无创连续血压监测(CNAP)与有创动脉内测压比较,数据高度准确

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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

•论著• 文章编号= 1009 -4237 (2018) 03 -0171 -05连续无创动脉血压（C N A P)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赵鹏，卫娜，王倩梅，李平方，尹文【摘要】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15mm测量1次）及CNAP进行动脉血压监测的数据，并使用B lad-A ltm a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): -6mmHg( ±21m mHg)，舒张压（DAP): -3mmHg( ±17mmHg)，平均动脉压（MAP): -7mmHg( ±18mmHg)。

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(!4m in)41 例（SAP< 90mmHg 26 例，MAP< 65mmHg 15 例），其中16 例（SAP< 90mmHg 11 例，MAP<65mmHg 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。

【关键词】创伤；动脉压；收缩压；舒张压；低血压；监测【中图分类号】R641 【文献标识码】A 【D0I】10. 3969/j.issn. 1009 -4237.2018.03.003Correlationof continuous non-invasive arterial pressure ( CNAP) systemand intermittent arterial pressure monitoring for trauma patientsin the emergency departmentZHAOPeng，WEI N a，WANGQian-mei，LI Ping-fang，YINWen(Department of Emergency Medicine，XijingHospital，Fourth Military MedicineUniversity，Xi’an 710032 , China)【A bstract】Objective To compare continuous AP measurements obtained by CNAP with intermittent oscil- lometric AP measurements in ED trauma patients & and to investigate whetlier continuous non-invasive AP monitoringaiows detection of relevant hypotensive episodes that might be missed by intermittent AP monitoring. MethodsTotally 110 trauma patients w ho required AP monitoring in the ED were analyzed in this prospective comparisonstudy. Continuous AP monitoring was performed using CNAP technology over a 2h period. The oscillometric AP values were recorded s imultaneously every 15 minutes for the comparison of botli metliods. For statistical evaluation，Bland-Altman plots accounting for repeated AP measurements per individual were used. Results The mean difer-ence ( 土 standard deviation) between AP measurements obtained by CNAP and oscillometric AP measurements was-6mmHg( ± 21 mmHg) 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 CNAPdevice detected hypotensive episodes ( !4minutes) defined as either SAP <90 mmHg or MAP < 65mmHg in 26patients and 15 patients Respectively. In 11 ( SAP <90mmHg) and 5 ( MAP < 65mmHg) of tliese patients & hypotension was also detected by the subsequent intermittent oscillometric AP measurement. Conclusions tem for noninvasive continuous AP measurement shows reasonable agreement witli 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 witli intermittent AP measurement.【Key words 】trauma; artery pressure; systolic blood pressure; diastolic blood pressure; hypotension;monitering对急重症创伤患者进行监护治疗时，早期发现、作者单位：710032西安，第四军医大学西京医院急诊科通信作者：尹文，E-mail:xjyyyw@共同第一作者：卫娜期期治疗患者克状态。

12.4评估一种的新的型地自动的无创脉压变异率算法CNAP—PPV准确

Evaluation of a novel automated non-invasive pulse pressure variationalgorithm(评估一种新型的自动无创脉压变异率算法)摘自：国际期刊：Computers in Biology and Medicine Volume 43, Issue 10 , Pages 1583-1589, 1 October 2013.摘要：对于机械通气的患者，PPV（脉压变异率）是一种有效的对病人液体进行管理的指导参数。

我们通过与手动计算PPV作比较，评估了一种实时的自动计算PPV的算法。

选取10例急危重症患者，通过导管介入进行有创血压监测和通过CNAP每搏即时连续无创血压监测系统进行无创血压监测。

基于这两种血压监测方法，分别计算手动方式和自动方式下的PPV （IBP：PPV-manIBP和PPV-autoIBP；CNAP：PPV-manCNAP和PPV-autoCNAP），其结果为：PPV-manIBP和PPV-autoIBP的偏差和标准方差为-0.19±1.65%，PPV-manCNAP和PPV-autoCNAP的偏差和标准方差为-1.02±2.03%，PPV-autoCNAP和PPV-manIBP的偏差和标准方差为-,2.10±3.14%。

结果表明自动的CNAP-PPV算法对于无创血压监测波形和有创血压监测波形都能很好指导病人的液体管理，但需更多的临床评估。

引言：一些研究的结果证明了有导向的液体管理（在外科手术和ICU中，病人的液体给予需要基于客观变量的变化而不是基于一般偏差的估计）能够明显提高病人的预后结果。

最近，对于机械通气状态下的镇静病人的血流动力学功能分析已成为对液体管理更优的办法（例如：是否通过液体管理--减少流量的给予，能够让心输出量显著增加）。

已经证明，动态指标对于病人的液体响应能力优于静态指标。

3.2 CNAP和IAP血压监测在心脏外科重症监护病房的比较

A comparison of a continuous noninvasive arterial pressure (CNAP™) monitor with an invasive arterial blood pressure monitor in the cardial surgical ICUCNAP和IAP血压监测在心脏外科重症监护病房的比较摘要：成人心脏外科手术中血压的测量和显示是非常重要的，同时由于要降低手术并发症的风险，无创血压监测则显得非常重要的。

CNAP每搏即时连续无创血压监测系统已经在临床上得到认可。

在本研究中采用了30例心脏外科ICU对CNAP和IAP血压监测进行比较。

这30例病人包含自主呼吸、机械呼吸、给予或者未给予强心药的病人。

使用CNAP和IAP 监测技术在2小时内，每分钟同时记录手术病人的收缩压、舒张压、平均动脉压。

通过得到曲线图和Bland-Altman差异图来评估其是否具有一致性和其存在的偏差大小。

分析的数据共有3600对，其中，使用CNAP监测得到的收缩压偏差：10.415mmHg，舒张压偏差：-5.3386mmHg，平均动脉压与IAP基本一致，其偏差仅有0.03944mmHg。

