四肢血压测量在急诊分诊中的应用

Application of Extremity Blood Pressure Measurement in Emergency Triage

目的探讨四肢血压测量在急诊分诊中的意义。方法选择2012年7月—2013年6月急诊科就诊的血压异常患者共258例为研究对象,应用汞式血压计测量四肢血压,并计算踝臂血压指数,踝臂血压指数<0.9或踝臂血压指数>1.3为异常组,0.9≤踝臂血压指数≤1.3为正常组,追踪两组临床诊断。结果左侧上肢的收缩压、舒张压与右侧上肢的收缩压、舒张压比较,左侧下肢的收缩压、舒张压与右侧下肢的收缩压、舒张压比较,差异均无统计学意义,患者下肢收缩压比同侧收缩压高(10.8±2.3)和(10.9±3.1)mmHg,舒张压差距较小(1.4±0.8)和(2.0±0.9)mmHg。左侧上肢收缩压比右侧上肢高(>5 mmHg)者占29.0%,右侧上肢收缩压比左侧上肢高者占23.7%;左侧上肢舒张压比右侧上肢高(>5 mmHg)者占25.6%,右侧上肢舒张压比左侧上肢高者占19.0%,差异均无统计学意义,下肢血压与上肢血压统计结果相似,也无统计学意义。踝臂血压指数异常组诊断主动脉夹层13例,正常组诊断主动脉夹层3例,经比较差异有统计学意义(χ2=160.1103,P=0.0001)。结论四肢血压测定便于更为精确地获取患者的血压值,从而提高对高血压的诊断水平,能识别血管事件的高危人群,早期发现潜在威胁生命的疾病。

Objective To explore the effect of extremity blood pressure measurement in emergency triage and its significance. Methods From July 2012 to June 2013, totally 258 patients in emergency department with abnormal blood pressure were included in the study and mercury sphygmomanometer was applied for the measurement of their limb blood pressure, then the ankle-brachial pressure index （ABI） value was calculated. Patients with ABI value〈0.9 or 〉1.3 were included into one group, while those with ABI value between 0.9 and 1.3 into another group. Patients ’ clinical diagnosis were traced. Results There were no statistical significances in the comparison between systolic and diastolic blood pressure left and right upper arm and between left and right lower limbs. Among patients with abnormal ABI value, totally 13 cases were diagnosed as aortic dissection and 3 cases were diagnosed as aortic dissection with normal ABI value. The difference was statistically significant （ P〈0.01）. Conclusion In the emergency triage, it is simple and convenient while effective to take extremity blood pressure measurement which offers accurate blood pressure value that helps to improve the diagnosis of hypertension and antihypertensive treatment as well as better guidance prognosis. ABI index in emergency department can help to identify high risk of vascular events and predict cardiovascular events.