Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy:Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.

A Deep Learning-Based Continuous Blood Pressure Measurement by Dual Photoplethysmography Signals

This study proposed a measurement platform for continuous blood pressure estimation based on dual photoplethysmography(PPG)sensors and a deep learning(DL)that can be used for continuous and rapid measurement of blood pressure and analysis of cardiovascular-related indicators.The proposed platform measured the signal changes in PPG and converted them into physiological indicators,such as pulse transit time(PTT),pulse wave velocity(PWV),perfusion index(PI)and heart rate(HR);these indicators were then fed into the DL to calculate blood pressure.The hardware of the experiment comprised 2 PPG components(i.e.,Raspberry Pi 3 Model B and analog-todigital converter[MCP3008]),which were connected using a serial peripheral interface.The DL algorithm converted the stable dual PPG signals acquired from the strictly standardized experimental process into various physiological indicators as input parameters and finally obtained the systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP).To increase the robustness of the DL model,this study input data of 100 Asian participants into the training database,including those with and without cardiovascular disease,each with a proportion of approximately 50%.The experimental results revealed that the mean absolute error and standard deviation of SBP was 0.17±0.46 mmHg.The mean absolute error and standard deviation of DBP was 0.27±0.52 mmHg.The mean absolute error and standard deviation of MAP was 0.16±0.40 mmHg.

A survey of recent reports on ambulatory blood pressure monitoring

This article is a review of 25 publications on ambulatory blood pressure monitoring(ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure(BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients' BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular(CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different agegroups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.

Forearm Loss Caused by Automated Non-Invasive Blood Pressure Cuff Malfunction: A Hearsay Report

Failure of an automated blood pressure cuff to deflate when a patient is under general anesthesia can lead to catastrophic consequences if unnoticed for more than three hours [1]. We present this as a hearsay case in which an automated blood pressure cuff of the Spacelabs Ultraview Clinical Workstation monitor (model No. 90385) applied pressure for about five hours resulting in limb thrombosis. In order to analyze this catastrophe, simulation scenarios were tested to elucidate the possible errors and malfunctions that may have led to this injury. We present the analysis of the advantages and validity of the hearsay case report. We also include our proposed criteria that should be required when a hearsay case is considered for publication.

Noncontact Monitoring of Relative Changes in Blood Pressure Using Microwave Radar Sensors

This study aims to confirm whether noncontact monitoring of relative changes in blood pressure can be estimated using microwave radar sensors. First, an equation to estimate blood pressure was derived, after which, the effectiveness of the estimation equation was confirmed using data obtained by a noncontact method while inducing variations in blood pressure. We considered that the Bramwell-Hill equation, which contains some parameters that directly indicate changes in blood pressure, would be an appropriate reference to construct an estimation equation for the noncontact method, because measurements using microwave radar sensors can measure minute scale motion on the skin surface induced by the pulsation of blood vessels. In order to estimate relative changes in blood pressure, we considered a simple equation including the pulse transit time (PTT), amplitude of signals and body dimensions as parameters. To verify the effectiveness of the equation for estimating changes in blood pressure, two experiments were conducted: a cycling task using an ergometer, which induces blood pressure fluctuations because of changes in cardiac output, and a task using the Valsalva maneuver, which induces blood pressure fluctuations because of changes in vascular resistance. The results obtained from the two experiments suggested that the proposed equation using microwave radar sensors can accurately estimate relative changes of blood pressure. In particular, relatively favorable results were obtained for the changes in blood pressure induced by the changes in cardiac volume. Although many issues remain, this method could be expected to contribute to the continuous evaluation of cardiac function while reducing the burden on patients.