Bland-Altman 差异图显示出CNAP和IAP分布的一致性和良好的相关性。

其中一致性良好的概率是94.5%（收缩压）/95.1%(舒张压)/99.4%(平均动脉压),计算的一致性误差是：-4.60-25.43mmhg（收缩压）/-13.38-2.70mmhg(舒张压)/-5.95-6.03mmhg（平均动脉压）.曲线图和Bland-Altman 的结果是相似的。

所以，CNAP是一种可靠的、无创的、连续的血压监测系统，能够提供与有创血压监测一样连续准确实时的血压监测评估。

CNAP可以代替IAP。

关键词：动脉血压，连续无创动脉血压，监测"与有创作比较、心脏外科手术ICU、30例病人1、有创作比较；2、其中作者还提出：对于不同的指套型号，其血压监测没有显著地变化，验证CNAP指套的稳定性。

无创连续血压监测(CNAP)与有创动脉内测压比较,数据高度准确

Continuous non-invasive arterial pressure shows high accuracy in comparison to invasive intra-arterial blood pressure measurement无创连续血压监测(CNAP)与有创动脉内测压比较，数据高度准确Sackl-Pietsch E., Department of Anesthesiology, Landeskrankenhaus Bruck an der Mur,AustriaI.简介连续血压监测是众多临床监护设备的参数之一，尤其对于围术期监测。

对于外科住院病人来说，美国麻醉医师协会（ASA）要求至少对患有严重系统疾病的病人在围术期进行连续血压监测，这需要用有创的方法在动脉内放置导管测量。

在其他情况下，监护常规使用无创间隔血压监测。

因此，许多病人的血压监测并不是连续即时的。

最近来自奥地利和德国具有代表性的调查显示，82%的外科住院手术是使用无创血压监测，其中，25%的病例特别是一些可预测的血流动力学不稳定的病人或可能需要有创测压的病人（例如，泌尿系统手术，腹腔镜手术、整形手术或血管手术、妇产科手术、肠道手术、择期或急诊外伤手术）也是采用无创测压法，麻醉医师更倾向于使用无创连续血压监测以便更好管理病人的血流动力学。

在剩余的18%外科住院手术中，有创测压主要用于可预测的心血管不稳定的病人。

因此，ASA推荐指南特别要求不管是否需要反复血气分析，都必须进行连续血压测量。

请注意，在有创血压监测的病例中，有26%的病例进行有创插管仅仅是为了连续血压监测（并没有血气分析的需要），这是一个费时、费钱的方法，既导致病人痛苦又存在感染风险，因此如果有可能，须用无创测压来取代有创测压。

有大量的研究强调在围术期连续血压监测的重要性：例如，外科手术过程中，由于使用上臂袖带间隔测压，20%以上的低血压不被发现，另外20%的低血压发现被延迟。

6.3 新型连续无创血压监测系统CNAP在全麻手术中的精确性和准确性的评估

Precision and accuracy of a new device (CNAP TM) forcontinuous non-invasive arterial pressure monitoring:assessment during general anaesthesia(连续无创血压监测系统CNAP TM在全麻手术中的精确性和准确性的评估)主要观点：1、在全麻手术中，连续无创血压监测系统CNAP显示出可与桡动脉介入有创血压监测一样的精确性和准确度2、对于非常需要进行无创血压监测的患者，CNAP将是一种代替有创血压监测的有用的办法。

背景：对于施行脊髓麻醉镇静阶段的病人，连续无创血压监测系统CNAP显示出比间断血压监测方式的优越性。

我们通过分析全麻过程中CNAP与有创血压监测的一致性评估了CNAP的性能。

方法：研究中选取88例病人，包括腹部手术、脑部手术、神经外科手术患者。

在统一手臂上进行有创血压监测和CNAP无创血压监测，并比较器收缩压、舒张压和平均动脉压的值。

分析有创血压监测值和CNAP每搏血压监测值来判断CNAP的精确性和准确性。

同时，我们比较了这两种方法对血压快速变化频率和和低血压监测的及时性。

结果：与有创血压监测相比，CNAP监测到的血压值偏差分别为：4.5,3.1，3.2mmHg(收缩压、舒张压、平均动脉压），两者没有显著地不同。

频率变化快慢有些许不同，计算出的一致性范围为：81%，64%，76%(收缩压、舒张压、平均动脉压），对应的血压偏差为±17.6mmHg，±11.4mmHg，±12.0mmHg。

CNAP和IAP同时监测到血压变化的频率为82.1%，及时监测低血压发生为84.6%。

结论：在全麻手术中，CNAP能够提供同有创血压监测一样连续实时的血压值。

全麻-含腹部心脏神经外科-有创做比较-88例患者1、有创作比较，全麻阶段；2、作者最后的讨论：收缩压、舒张压和平均动脉压的测量并没有达到与动脉导管穿刺一样的很满意的结果。

分析全身麻醉中连续无创动脉血压监测、有创动脉血压监测一致

分析全身麻醉中连续无创动脉血压监测、有创动脉血压监测一致发表时间：2018-11-30T12:17:07.787Z 来源：《健康世界》2018年21期作者：刘玉全[导读] 探讨全身麻醉中连续无创动脉血压监测、有创动脉血压监测一致性云南省砚山县人民医院麻醉科 663100摘要：目的：探讨全身麻醉中连续无创动脉血压监测、有创动脉血压监测一致性。

方法：本次研究用随机数字表法纳入对象50例行全身麻醉患者，给患者行连续无创动脉血压监测获得的数据为观察组，行有创动脉血压监测获得的数据为对照组，对比两组数据间存在的差异性。

结果：两组获得的数据中MAP、SVV、CO、SV这4个指标水平比较，差异无统计学意义，P＞0.05；而两组数据中SBP、DBP、PPV这3个指标水平比较，差异存在统计学意义，P＜0.05。

