二次改良柯氏音法在心血管疾病病人血压测量及管理中的应用研究

Study on the application of re-modified Korotkoff Sound Method in measurement and management of blood pressure in patients with cardiovascular diseases

[目的]探讨二次改良柯氏音法在心血管疾病病人血压测量和护理中的应用价值,以期为临床血压的护理管理和血压测量方法的改进提供相关参考。[方法]选择2017年1月—2018年5月在某医院就诊且进行主动脉腔内血压测量的249例住院病人作为研究对象,根据相关心血管疾病的诊断标准进行亚组筛选,并以病人的主动脉腔内血压作为血压真实性和准确性的金标准,每例病人均进行3种方法的血压测量,其中腔内血压的测量以压力传感器的读数作为标准,共计3次,每次读数间隔1~2 min,计算平均值作为腔内血压的测量结果;传统柯氏音法和二次改良柯氏音法的测量均以水银血压计作为测量工具,每例病人进行3次血压测量,每次测量间隔1~2 min,同样计算3次测量的平均值作为无创血压的测量结果。[结果]3种方法测量所得血压值平均分别为136/84mmHg(主动脉腔内血压测量法)、129/78 mmHg(传统柯氏音法)、132/82 mmHg(二次改良柯氏音法),与主动脉腔内血压比较,传统柯氏音和二次改良柯氏音法测量所得收缩压及舒张压数值均明显偏低,二次改良柯氏音法的测量结果更接近腔内血压;两种无创方法测量所得的结果与腔内血压测量所得结果比较,差异均具有统计学意义(P<0.05)。一致性检验分析结果提示两种无创血压测量法所得的收缩压与舒张压差值均值均不同程度地偏移0值参考线。[结论]以主动脉腔内血压作为参考标准,无创血压测量所得数值明显低估了病人的真实血压情况,二次改良柯氏音法较传统柯氏音法具有更好的准确性和稳定性。

Objective:To probe into the application value of re-modified Korotkoff Sound Method in the measurement and nursing of blood pressure in patients with cardiovascular diseases,and to provide a reference for nursing management and measurement improvement of blood pressure in the clinical.Methods:A total of 249 inpatients receiving intra-aortic pressure measurement in a hospital from January 2017 and May 2018 for were selected as the subjects.According to the diagnostic criteria of relevant cardiovascular diseases,subgroups screening was conducted.And patients′aortic lumen blood pressure values were taken as the gold standard of authenticity and accuracy of measured blood pressure values.Each patient was measured blood pressure by three methods.As an invasive blood pressure measurement tool,intra-aortic pressure was measured by pressure sensor.And the sensor′s readings were recorded for three times for each patients,with each reading interval about one-two minutes.Then the mean value was calculated as the measurement result of intracavitary blood pressure.Mercury sphygmomanometer was as represent of the non-invasive blood pressure measurement tool,and was used in both the traditional and re-modified Korotkoff Sound Method.As same as above,blood pressure values of each patient were measured for three times with an interval of one-two minutes.The mean value of three measurements was also calculated as the measurement result of non-invasive blood pressure measurement.Results:The mean values of three measurement methods were 136/84 mmHg by intra-aortic blood pressure measurement,129/78 mmHg by traditional Korotkoff Sound Method and 132/82 mmHg by re-modified Korotkoff Sound Method),respectively.Compared with intra-aortic blood pressure,the values of systolic blood pressure and diastolic blood pressure measured by the traditional and the re-modified Korotkoff Sound Method were all significantly lower.But the values measured by the re-modified Korotkoff Sound Method were closer to the values measured in the aorta.The results measured by the two non-invasive methods were statistically significant differences,compared with the results measured in the aorta(P<0.05).The analysis results of consistency test showed that the mean values of two kinds of non-invasive blood pressure measurement methods all had deviations to the 0 reference line in different degrees.Conclusions:With intra-aortic blood pressure value as the reference standard and patient′s true blood pressure,the values of non-invasive blood pressure measurement tools are significantly lower than the truth values.Relatively speaking,the re-modified Korotkoff Sound Method has better veracity and stability than the traditional method.