A Survey of the Incidence and Consequences of Invasive Blood Pressure Measuring Errors Caused by Arterial Line Occlusion

Objective: The objective is to investigate the incidence and consequences of arterial line occlusion during invasive blood pressure monitoring in the form of questionnaire survey. Methods: The questionnaires were randomly distributed to the anesthesiologists who participated the 22nd annual meeting of Chinese society of anesthesiology. The main contents of this survey included the arterial line managing status, the incidence of arterial line occlusion, the effects of arterial line occlusion on the anesthesiologists’ therapy and consequences caused by arterial line occlusion. Results: Totally 294 questionnaires were collected, in which 261 questionnaires were valid. In all respondents, 28.3% expressed that they could not flush arterial line on time, and 95.4% had experienced flushing arterial line only or sometimes or occasionally when the arterial waveform was not normal. Furthermore, 93.9% had experienced partial occlusion of the arterial line, and 79.3% had experienced complete occlusion. According to the serious recall of the respondents, the incidence of partial arterial line occlusion was 17.7% ± 22.0%, and the incidence of complete arterial line occlusion was 3.6% ± 8.1%. For all the respondents, 89.7% had experienced suspecting arterial line occlusion while real hypotension occurred, 65.1% had experienced not treating hypotension timely due to this suspicion, and 31% had experienced serious consequences caused by this suspicion. Conclusion: The incidence of arterial line occlusion is high during invasive blood pressure monitoring, which is a threat to the patients’ safety. So, intensive attention should be paid to the arterial line management.

上海市护理学会《有创动脉血压监测方法》团体标准解读

上海市护理学会于2023年11月发布了《有创动脉血压监测方法》团体标准,规范了成人和儿童有创动脉血压的监测方法,包括基本要求、监测对象、测量通路、测量方法、操作要点、导管维护与观察及并发症预防。文章对标准中给出的建议进行解读,以期帮助各类医疗机构护士更好地理解并应用该标准。

基于卷积神经网络-长短期记忆神经网络模型利用光学体积描记术重建动脉血压波信号

目的直接动脉血压(arterial blood pressure,ABP)连续监测是侵入式的,传统袖带式的间接血压测量法无法实现连续监测。既往利用光学体积描记术(photoplethysmography,PPG)实现了连续无创血压监测,但其为收缩压和舒张压的离散值,而非ABP波的连续值,本研究期望基于卷积神经网络-长短期记忆神经网络(CNN-LSTM)利用PPG信号波重建ABP波信号,实现连续无创血压监测。方法构建CNN-LSTM混合神经网络模型,利用重症监护医学信息集(medical information mart for intensive care,MIMIC)中的PPG与ABP波同步记录信号数据,将PPG信号波经预处理降噪、归一化、滑窗分割后输入该模型,重建与之同步对应的ABP波信号。结果使用窗口长度312的CNN-LSTM神经网络时,重建ABP值与实际ABP值间误差最小,平均绝对误差(mean absolute error,MAE)和均方根误差(root mean square error,RMSE)分别为2.79 mmHg和4.24 mmHg,余弦相似度最大,重建ABP值与实际ABP值一致性和相关性情况良好,符合美国医疗器械促进协会(Association for the Advancement of Medical Instrumentation,AAMI)标准。结论CNN-LSTM混合神经网络可利用PPG信号波重建ABP波信号,实现连续无创血压监测。

持续动脉压监测对经桡动脉入路脑血管造影术中导管扭转打结的预防价值

目的探讨经桡动脉入路脑血管造影中持续动脉压监测在发现导管扭转打结中的作用。方法回顾性分析2017年7月至2019年12月接受经桡动脉入路脑血管造影的116例缺血性脑血管病患者的临床病例资料,其中80例造影过程中接受持续动脉压监测(测压组),另36例作为无测压组。在操作过程中,动脉压力差变小甚至曲线变平提示导管某段发生扭转打结。比较两组患者的性别、年龄、主动脉弓型等基本临床病例信息,手术适应证、透视时间、手术时间,以及造影过程中导管扭转打结发生率。结果两组患者性别、年龄、主动脉弓型、透视时间、手术时间差异均无统计学意义。测压组动脉导管扭转打结发生率低于无测压组(0 vs 8.33%,P=0.047)。结论持续动脉压力监测有助于发现早期桡动脉入路脑血管造影过程中导管扭转打结,进而降低相关并发症的发生,值得推广应用。