结论：接受全身麻醉的患者使用连续无创动脉血压监测和有创动脉血压监测的效果具有一致性，不过在SBP、DBP、PPV这3个指标监测时，会出现不同程度的差异，临床应用时需高度重视此方面情况。

关键词：全身麻醉；连续无创动脉血压监测；有创动脉血压监测；一致性临床上多种疾病患者均需接受外科手术治疗，故而需要接受全身麻醉以保证手术顺利实施与完善，此时对患者血流动力学监测的工作尤为重要。

目前，临床上用来进行全身麻醉中患者血流动力学监测的方法或者仪器诸多，不过其适应性与效果均是不同的。

本次研究则旨在对全身麻醉中连续无创动脉血压监测、有创动脉血压监测一致性进行探讨。

1资料与方法1.1一般资料本次研究中用随机数字表法在我院2017年1月-2018年6月接收的行全身麻醉手术治疗患者50例为对象，其中男女比例是27：23，年龄是在23-65岁之间、均值是（34.19±5.06）岁，采用美国麻醉医师协会（ASA）麻醉风险分级评价患者的麻醉风险分级在I-II级之间，且患者体内的血红蛋白水平＞110g/L，排除合并高血压和心脏疾病、糖尿病以及外周血管疾病的患者，患者均签署了知情同意书。

10.12 连续无创血压监测：血管外科手术期间CNAP血压监测的评估

Continuous noninvasive arterial pressure measurementevaluation of CNAP device during vascular surgery
连续无创血压监测：血管外科手术期间CNAP血压监测的评估
目标：标准的无创血压监测是一个间断的、不连续的监护过程。

对于得到每搏连续的血压监测值是采用有创的监测方法如：插入动脉导管，这种方法容易引发一系列的严重的并发症。

CNAP监测技术是一种每搏即时连续无创的血压监测技术。

本研究主要介绍了利用CNAP血压监测方法和有创血压监测的方法所得到的血压值是否有相同的趋势和良好的相关性。

病人和方法：25例施行大血管手术的病人。

分别取得无创（使用CNAP）和有创监测方法下舒张压、收缩压、平均动脉压的数据值。

手术过程中1小时内每隔1分钟测量血压的监测值。

结果：在使用CNAP和有创监测两种血压监测方法中取得了1500对数据，其中148对数据被消除了。

有创和无创血压测量范围值分别为：收缩压63-205mmHg，57-187mmHg；平均压38-143mmHg，43–142 mmHg ；舒张压29–126 mmHg ，33–121 mmHg 。

CNAP和IAP 监测下的偏差（置信区间为95%）分别为：7.2（17.7 - 32.2 mmHg ，收缩压），1.8（22.0-18.3 mmHg ，平均动脉压），7.5（27.3 - 12.4 mmHg，舒张压）。

与动脉基准线比较CNAP监测偏差小于10%的概率为：69%，86%，91%（收缩压、舒张压和平均动脉压）。

结论：在血管外科手术中，CNAP对平均动脉压的监测准确度很高。

7.8 使用无创连续血压监测(CNAP)进行的血液动力学管理：与传统袖带血压监测的比较

Hemodynamic Management with Non Invasive and Continuous Arterial Pressure Monitoring (CNAP): Comparison with Traditional Cuff PressureMonitoring
使用无创连续血压监测（CNAP）进行的血液动力学管理：与传统袖带血压监测的比较
背景：CNAP为无创连续血压监测。

与传统的BP袖带监测比较（BP袖口）（每5分钟），它可以快速及时的监测到血压的变化。

本研究的目的是评估该装置与袖带血压监测在减少术中低血压或高血压相比的反应时间。

方法：本研究通过加州大学的26例腹部手术进行研究，袖带监测为没5分钟监测一次，CNAP 血压监测同步进行。

设计为监测数值在CNAP血压监测的增加或减少20%为可接受范围，反应时间在CNAP变化的20%为可接受范围。

结果：总共26例患者（年龄50±13，体重81±16kg，身高169±9cm），平均监测时间为2.5±0.4小时，CNAP和袖带动脉压监测269对数据中87.7%的数据趋势一致。

使用袖带血压监测时低血压监测结果为21±6min，高血压为16±7min，使用CNAP监测低血压时间为7±5min （P<0.001）,高血压时间为4±3min（P<0.001）
讨论：与传统间歇性袖带血压监测相比，CNAP®监测系统能够大大缩短发现高血压和低血压的时间。

3.1 ICU病人进行连续血压监测,CNAP连续血压监测系统与使用A-Line动脉穿刺的有创血压监测对比

Continuous Blood Pressure Readingsin Intensive Care Patients, Comparison of a Continuous Non-Invasive Pressure Device andInvasive Recording by means of an Arterial Line(ICU连续血压监测，比较CNAP连续血压监测系统和使用A-Line动脉穿刺有创血压监测)背景：血压监测是ICU病房监测的常规指数，其必须准确、易于使用、连续且避免并发症。

新型的CNAP每搏、无创、连续即时血压监测系统能够提供连续的血压读数。

这篇研究将比较使用CNAP 无创血压监测和A-line进行有创血压监测的一致性。

方法：97例重危患者（麻醉等级3-5度）包括施行心脏瓣膜移植术、心血管移植术的ICU病人。

41例病人心律失常（CA组）。

50例病人窦性心率不齐（SR组）。

通过动脉穿刺进行有创血压监测，同时CNAP通过对侧的手臂进行监测。

通过随机选取150对CNAP和IAP监测指数的读数值进行比较。

通过使用Bland-Altman方法对两种监测方法得到的数据进行分析和比较，计算偏差率。

结果：我们选取了9607个合理的血压读数，最后计算的偏差率，标准偏差、误差百分率（PE）为：SR组的收缩压偏差为4.39(11.7)mmHg,PE指数为21.7%；平均动脉压偏差为5.7（6.7）mmhg，PE指数为17.8%；舒张压偏差指数为8.5（7.8）mmhg，PE指数为25.5%；CA组的收缩压偏差为4.9(13.8)mmHg,PE指数为24.8%；平均动脉压偏差为-4.9（9.1）mmhg，PE指数为23.1%；舒张压偏差指数为-8.6（9.0）mmhg，PE指数为28.3%结论：在ICU血压监测中，与IAP作比较，CNAP显示出较好的一致性和足够的精确度。

