MAP<70 mmHg）三个亚组，分别进行IBP和NBP的收缩压、舒张压、PP以及MAP间的配对t检验。以P<0.05为差异具有统计学意义。

结果

有创收缩压和无创收缩压之间比较，差异具有统计学意义［（128.08±35.48）mmHg vs（122.56±24.84）mmHg，t=7.896，P<0.001）］；有创舒张压和无创舒张压之间比较，差异具有统计学意义［（65.66±13.69）mmHg vs（67.98±13.31）mmHg，t=-8.294，P<0.001］；有创PP和无创PP之间比较，差异具有统计学意义［（62.42±28.93）mmHg vs（54.58±20.00）mmHg，t=11.697，P<0.001］；有创MAP和无创MAP之间比较，差异无统计学意义［（86.47±18.94）mmHg vs（86.17±15.33）mmHg，t=0.867，P=0.386］。亚组分析显示高血压组（n=254）：有创收缩压和无创收缩压之间比较，差异具有统计学意义［（163.75±33.93）mmHg vs（152.16±16.78）mmHg，t=6.52，P<0.001］，有创舒张压和无创舒张压之间比较，差异具有统计学意义［（79.17±11.03）mmHg vs（83.69±9.50）mmHg，t=-6.85，P<0.001）］，有创PP和无创PP之间比较，差异具有统计学意义［（84.57±31.50）mmHg vs （68.47±20.72）mmHg，t=9.76，P<0.001］；正常血压组（n=687）：有创收缩压和无创收缩压之间比较，差异具有统计学意义［（122.66±24.74）mmHg vs（118.70±15.14）mmHg，t=5.071，P<0.001）］，有创舒张压和无创舒张压之间比较，差异具有统计学意义［（63.97±10.34）mmHg vs（65.60±8.49）mmHg，t=-5.049，P<0.001）］，有创PP和无创PP之间比较，差异具有统计学意义［（58.69±23.05）mmHg vs （53.10±11.90）mmHg，t=7.682，P<0.001］；低血压组（n=131）：有创收缩压和无创收缩压之间比较，差异无统计学意义［（87.35±24.33）mmHg vs（85.41±11.99）mmHg，t=1.109，P=0.269］，有创舒张压和无创舒张压之间比较，差异具有统计学意义［（48.32±8.27）mmHg vs（49.98±8.06）mmHg，t=-2.073，P=0.040］，有创PP和无创PP之间比较，差异具有统计学意义［（39.03±24.00）mmHg vs（35.43±13.97）mmHg，t=1.806，P<0.001］。

结论

有创收缩压大于无创收缩压、有创舒张压小于无创舒张压、有创PP大于无创PP，而有创MAP等于无创MAP。采用MAP数值较采用收缩压和（或）舒张压数值可以消除IBP和NBP测量之间的差异。

关键词: 有创血压, 无创血压, 收缩压, 舒张压, 平均动脉压, 脉压

Objective

To compare the differences between noninvasive and invasive blood pressure in critical ill patients.

Methods

1072 pairs of invasive blood pressure by radial/ulnar artery catheter and noninvasive blood pressure by cuff on the same arm were collected from March 2016 to September 2016. The systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure were analyzed by paired t-test. In addition, the same comparison was performed in subgroups, high blood pressure (MAP≥97 mmHg) (1 mmHg=0.133 kPa), normal blood pressure (70 mmHg≤MAP<97 mmHg) and low blood pressure (MAP<70 mmHg) according to the noninvasive mean blood pressure. Two-tailed P-values<0.05 were considered statistically significant.

Results

There was a significant statistically difference between invasive systolic blood pressure and the noninvasive systolic pressure [(128.08±35.48) mmHg vs (122.56±24.84) mmHg, t=7.896, P<0.01). Similar results were found between invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(65.66±13.69) mmHg vs (67.98±13.31) mmHg, t=-8.294, P<0.01], also the invasive pulse pressure and the noninvasive pulse pressure [(62.42±28.93) mmHg vs (54.58±20.00) mmHg, t=11.697, P<0.01]. However, no significant difference was found between the invasive and noninvasive mean arterial pressure [(86.47±18.94) mmHg vs (86.17±15.33) mmHg, t=0.867, P=0.386]. Subgroups analysis showed that in the high blood pressure subgroup (n=254), a significant statistically difference exists between invasive systolic blood pressure and the noninvasive systolic pressure [(163.75±33.93) mmHg vs (152.16±16.78) mmHg, t=6.52, P<0.001] as well as invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(79.17±11.03) mmHg vs (83.69±9.50) mmHg, t=-6.85, P<0.001], similarly results were also found in invasive pulse pressure and the noninvasive pulse pressure [(84.57±31.50) mmHg vs (68.47±20.72) mmHg, t=9.76, P<0.001]; in normal blood subgroup (n=687), a statistically difference exists in systolic blood pressure, diastolic blood pressure and pulse pressure, respectively between invasive and non-invasive measurements [(122.66±24.74) mmHg vs (118.70±15.14) mmHg, t=5.071, P<0.001; (63.97±10.34) mmHg vs (65.60±8.49) mmHg, t=-5.049, P<0.001; (58.69±23.05) mmHg vs (53.10±11.90) mmHg, t=7.682, P<0.001]; by contrast, in low blood pressure subgroup (n=131), no significant statistically difference was found in invasive systolic blood pressure and the noninvasive systolic pressure [(87.35±24.33) mmHg vs (85.41±11.99) mmHg, t=1.109, P=0.269], significant difference was found between invasive diastolic blood pressure and the noninvasive diastolic blood pressure [(48.32±8.27) mmHg vs (49.98±8.06) mmHg, t=-2.073, P=0.040], as well as invasive pulse pressure and the noninvasive pulse pressure [(39.03±24.00) mmHg vs (35.43±13.97) mmHg, t=1.806, P<0.001].