连续有创动脉血压监测联合TEE在心脏病患者非心脏手术麻醉期间的应用效果

目的探讨连续有创动脉血压监测联合经食管超声心动图(TEE)在心脏病患者非心脏手术麻醉期间的应用效果。方法回顾性分析2020年1月至2022年12月我院收治的60例心脏病患者的临床资料。患者均开展非心脏手术,并应用连续有创动脉血压监测联合TEE。分析患者术中的血压水平和气管插管后即刻(T1)、3 min(T2)、10 min(T3)、30 min(T4)的心率(HR)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室射血分数(EF)、每搏输出量(SV)、心输出量(CO)水平。结果60例心脏病患者在开展非心脏手术过程中,28例患者在麻醉过程中生命体征平稳,且血压波动水平未超过基础值的10%;32例患者血压波动水平超过基础值的10%,其中有26例患者在2 min内得到有效处理,5例患者在2~3 min得到有效处理,余1例患者则在3~4 min内得到处理,且有31例患者在5 min内血压水平恢复至目标范围内,1例患者在10 min内恢复至目标范围内;T2、T3、T4时刻的HR、LVEDV、LVESV、SV、EF、CO水平均高于T1时刻。结论连续有创动脉血压监测联合TEE在心脏病患者非心脏手术术中具有较高的应价值,能有效监测患者血压水平和麻醉诱导时及麻醉过程中心功能变化情况,为指导医师在手术过程中采取有效措施来维持患者循环和心功能水平保持稳定提供可靠依据,在保证患者术中生命安全具有积极意义。

多维多元创优护理在ICU脓毒性休克有创动脉血压监测护理中的应用

目的:观察多维多元创优护理在ICU脓毒性休克有创动脉血压监测护理中的应用效果。方法:选择2021年5月-2022年6月广东医科大学附属第二医院收治的80例脓毒性休克患者作为研究对象,以入院时间分为对照组和试验组,2021年5月-2021年11月收治的40例患者为对照组,2021年12月-2022年6月收治的40例患者为试验组,对照组患者接受有创动脉血压监测常规护理,试验组患者在常规护理的基础上接受多维多元创优护理,比较两组患者监测依从性、护理有效率、不良事件发生率和护理满意度。结果:试验组患者干预后焦虑评分为(49.28±2.34)分,低于对照组患者的(56.65±2.51)分,差异有统计学意义(t=13.583,P<0.05);试验组患者不良事件发生率(5.00%)低于对照组患者(20.00%),差异有统计学意义(χ^(2)=4.114,P<0.05);试验组患者监测依从率和护理有效率分别为97.50%、100.00%,明显高于对照组患者的80.00%、85.00%,差异有统计学意义(χ^(2)=4.507、6.486,P<0.05);试验组患者护理满意度评分中的操作技术为(83.02±2.51)分、健康指导为(81.65±3.52)分、服务态度为(82.68±2.95)分、安全管理为(82.66±3.50)分、护理效果为(83.22±3.14)分,均高于对照组患者,差异有统计学意义(t=5.438、2.402、4.509、5.687、5.566,P<0.05)。结论:采用多维多元创优护理开展ICU脓毒性休克有创动脉血压监测护理活动,可显著改善患者的焦虑情绪与监测依从率,提高监测安全有效性,提升护理满意度。

用于动脉血压监测的柔性超声换能器阵列

作为重要的生命体征之一,血压是心血管疾病风险评价指标。中心动脉压与靶器官损害和心血管疾病有很强的病理生理联系,动脉血压监测对心脑血管事件有较高的预测价值,可为人体心脏机能、动脉弹性表征等临床诊断提供依据。本文提出的超声压电换能器阵列相比于传统的刚性超声探头,具有柔性、可以贴合人体颈部的特点。制作并对比了低频(2.5 MHz)和高频(4.5 MHz)的1×16线性超声换能器阵列,两个阵列均在仿组织超声体模上进行了成像,穿透深度分别为90和40 mm。换能器阵列在相控阵聚焦发射模式下已实现对颈动脉的连续血压重复检测。与医用中心动脉压检测仪的测量结果对比表明,在静息状态下柔性阵列与医用检测仪所测血压波形的平均相对误差为3.83%,剧烈运动后平均相对误差为5.47%,动脉血压波形测量结果准确,医用价值丰富。