在窦性失常（SR组）组中，CNAP和IAP两者具有互换性标准。

14.2 连续无创血压监测系统CNAP与有创血压监测在ICU的对比评估

引言：对于急危重症室的病人降低其手术并发症的风险和减轻有创穿刺带来的负担越来越重要。

对血压的连续无间隔测量属于ICU室病人监测的标准血流动力学监测。

一种新发展起来的连续无创血压监测方法（CNAP）因其高度的准确性已经在麻醉中被使用。

我们研究的目的是在ICU室使用CNAP血压监测仪与有创血压监测金标准进行比较。

方法：在这项预期的研究中我们选择49例ICU室的急危重症患者。

有3例病人不能使用CNAP进行监测，因此用于研究的是46例满足条件的病人数据。

所有的病人都处于镇静和机械通气状态。

同时，所有的病人都接受血管加压治疗。

CNAP被安置在一只手的两只手指上，另一只手同时进行桡动脉介入导管动脉血压监测。

所有测量数据以100Hz的采样频率被记录下来，通过算法自动识别每次脉搏的跳动。

每个病人的平均记录时间是163min。

结果：我们总共分析了500.000跳动。

在所有有效的数据点中我们观察到平均动脉压的偏差是-7.49mmHg，标准差是10.90mmHg。

Bland-Altman差异分析图显示在所有测量的血压值中CNAP和IBP的监测值其差异的分布是均匀的，一致性是良好的。

偏差的范围是0.28mmHg到23.9mmHg（平均值为-6.6mmHg）,标准差范围是2.0mmHg到14.9mmHg（平均值为5.8mmHg）结论：在我们的研究中，对于急危重症室中的患者CNAP与IAP血压监测显示出良好的一致性。

对于个人的监测结果，其偏差在0.28mmHg和23mmHg之间。

需要进行进一步的分析来解释这种病人之间的个体差异性。

这篇研究的未来展望是来验证这种连续无创血压监测方式用来预测病人液体体积血流动力学是否合适。

有创动脉血压和无创动脉血压的对比

有创动脉血压和无创动脉血压的对比有创动脉血压的测量对于严重的危重患者和手术患者，无法连续显示瞬间的血压变化，因此对于血压不稳定及失血性休克的危重患者，尤其是手术患者，无创血压的监测尤为重要，与有创血压监测相比，无创血压可以提供连续、可靠、准确的监测数据。

目前，临床上监测动脉血压的方式分为有创（桡动脉穿刺）和无创（袖带法）两种。

袖带法的原理是通过检测动脉血管壁的运动、博动的血液或血液容积等参数间接得到血压，主要是用充气袖带阻断四肢动脉，通过柯氏音或示波法来测量血压。

这种方法最大的缺陷是不能实时的检测，结果较延迟，也易受人工加压、袖带宽度和松紧度的影响。

有创动脉血压检测即桡动脉穿刺的原理是将套管留置于周围动脉内直接测压的监测方法,能连续监测动脉收缩压、舒张压和平均动脉血压。

有创动脉血压监测缺陷是具有创伤性，技术要求高，有使外周动脉管腔部分或全部闭塞、假动脉瘤形成、OLser结节形成、在导管插入的地方形成血栓和脓毒血症的风险。

TL-200无创连续血液监测系统由浙江善时医疗器械有限公司引进美国先进技术而成的TL-200无创连续血液监测系统，能够提供连续、可靠、准确的监测数据。

TL-200是第三代完全无创的仪器，它能动态、实时地处理动脉血压的信号而不用外部校准，对医护人员的技术要求低。

该仪器能够监测每一次脉搏跳动时的桡动脉压的波形和收缩压、舒张压、平均血压和脉搏，其准确性，灵敏性几乎等同于桡动脉穿刺，并且不存在桡动脉穿刺所引起的并发症的风险,这对于临床上具有重大的意义，尤其是对于危重病人。

资料来源：浙江善时医疗器械有限公司••••••••••••••••••【唯美句子】走累的时候，我就到升国旗哪里的一角台阶坐下，双手抚膝，再闭眼，让心灵受到阳光的洗涤。

