连续无创动脉血压监测在气管镜诊疗麻醉中的应用

Efficacy of a continuous non-invasive arterial blood pressure monitor system for bronchoscope diagnosis and treatment under general anesthesia

目的比较连续无创动脉血压(continuous non-invasive arterial blood pressure, CNAP)监测与无创动脉血压(non-invasive blood pressure, NIBP)监测在气管镜诊疗麻醉监测中的应用价值,研究CNAP是否可以提高低血压检出率,早期发现低血压,从而提高患者的安全性。方法门诊气管镜诊疗麻醉患者20例,诱导前一侧上肢行NIBP监测,另一侧上肢连接无创实时动脉血压监测系统行CNAP监测,测量至术毕。每1 min记录CNAP的SBP、DBP、MAP,每3 min记录相对应点NIBP的SBP、DBP、MAP。分别统计CNAP与NIBP的低血压(SBP<80 mmHg,1 mmHg=0.133 kPa)次数,计算两种血压测定方法下低血压检出率和低血压检出时间,比较两种血压测定结果的一致性和相关性,记录和比较两种监测方法的相关并发症。结果CNAP与NIBP的低血压检出率分别是17.2%和14.7%(P<0.05),低血压检出时间分别为(1.2±0.4)min和(3.0±0.0)min(P<0.05)。CNAP与NIBP所测SBP、DBP、MAP偏倚分别为(1.5±8.8)、(1.1±8.2)mmHg和(1.3±7.1)mmHg,一致性界限分别为-18.70~15.70 mmHg、-17.20~14.90 mmHg、-15.30~12.70 mmHg,在其相应的一致性界限范围内所占比例分别为96.70%、97.10%、97.10%。CNAP与NIBP所测SBP、DBP和MAP的相关系数r分别为0.910、0.861和0.941(P<0.05)。所有患者均未发生并发症。结论CNAP能够更灵敏、及时地发现低血压,与NIBP具有较高的一致性和相关性,CNAP可提高气管镜诊疗麻醉监测的安全性。

Objective To compare continuous non-invasive arterial blood pressure (CNAP) monitoring with non-invasive blood pressure (NIBP) monitoring in anesthesia monitoring application value of bronchoscope diagnosis and treatment, and to find whether the CNAP can improve the detection rate of hypotension and detect low blood pressure earlier so that improve the safety of patients. Methods Twenty patients undergoing bronchoscope diagnosis and treatment under general anesthesia from outpatient were included in this study. The NIBP monitoring was put on one side of the upper limb and the CNAP monitoring was connected to the other side upper limb before inducement of general anesthesia. Both connections were kept until the end of operation. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) of the CNAP were recorded one time per minute whereas the SBP, DBP and MAP of NIBP were recorded one time every 3 min. The low blood pressure (SBP<80 mmHg, 1 mmHg=0.133 kPa) frequency of CNAP and NIBP were respectively counted. The low blood pressure detection rate and the hypotension checkout time of NIBP and CNAP were calculated respectively. The consistency and correlation between the two blood pressure measurements were compared. At the same time, the complications of the two methods of monitoring were recorded and compared. Results The low blood pressure detection rate of CNAP and NIBP was 17.2% and 14.7%(P<0.05). The hypotension checkout time of CNAP and NIBP were (1.2±0.4) min and (3.0±0.0) min respectively (P<0.05). The SBP, DBP and MAP bias of CNAP and NIBP measurement were (1.5±8.8),(1.1±8.2) mmHg and (1.3±7.1) mmHg respectively. Consistency limits were -18.70-15.70 mmHg,-17.20-14.90 mmHg and -15.30-12.70 mmHg respectively. The proportion within the scope of the consistency of its corresponding boundary were 96.70%, 97.10% and 97.10% respectively. The correlation coefficients of SBP, DBP and MAP measured by CNAP and NIBP were 0.910, 0.861 and 0.941 respectively (P<0.05). None of the patients had complications. Conclusions CNAP is more sensitive and timely in detecting hypotension. It has higher consistency and more correlation than NIBP. Thus, CNAP can improve the safety of anesthesia monitoring for bronchoscope diagnosis and treatment.