AIS血压变异性对颈动脉粥样硬化及认知功能影响

目的探究急性缺血性脑卒中(AIS)病人血压变异性对颈动脉粥样硬化(CAS)及认知功能的影响。方法前瞻性选取2020年3月—2021年2月郑州人民医院收治的AIS病人335例,运用Logistic回归模型对AIS病人CAS及认知功能障碍进行单因素和多因素分析,采用Pearson检验分析AIS病人血压变异性指标与CAS及认知功能障碍的相关性。结果Logistic单因素和多因素分析结果表明,病人年龄、同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、24 h平均舒张压(24h MDBP)、24 h平均收缩压(24h MSBP)、24 h舒张压变异系数(24h DBP-CV)和24 h收缩压变异系数(24h SBP-CV)均为AIS病人CAS的影响因素(OR=1.652~3.795,95%CI=(1.227~2.853)~(2.301~17.142),P均<0.05);病人年龄、教育程度、糖尿病史、24h MDBP、24h MSBP、24h DBP-CV和24h SBP-CV等均为AIS病人认知功能障碍的影响因素(OR=1.613~3.177,95%CI=(1.206~2.113)~(2.241~10.024),P均<0.05)。AIS病人24h MDBP、24h MSBP、24h DBP-CV、24h SBP-CV均与CAS(r=0.426~0.495,P均<0.05)及认知功能障碍(r=0.433~0.536,P均<0.05)存在正向相关性。结论血压变异性是AIS病人CAS及认知功能障碍的重要影响因素,临床应密切关注并监测AIS病人血压水平变化,有效控制血压变异性或者降低血压波动幅度,以降低发生CAS及认知功能障碍风险。

ICU患者外周动脉导管非计划性拔管风险预测模型的构建及验证

目的构建并验证ICU患者外周动脉导管非计划性拔管的风险预测模型。方法选择300例(建模组)ICU留置外周动脉导管患者作为研究对象,回顾性收集患者相关资料,采用单因素分析、logistic回归分析筛选非计划性拔管的危险因素,构建风险预测模型。选择117例ICU留置外周动脉导管患者对风险预测模型进行验证。结果建模组23.00%患者发生非计划性拔管。年龄≥65岁,并存高血压、静脉血栓栓塞症,置入部位为桡动脉及置入导管为静脉留置针是ICU患者外周动脉导管非计划性拔管的高危因素(均P<0.05)。预测模型的ROC曲线下面积为0.888。模型验证结果显示,ROC曲线下面积为0.903,灵敏度为86.2%,特异度为85.2%,约登指数为0.714。结论构建的ICU患者外周动脉导管非计划性拔管的风险预测模型预测效果良好,可为医护人员及时采取预防性护理措施提供依据。

每搏连续无创血压监测系统在心脏瓣膜术后低心排血量综合征监护中的应用

目的:探讨每搏连续无创血压(continuous noninvasive arterial pressure,CNAP)监测系统在心脏瓣膜术后低心排血量综合征(low cardiac output syndrome,LCOS)监测中的应用价值。方法:选取福建省立医院2020年4月-2022年4月心脏瓣膜术后合并LCOS患者76例。随机将其分为对照组(n=44)和CNAP组(n=32)。对照组给予常规治疗,CNAP组给予CNAP指导治疗。比较两组瑞芬太尼、丙泊酚、多巴酚丁胺和去甲肾上腺素总用量,ICU住院时间,有创机械通气时间,液体平衡总量。结果:两组瑞芬太尼、丙泊酚总用量、ICU住院时间、有创机械通气时间比较,差异均无统计学意义(P>0.05)。CNAP组多巴酚丁胺总用量、去甲肾上腺素总用量、液体平衡总量均小于对照组,差异均有统计学意义(P<0.05)。结论:应用CNAP指导心脏瓣膜术后LCOS患者的治疗能够优化此类患者术后的血流动力学管理。