懒洋洋的幸福。

顶 3 收藏 2•【唯美句子】一个人踮着脚尖，在窄窄的跑道白线上走，走到很远的地方又走回来。

阳光很好，温暖，柔和。

漫天的安静。

顶7 收藏7•【唯美句子】清风飘然，秋水缓淌。

Continuous non-invasive arterial pressure shows high accuracy

Continuous non-invasive arterial pressure shows high accuracy in comparison to invasive intra-arterial blood pressure measurementI. INTRODUCTIONContinuous blood pressure (BP) monitoring is required in a mul-titude of clinical settings, especially in perioperative care. For inpatient surgeries, the American Society of Anesthesiologists (ASA) requires continuous perioperative blood pressure monito-ring at least for patients with severe systemic disease; this neces-sitates the invasive placement of an intra-arterial catheter. In all other cases intermittent non-invasive blood pressure monitoring (NBP) is the standard of care. Therefore, most patients’ blood pressure is not monitored at all times.A recent representative survey(1)among Austrian and German physicians (N=198) provides evidence that, in 82% of inpatient surgerical operations, non-invasive blood pressure monitoring is used. However, in 25% of these cases, especially in cases where hemodynamic instability is expected or where aggressive ma-nagement of blood pressure might be required (e.g. in urologic, extended laparoscopic, orthopedic or vascular surgery, in surgery within gynecology and obstetrics, in medium to extended inte-stinal surgery and elective or urgent trauma surgery(2)), anesthe-siologists would prefer a non-invasive continuous blood pressure monitoring to give them better control over the patient’s hemo-dynamics. In the remaining 18% of inpatient surgerical opera-tions, BP is measured continuously using invasive catheters (IBP), mainly in patients where cardio-vascular instability is expected. For these reasons ASA guidelines specifically require continuous BP measurement whether or not repeated blood gas analysis is needed. Note that, in 26% of these cases the invasive catheter is inserted only to enable continuous blood pressure monitoring. However, this is a time-consuming and cost-intensive procedure, causing pain for the patient and including a risk of infection, and thus should be replaced by a non-invasive method if possible. There are a number of studies stressing the importance of con-tinuous perioperative blood pressure monitoring: for example more than 20% of all hypotensive episodes during surgery may be missed by intermittent upper-arm blood pressure readings and another 20% may be detected with a delay(3). This in turn may prevent immediate treatment or even lead to missing com-plete hypotensive episodes. It has been shown that intraopera-tive hypotension preceeds 56% of perioperative cardiac arrests(4) and is associated with a significant increase of the 1-year post surgical mortality rate(5), indicating that intermittent NBP moni-toring can be insufficient.Consequently, there seems to be a discrepancy between the number of cases where continuous blood pressure monitoring is needed and those cases where it is actually used: due to their invasive nature and associated risks, intra-arterial catheters can only be justified in a limited number of patients, whereas anesthesiologists would like to perform risk-free continuous BP monitoring in a greater number of cases. For exactly these situ-ations CNAP™ has recently become available(6, 7, 8, 9, 10, 11). CNAP™is designed for anesthesiologists who look for more control in situations when continuous blood pressure is desirable, but the risks and burden of an arterial line are not justified. CNAP™ pro-vides continuous, non-invasive and risk-free beat-to-beat blood pressure measurement.The aim of the present report is to evaluate the accuracy of CNAP™ in a real-life perioperative setting by comparing simulta-neous measurements using CNAP™ to continuous intra-arterial blood pressure monitoring.II. MeThODsData recorDingThe measurements were conducted in a perioperative setting at the Department of Anesthesiology at Landeskrankenhaus Bruck an der Mur (Austria). In all patients included in this re-port, continuous BP monitoring was clinically indicated. Arterial pressure was measured simultaneously with an invasive catheter (Edwards Life Sciences™Pressure Monitoring Set, Irvine, USA, connected to Datex Ohmeda S/5 monitor, GE, Helsinki, Finland) and with the CNAP™ Monitor 500i (CNSystems Medizintechnik AG, Graz, Austria) in fifteen patients undergoing orthopedic, cardiac and vascular surgeries (seven female and eight male pa-tients, mean age of 71 years, range 33 to 82 years, ASA classi-fications I-III: I in 1 case, II in 12 cases, III in 2 cases). The arterial catheter was placed ipsi-laterally (n=5) or contra-laterally (n=10) to the CNAP™ finger cuff in the A. radialis or A. brachialis, de-pending on indication and requirements. The surgery durations averaged 1h39min with a minimum of 44min and a maximum of 3h01min, the total duration of recordings obtained was ap-prox. 25 hours.Data processingFrom the IBP as well as from the CNAP™ signal, systolic, diastolic and mean pressure values were derived for each second. If one of the signals was missing (e.g. due to transmission faults or ar-tifacts) for one data point, all other measurements for that data point were consequently discarded. Otherwise, no further data processing was performed and a total of 75,485 data points were included into the statistical comparison.Data comparisonFor a comprehensive evaluation of CNAP™, its underlying me-chanisms have to be considered: CNAP™ is an integrated soluti-on where relative BP changes are measured at the finger sensor and then turned into absolute values based on initial readings from an integrated NBP-unit. This fact needs to be taken into consideration when comparing the blood pressure readings re-corded by CNAP™ and IBP.Sackl-Pietsch E., Department of Anesthesiology, Landeskrankenhaus Bruck an der Mur, AustriaSince three measurement positions are combined in this compa-rison (CNAP ™ finger sensor, CNAP ™ NBP-unit and IBP catheter), some physiological facts have to be taken into