连续无创动脉血压(CNAP)与间歇动脉血压监测在急诊创伤患者救治中的一致性分析

Correlation of continuous non-invasive arterial pressure (CNAP) system and intermittent arterial pressure monitoring for trauma patients in the emergency department

目的对比连续无创动脉血压(continuous non-invasive arterial pressure,CNAP)与心电监护仪间歇式动脉血压监测对急诊创伤患者血压监测结果的一致性,并探讨CNAP是否可发现使用心电监护仪间歇式动脉血压监测时未发现的低血压发作。方法本研究采取前瞻性试验方法对比分析110例急诊创伤患者在2h内同时使用心电监护仪(每15min测量1次)及CNAP进行动脉血压监测的数据,并使用BlandAltman散点图对获得的数据进行统计学分析。结果 CNAP和心电监护仪间歇式监测获得的动脉血压之间的平均差(±标准差)为:收缩压(SAP):-6mm Hg(±21mm Hg),舒张压(DAP):-3mm Hg(±17mm Hg),平均动脉压(MAP):-7mm Hg(±18mm Hg)。在心电监护仪监测的间隔期,由CNAP监测到明确的低血压发作(≥4min)41例(SAP<90mm Hg 26例,MAP<65mm Hg 15例),其中16例(SAP<90mm Hg 11例,MAP<65mm Hg 5例)在随后的心电监护中也被监测出低血压。结论急诊创伤患者使用CNAP与心电监护仪间歇式测量的动脉血压具有一致性,而CNAP能够快速识别被心电监护仪间歇式动脉血压监测遗漏或延迟发现的低血压发作。

Objective To compare continuous AP measurements obtained by CNAP with intermittent oscillometric AP measurements in ED trauma patients,and to investigate whether continuous non-invasive AP monitoring allows detection of relevant hypotensive episodes that might be missed by intermittent AP monitoring.Methods Totally 110 trauma patients who required AP monitoring in the ED were analyzed in this prospective comparison study.Continuous AP monitoring was performed using CNAP technology over a 2h period.The oscillometric AP values were recorded simultaneously every 15 minutes for the comparison of both methods.For statistical evaluation,Bland-Altman plots accounting for repeated AP measurements per individual were used.Results The mean difference(±standard deviation)between AP measurements obtained by CNAP and oscillometric AP measurements was-6mmHg(±21mmHg)for systolic AP(SAP),-3mmHg(±17mmHg)for diastolic AP(DAP),and-7mmHg(±18mmHg)for mean AP(MAP),respectively.In the interval between two oscillometric measurements,the CNAP device detected hypotensive episodes(≥4 minutes)defined as either SAP<90 mmHg or MAP<65mmHg in 26 patients and 15 patients,respectively.In 11(SAP<90mmHg)and 5(MAP<65mmHg)of these patients,hypotension was also detected by the subsequent intermittent oscillometric AP measurement.Conclusions CNAP system for noninvasive continuous AP measurement shows reasonable agreement with intermittent oscillometric measurements in ED trauma patients.Continuous AP monitoring allows immediate recognition of clinically relevant hypotensive episodes,which are missed or only belatedly recognized with intermittent AP measurement.