PICU有创动脉血压监测患儿导管堵管发生相关因素及预测模型构建

目的:探讨儿科重症监护室(PICU)有创动脉血压监测患儿导管堵管发生相关因素,并构建预测模型。方法:选取北京大学第一医院2018年1月至2022年12月PICU患儿267例,均经桡动脉置管行有创动脉血压监测,根据有无导管堵管分为堵塞组与无堵塞组,收集两组临床资料,采用Lasso回归和logistic回归筛选PICU有创动脉血压监测患儿导管堵管发生的相关因素,构建Nomogram预测模型,采用校准曲线和受试者工作特征(ROC)曲线验证预测模型的预测价值。结果:单因素分析封管液、一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)是PICU有创动脉血压监测患儿导管堵管的影响因素(均P<0.05);Lasso回归分析选出8个预测因素为一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、PT、APTT;logistic回归分析,一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、PT、APTT是PICU有创动脉血压监测患儿导管堵管的相关影响因素(均P<0.05);据此构建Nomogram预测模型的一致性指数(C-index)为0.945,校准度为0.928,且拟合良好(χ^(2)=8.741,P=0.593);ROC曲线分析,该模型预测PICU有创动脉血压监测患儿导管堵管的AUC为0.926(95%CI:0.871~0.984)。结论:PICU有创动脉血压监测患儿导管堵管的相关因素包括一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、PT、APTT,由上述因素构建的预测模型具有可靠的预测价值。

一种精确监测低灌注下无创血压的前端采集设计

本研究针对现有无创血压监测设备采集前端无法实现低灌注信号准确监测的情况,提出一种基于恒定容积法的低灌注血压精确监测的指尖前端采集方案,并基于动物实验,研究了低灌注情况下光电脉搏波及压力脉搏波信号精确采集对血压准确检测的关键影响。6个动物(猪)实验样本的数据分析结果显示,本研究设计的采集前端在低灌注状态下,连续无创血压监测精度可控制在±10 mmHg内,且血压波动追踪相关性大于80%。基于本研究进行低灌注下的无创血压监测在重灾现场、重症临床监护、慢病监护等方面具有重要意义。

重症医学科动脉留置导管临床应用及护理进展

动脉穿刺置管常用于危重或拟行大手术患者,有助于为治疗提供准确的信息。动脉留置导管为创伤性的治疗措施,若操作或维护不当则容易产生并发症。本文通过阐述重症医学科动脉留置导管的临床应用及其护理进展,以期为提高穿刺成功率和制定优质的干预策略提供理论依据。

LISA技术联合NCPAP治疗新生儿呼吸窘迫综合征的有效性分析

目的:探究经胃管注入肺表面活性物质(pulmonary surfactant,PS)治疗(LISA技术)联合新生儿持续气道正压通气(neonatal continuous positive airway pressure ventilation,NCPAP)治疗新生儿呼吸窘迫综合征的有效性。方法:选取2021年7月-2022年10月于阳江市人民医院就诊的80例符合入组标准的呼吸窘迫综合征新生儿作为本次研究对象。根据随机数表法将患儿分为对照组和研究组,各40例。研究组应用LISA技术联合NCPAP治疗,对照组应用经气管插管注入PS技术(INSURE技术)联合NCPAP治疗。比较两组治疗前后动脉血气指标、近期治疗效果及并发症发生情况。结果:两组治疗前及治疗后1 h、12 h、24 h血p H值、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))比较,差异无统计学意义(P>0.05);治疗后1 h、12 h、24 h,两组血pH值、PaO2较治疗前均升高,PaCO_(2)较治疗前均降低,差异有统计学意义(P<0.05)。研究组治疗总有效率为92.5%,高于对照组的85.0%,但两组比较差异无统计学意义(P>0.05)。研究组并发症发生率为7.5%,显著低于对照组的32.5%,差异有统计学意义(P<0.05)。结论:LISA技术联合NCPAP方案治疗新生儿呼吸窘迫综合征有良好的效果,可以有效改善血pH值、PaO_(2)及PaCO_(2)水平,降低术后并发症发生率。