account: namely, transformations of BP amplitudes and waveforms as illustrated in figure 1. These imply that a systematic offset between CNAP ™ and IBP would be expected.It is therefore not surprising that even the AAMI-SP10 standard recommended by the FDA reports substantial differences bet-ween indirect NBP and direct intra-arterial measurements (12). A meta-analysis with the results of nine studies totaling 330 pati-ents was performed which quantifies this systematic offset: the average differences between arterial and NBP-cuff systolic BP ranged from 0.8 to 13.4 mmHg with standard deviations (SD) ranging from 0 to 13.0 mmHg. Diastolic BP showed average differences from 0.8 to 18.0 mmHg with SDs ranging from 0.0 to 10.2 mmHg.This offset may be even greater when IBP and NBP recordings are taken on contra-lateral arms. Note that in 10 out of the 15 patients reported here, CNAP ™ and IBP were placed on contra-lateral arms.Therefore, the following differences between CNAP ™ and IBP would be expected:(i) Differences between the two BP waveforms.(ii) The characteristic offset between the absolute values of sy-stolic, diastolic and mean pressure.III. ResULTsWaveform comparisonFigure 2 shows blood pressure waveforms recorded by CNAP ™ compared directly to intra-arterial blood pressure waveforms. The upper graph shows a short episode of stable blood pres-sure. The up arrows indicate rising and the down arrows indi-cate falling BP ramps considered as results of volume status, thefigure 1: Different blood pressure waveforms and amplitudes in the (1) A. brachialis, (2) A. radialis and (3) A. digitalis, resulting in differentsystolic and diastolic valuesFrank-Starling mechanism and autonomic regulation (13). The lo-wer graph shows BP changes caused by perioperative treatment or patient movement. Due to the fact that data was recorded in the clinical routine, no further information about the patient`s treatment at this special time slice is available. Nevertheless, the good concordance of waveforms indicates that CNAP ™ can fol-low fast blood pressure variations changes as well as IBP .HemoDynamic cHangesFor clinical application it is important to ensure that CNAP ™ is able to monitor fast hemodynamic changes. In figure 3 an example is displayed where short-term hemodynamic variability over 25 minutes of orthopedic surgery can be observed clearly: CNAP ™ and IBP display a parallel hemodynamic trend with the typical offset between indirect and direct measurement methods.figure 2: Blood pressure tracings showing the agreement of CNAP™ (solid line) with IBP (dotted line) during anesthesia.Boxplots for all patients’ Data setsFigure 4 shows boxplots for all 15 data sets, for mean BP values. This graph illustrates that most of the patients show a characte-ristic offset between CNAP ™ and IBP .BlanD-altman-plots for tHe complete Data setThe differences of CNAP ™ and IBP data points were computed for every data point (n = 75,485) and plotted against the ave-rage, resulting in the Bland-Altman-plot of Figure 5. No distinct trend ofblood pressure difference in relation to the absolutemean values of pressure can be detected, i.e. the difference bet-ween the two recording methods is the same over the whole range of values.Furthermore, table 1 shows mean values and standard devia-tions of differences of CNAP ™ to IBP for systolic, mean and di-astolic pressure for each patient separately as well as for the whole sample.IV . DIsCUssIONWithin an every day clinical setting, CNAP ™ and IBP readings were recorded simultaneously during inpatient surgeries. The re-sults of this perioperative comparison indicate that CNAP ™ has a high utility during anesthetic care: the overall statistical analyses of systolic, mean and diastolic blood pressure show small diffe-rences and standard deviations between the two methods. The graphical comparison of BP waveforms and short-term trendsduring anesthesia indicates that CNAP ™ can follow hemodyna-mic variability as fast as IBP . These results indicate a high ac-curacy of the non-invasive CNAP ™ device in comparison to the invasive measurement. The waveforms of CNAP ™ and IBP shown in figure 2 comply well with physiological expectations (see section “Methods”). As canbe seen, CNAP ™ corresponds to the IBP signal both in resting con-ditions as well as in movement.For perioperative usability of the CNAP ™ system, it is essential to show that CNAP ™ can deal with hemodynamic changes as well as IBP: the trends of systolic, diastolic and mean BP depictedin figure 3 show excellent visual accordance between the two devices.figure 3: Comparison of short-term trends of systolic, diastolic and mean blood pressure measurements from CNAP ™ (solid lines) and from IBP (dotted lines) during 25 min of anesthesia.figure 4: Boxplots of differences between CNAP ™ and IBP values for all 15 patients (mean BP [mmHg]). The boxes contain the middle 50% of the data, the horizontal lines show the median. The upper and lower edges of the boxes indicate the 75th and 25th percentiles, respectively. The 5-95% range of the data is indicated by the ends of the vertical lines.figure 5: Bland-Altman-plot of differences vs. average of all data points (CNAP ™ vs. IBP values, n=75,485) for mean BP [mmHg].Systolic BP Mean BPDiastolic BPpatient mean SD mean SD mean SD 1-10,0313,834,299,878,806,8022,567,5416,095,8219,245,883-2,817,176,996,5112,277,214-7,8212,061,8812,629,9414,1151,316,6314,415,8820,254,706-16,435,11-9,444,15-3,994,387-1,338,005,446,1514,465,078-10,775,691,913,717,342,869-11,207,78-0,816,713,756,9110-9,937,821,933,867,163,2211-25,828,37-7,484,620,223,8912-1,456,956,527,7310,956,41130,2411,626,817,9111,097,341433,554,5932,007,1037,775,77152,8910,4913,585,8419,694,99Total-2,9613,816,6611,2312,3610,91taBle 1: Means and standard deviations (SD) of differences between CNAP TM and IBP [mmHg].To illustrate the overall agreement between CNAP™ and IBP, fi-gures 4 and 5 sum up the results for all 15 patients. The va-lidation of CNAP™with a total observation duration of about 25 hours and 