Conclusions

The invasive systolic blood pressure is higher than the noninvasive systolic blood pressure while the invasive diastolic blood pressure is lower than the noninvasive diastolic blood pressure and the invasive pulse pressure is higher than the noninvasive pulse pressure. No difference is found between the invasive and the noninvasive mean arterial pressure. The mean blood pressure may eliminate the differences between invasive and noninvasive blood pressure.

Key words: Invasive blood pressure, Noninvasive blood pressure, Systolic blood pressure, Diastolic blood pressure, Pulse pressure, Mean arterial blood pressure

表1 不同血压亚组之间一般资料的比较

不同亚组	例数	年龄（岁，±s）	男/女（例）	APACHE Ⅱ评分（分，±s）	n
高血压组	25	58±5	13/12	19±7	254
正常血压组	64	56±3	34/30	14±4	687
低血压组	13	60±8	7/6	24±8	131
合计	102	57±8	54/48	18±5	1072

表1 不同血压亚组之间一般资料的比较

不同亚组	例数	年龄（岁，±s）	男/女（例）	APACHE Ⅱ评分（分，±s）	n
高血压组	25	58±5	13/12	19±7	254
正常血压组	64	56±3	34/30	14±4	687
低血压组	13	60±8	7/6	24±8	131
合计	102	57±8	54/48	18±5	1072

表2 有创和无创之间SBP、DBP、PP、MAP的比较（mmHg，±s）

类别	SBP	DBP	PP	MAP
有创	128.08±35.48	65.66±13.69	62.42±28.93	86.47±18.94
无创	122.56±24.84	67.98±13.31	54.58±20.00	86.17±15.33
t值	7.896	-8.294	11.697	0.867
P值	<0.001	<0.001	<0.001	0.386

表2 有创和无创之间SBP、DBP、PP、MAP的比较（mmHg，±s）

类别	SBP	DBP	PP	MAP
有创	128.08±35.48	65.66±13.69	62.42±28.93	86.47±18.94
无创	122.56±24.84	67.98±13.31	54.58±20.00	86.17±15.33
t值	7.896	-8.294	11.697	0.867
P值	<0.001	<0.001	<0.001	0.386

表3 不同血压亚组之间IBP与IBP的比较（mmHg，±s）

不同亚组		IBP	NBP	t值	P值
高血压组（n=254）		?	?	?	?
?	SBP	163.75±33.93	152.16±16.78	6.52	<0.001
?	DBP	79.17±11.03	83.69±9.50	-6.85	<0.001
?	PP	84.57±31.50	68.47±20.72	9.76	<0.001
?	MAP	107.36±15.63	106.51±7.66	0.99	0.286
正常血压组（n=687）		?	?	?	?
?	SBP	122.66±24.74	118.70±15.14	5.071	<0.001
?	DBP	63.97±10.34	65.60±8.49	-5.049	<0.001
?	PP	58.69±23.05	53.10±11.90	7.682	<0.001
?	MAP	83.54±12.53	83.30±7.81	0.583	0.520
低血压组（n=131）		?	?	?	?
?	SBP	87.35±24.33	85.41±11.99	1.109	0.269
?	DBP	48.32±8.27	49.98±8.06	-2.073	0.040
?	PP	39.03±24.00	35.43±13.97	1.806	<0.001
?	MAP	61.33±10.72	61.79±6.92	-0.617	0.538

表3 不同血压亚组之间IBP与IBP的比较（mmHg，±s）

不同亚组		IBP	NBP	t值	P值
高血压组（n=254）		?	?	?	?
?	SBP	163.75±33.93	152.16±16.78	6.52	<0.001
?	DBP	79.17±11.03	83.69±9.50	-6.85	<0.001
?	PP	84.57±31.50	68.47±20.72	9.76	<0.001
?	MAP	107.36±15.63	106.51±7.66	0.99	0.286
正常血压组（n=687）		?	?	?	?
?	SBP	122.66±24.74	118.70±15.14	5.071	<0.001
?	DBP	63.97±10.34	65.60±8.49	-5.049	<0.001
?	PP	58.69±23.05	53.10±11.90	7.682	<0.001
?	MAP	83.54±12.53	83.30±7.81	0.583	0.520
低血压组（n=131）		?	?	?	?
?	SBP	87.35±24.33	85.41±11.99	1.109	0.269
?	DBP	48.32±8.27	49.98±8.06	-2.073	0.040
?	PP	39.03±24.00	35.43±13.97	1.806	<0.001
?	MAP	61.33±10.72	61.79±6.92	-0.617	0.538

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Comparative study on the differences between noninvasive and invasive blood pressure in 102 critical patients

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Comparative study on the differences between noninvasive and invasive blood pressure in 102 critical patients