75,485 data points is very acceptable: the mean values and standard deviations of differences to the intra-arterial recordings comply with the results of the meta-analysis recom-mended by the FDA.As can be seen in figure 4, all patients have their own characte-ristic offset between CNAP™ and IBP. Only patient no. 14 seems to slightly deviate from the rest with a higher pressure difference which may be explained by the patients’ arteries: in patient no.14 the vessels were described by the clinician as ‘stiff’ and the IBP readings as ‘dependent on bedding’, thus making the arte-rial reference less reliable and the results surprisingly good. On the other hand, not even in the case where a patient’s peripheral perfusion was described by the physician as “poor” (patient no.11) did the CNAP™ system fail to quickly find a suitable BP wave-form and the results compared to IBP are very satisfactory.The individual, physiologically-determined offset can also be seen clearly in the cluster of data points of each patient in fi-gure 5 (e.g., note patient no. 14 in the upper right-hand corner). Nevertheless, the Bland-Altman-plot between CNAP™and IBP shows no distinct trend of mean pressure difference in relation to the average values of pressure, i.e. the difference between the two recording methods is the same over the whole range of values. This indicates that CNAP™ measurement is reliable in normal, hypotensive and hypertensive episodes.The mean values and standard deviations of differences bet-ween CNAP™ and IBP reported in table 1 confirm the findings of the meta-analysis in the current ANSI standard. These results are very satisfactory considering the patient sample included in this report. Note that data was recorded in patients with severe systemic disease or during higher-risk surgeries where the place-ment of an invasive catheter was motivated by safety conside-rations.Although the results of this report indicate a high clinical utility for CNAP™, some remarks should be added about the compa-rison to IBP measurements: there is common agreement that “true” blood pressure is best determined directly using a relia-ble, calibrated transducer in an artery. Nevertheless, there is also consensus that the direct intra-arterial measurement is fraught with its inherent set of issues, including variability with radial position, vasoconstriction, the effects of flow-velocity changes and the frequency response of amplifier and transducer. Taking this into account, the results of this present report are even more remarkable.V. CONCLUsIONThe reported results provide clear evidence of an excellent clini-cal feasibility and high accuracy of the non-invasive BP measure-ment device CNAP™ in comparison to IBP.With intermittent measurement of oscillometric sphygmoma-nometers (NBP), short-term but clinically relevant hemodynamic changes during anesthesia are not satisfactorily detectable. The-refore, the demand from anesthesiologists for a system provi-ding non-invasive, continuous beat-to-beat BP is increasing. CNAP™ provides patient comfort and usability similar to a stan-dard upper-arm NBP and clinical data shows that its accuracy is comparable to IBP. CNAP™ is therefore the convenient solution for anesthesiologists who want to have comprehensive hemo-dynamic control to ensure the very highest standards in patient safety.VI. ReFeReNCesvon Skerst B: Market survey, N=198 physicians in Germany and Austria,1.Dec.2007 - Mar 2008, InnoTech Consult GmbH, GermanyEzekiel MR. Handbook of Anesthesiology. Current Clinical Strategies Publi-2.shing. 2003Dueck R, Jameson LC. Reliability of hypotension detection with noninvasive 3.radial artery beat-to-beat versus upper arm cuff BP monitoring. AnesthAnalg 2006, 102 Suppl: S10Sprung J, Warner ME, Contreras ME et al. Predictors of Survival following 4.Cardiac Arrest in Patients Undergoing Noncardiac Surgery. Anesthesiology 2003; 99:259–69Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-5.year mortality after noncardiac surgery. Anesth Analg. 2005 Jan;100(1):4-10.Fortin J, Gratze G, Wach P, Skrabal: Automated non-invasive assessment of 6.cardiovascular function, spectra analysis and baroreceptor sensitivity for the diagnosis of syncopes. World Congress on Medical Physics and Biomedical Engineering. Med & Biol Eng & Comput, 35, Supplement I, 466 (1997).Gratze G, Fortin J, Holler A, Grasenick K, Pfurtscheller G, Wach P, Kotanko 7.P, Skrabal F: A software package for non-invasive, real time beat to beatmonitoring of stroke volume, blood pressure, total peripheral resistance and for assessment of autonomic function. Comp in Bio & Medicine; 28, 121-142 (1998).Fortin J, Habenbacher W, Gruellenberger R, Wach P, Skrabal F: Real-time Mo-8.nitor for hemodynamic beat-to-beat parameters and power spectra analysis of the biosignals. Proc. of the 20th Annual International Conference of the IEEE Eng in Medicine and Biology Society, 20, 1 (1998).Fortin J, Marte W, Grüllenberger R, Hacker A, Habenbacher W, Heller A,9.Wagner Ch, Wach P, Skrabal F: Continuous non-invasive blood pressure mo-nitoring using concentrically interlocking control loops. Computers in Biology and Medicine 36 (2006) 941–957Fort10. in J, Alkan S, Wrede C E, Sackl-Pietsch E and Wach P: ContinuousNon-invasive Arterial Pressure (CNAP™) – An Innovative Approach of theVascular Unloading Technique. Submitted for publication in Blood Pressure April 2008.Fortin J: Continuous Non-invasive Measurements of Cardiovascular Function.11.PhD-thesis, Institute of Biomedical Engineering, University of TechnologyGraz, 2007, pp. 103-21.Association for the Advancement of Medical Instrumentation. American 12.National Standard. Manual, electronic or automated sphygmomanometers ANSI/AAMI SP10-2002/A1. 3330 Washington Boulevard, Suite 400, Arling-ton, VA 22201-4598, USA: AAMI; 2003Parati G, Omboni St, Frattola A, Di Rienzo M, Zanchetti A, Mancia G. Dyna-13.mic evaluation of the baroreflex in ambulant subject. In: Blood pressure and heart rate variability, edited by di Rienzo et al. IOS Press, 1992, pp. 123-137.。

比较分析全身麻醉中连续无创动脉血压监测与有创动脉血压监测

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连续无创血压(CNAP)与传统无创血压(NIAP)在鼻内镜下鼻窦开放手术麻醉后血压监测中的比较

连续无创血压 (CNAP)与传统无创血压(NIAP)在鼻内镜下鼻窦开放手术麻醉后血压监测中的比较摘要：目的探讨连续无创血压(CNAP)与传统无创血压(NIAP)在鼻内镜下鼻窦开放手术麻醉后血压监测中的比较。

方法从2018年8月~2020年8月时间段选取80例行鼻内镜下鼻窦开放手术的患者为研究对象，采用随机数字表法将患者分为2组，即对照组与观察组，每组各40例，前者采用NIAP监测患者血压数据，后者采用CNAP监测患者血压数据，对比两组患者麻醉后血压水平、血流动力学稳定时间及术后并发症发生情况。

结果两组患者血压监测结果与对照组比较无显著差异（P＞0.05）；观察组血流动力学稳定时间长于对照组（P＜0.05）；观察组与对照组的并发症发生率分别为7.50%及30.00%，两组存在显著差异（P＜0.05）。

结论实施鼻内镜下鼻窦开放手术的患者，相比较NIAP监测，CNAP监测更有利于维持患者血流动力学的稳定，促使其安全渡过围术期。

关键词：CNAP；NIAP；鼻窦开放手术；血压监测鼻窦开放手术通过鼻内镜将鼻窦周围病变的骨质、组织切除，促使鼻窦充分引流至鼻腔，减轻患者炎症，其是治疗慢性鼻窦炎及鼻息肉的经典手术方式，具有视野清晰、损伤小及清除病变彻底的优点，在临床得以广泛使用，取得满意的效果。

手术常根据患者病变范围、患者全身情况及耐受情况选择适宜麻醉方式，然而麻醉后患者术中如出现血压异常增加或低血压等现象，会引发不同程度的围术期并发症[1]。

因此，围术期精准监测患者的血压波动情况，维持患者血流动力学稳定十分重要。

NIAP及CNAP是临床常用的血压监测工具，前者是一个间断且不连续的监测过程，因此患者手术过程中血压迅速发生变化可能不能及时发现，并加以纠正[2]；后者不仅可连续监测到每博血压值，还可为血压评估提供详细的数据，有利于维持患者血流动力学的稳定，促使患者顺利渡过围术期，减少各种并发症的发生[3]。

鉴于此，本次研究选取80例行鼻内镜下鼻窦开放手术的患者为主体，探讨NIAP及CNAP用于麻醉后血压监测的效果，具体如下：1一般资料与方法1.1一般资料从2018年8月~2020年8月时间段选取80例行鼻内镜下鼻窦开放手术的患者为研究对象。

全身麻醉中连续无创动脉血压监测与有创动脉血压监测的比较

临床医药文献电子杂志Electronic Journal of Clinical Medical Literature2019 年第 6 卷第 30 期2019 Vol.6 No.3037全身麻醉中连续无创动脉血压监测与有创动脉血压监测的比较张红，白晓龙（武安市第一人民医院，河北邯郸 056300）【摘要】目的探讨全身麻醉中连续无创动脉血压监测与有创动脉血压监测的比较。

方法以随机数字表法在我院2017年3月～2018年3月中收治的择期手术行全身麻醉的患者72例纳为对象，给患者行连续无创动脉血压监测（观察A组）、有创动脉血压监测（观察B组），比较两组的SBP、DBP、MAP数值。

结果观察A组的SBP、DBP、MAP数值与观察B组比较，差异无统计学意义，P＞0.05。

结论 CNMP和IAP这两种方式用于全身麻醉中患者动脉血压监测的效果差异不大，临床上可以根据患者的实际情况进行选择。

【关键词】全身麻醉；连续无创动脉血压监测（CNMP）；有创动脉血液（IAP）【中图分类号】R614 【文献标识码】A 【文章编号】ISSN.2095-8242.2019.30.37.01手术治疗是普外科常用的一种手段，通常可以治疗多种重大疾病，但患者接受手术治疗时，均需进行适当的麻醉才允许手术操作。

全身麻醉是手术治疗常用的麻醉方式之一，而麻醉期间应密切监测患者的心血管功能，以便出现异常时能够第一时间反应。

既往常以无创袖带监测患者的血压，虽然可以对患者的血压进行一定程度的监测，但是仍有许多患者的术中低血压状况不能被无创袖带血压监测出[1]。

近年临床上常用的血压监测手段诸多，比如CNMP 和IAP这两种方式，但其对于全身麻醉患者动脉血压监测的情况仍有争议。

本次研究旨在对CNMP和IAP监测全身麻醉中患者的动脉血压监测情况进行探讨。

1 资料与方法1.1 一般资料以随机数字表法在我院2017年3月～2018年3月中收治的择期手术行全身麻醉的患者72例纳为对象，纳入患者病情均经影像学、临床病理学、实验室检查证实，均需接受手术治疗；排除年龄未满18岁和体质量（BMI）＞35 kg/m2以及急诊手术、合并重度上肢水肿等情况的患者；患者男女比例是41:31，年龄在24～61岁之间、均值是（40.83±5.37）岁，美国麻醉师协会（ASA）分级在I-III级之间。

无创连续血压监测(CNAP)与有创动脉内测压比较,数据高度准确

无创连续血压监测(CNAP)与有创动脉内测压比较,数据高度准确Continuous non-invasive arterial pressure shows high accuracy in comparison toinvasive intra-arterial blood pressuremeasurement无创连续血压监测(CNAP)与有创动脉内测压比较，数据高度准确Sackl-Pietsch E., Department of Anesthesiology, Landeskrankenhaus Bruck an der Mur,AustriaI.简介连续血压监测是众多临床监护设备的参数之一，尤其对于围术期监测。

在其他情况下，监护常规使用无创间隔血压监测。

因此，许多病人的血压监测并不是连续即时的。

在剩余的18%外科住院手术中，有创测压主要用于可预测的心血管不稳定的病人。

因此，ASA推荐指南特别要求不管是否需要反复血气分析，都必须进行连续血压测量。

有创血压和无创血压测量值的比较

有创血压和无创血压测量值的比较
姚维红
【期刊名称】《现代中西医结合杂志》
【年(卷),期】2007(16)31
【摘要】近年来随着危重医学的发展及先进的医疗仪器的临床使用，创伤性血流动力学监测已经逐步被先进的无创性监测所代替而使临床应用日趋减少。

但从理论上讲，有创血压比较准确、可靠，较无创血压更接近正常值。

这无疑决定了它仍是手术室和ICU等大手术和抢救危重患者时不可缺少的手段。

而无创测压法具有操作简单、无痛苦、易接受等优点，在临床上广泛使用。

因此，找出它们的差异性，对比它们的差值大小及其规律性，提高无创血压值判断的准确性，利用有效血压更有效地指导临床抢救和治疗具有重要意义。

【总页数】1页(P4643)
【作者】姚维红
【作者单位】浙江省杭州市萧山区第一人民医院,浙江,杭州,311200
【正文语种】中文
【中图分类】R0443.5
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