PDF(Pubmed)
Abstract：
BACKGROUND: This study aimed to evaluate the accuracy of ankle blood pressure measurements in relation to invasive blood pressure in the lateral position.
METHODS: This prospective observational study included adult patients scheduled for elective non-cardiac surgery under general anesthesia in the lateral position. Paired radial artery invasive and ankle noninvasive blood pressure readings were recorded in the lateral position using GE Carescape B650 monitor. The primary outcome was the ability of ankle mean arterial pressure (MAP) to detect hypotension (MAP < 70 mmHg) using area under the receiver operating characteristic curve (AUC) analysis. The secondary outcomes were the ability of ankle systolic blood pressure (SBP) to detect hypertension (SBP > 140 mmHg) as well as bias (invasive measurement - noninvasive measurement), and agreement between the two methods using the Bland-Altman analysis.
RESULTS: We analyzed 415 paired readings from 30 patients. The AUC (95% confidence interval [CI]) of ankle MAP for detecting hypotension was 0.88 (0.83-0.93). An ankle MAP of ≤ 86 mmHg had negative and positive predictive values (95% CI) of 99 (97-100)% and 21 (15-29)%, respectively, for detecting hypotension. The AUC (95% CI) of ankle SBP to detect hypertension was 0.83 (0.79-0.86) with negative and positive predictive values (95% CI) of 95 (92-97)% and 36 (26-46)%, respectively, at a cutoff value of > 144 mmHg. The mean bias between the two methods was - 12 ± 17, 3 ± 12, and - 1 ± 11 mmHg for the SBP, diastolic blood pressure, and MAP, respectively.
CONCLUSIONS: In patients under general anesthesia in the lateral position, ankle blood pressure measurements are not interchangeable with the corresponding invasive measurements. However, an ankle MAP > 86 mmHg can exclude hypotension with 99% accuracy, and an ankle SBP < 144 mmHg can exclude hypertension with 95% accuracy.
METHODS: This prospective observational study included adult patients scheduled for elective non-cardiac surgery under general anesthesia in the lateral position. Paired radial artery invasive and ankle noninvasive blood pressure readings were recorded in the lateral position using GE Carescape B650 monitor. The primary outcome was the ability of ankle mean arterial pressure (MAP) to detect hypotension (MAP < 70 mmHg) using area under the receiver operating characteristic curve (AUC) analysis. The secondary outcomes were the ability of ankle systolic blood pressure (SBP) to detect hypertension (SBP > 140 mmHg) as well as bias (invasive measurement - noninvasive measurement), and agreement between the two methods using the Bland-Altman analysis.
RESULTS: We analyzed 415 paired readings from 30 patients. The AUC (95% confidence interval [CI]) of ankle MAP for detecting hypotension was 0.88 (0.83-0.93). An ankle MAP of ≤ 86 mmHg had negative and positive predictive values (95% CI) of 99 (97-100)% and 21 (15-29)%, respectively, for detecting hypotension. The AUC (95% CI) of ankle SBP to detect hypertension was 0.83 (0.79-0.86) with negative and positive predictive values (95% CI) of 95 (92-97)% and 36 (26-46)%, respectively, at a cutoff value of > 144 mmHg. The mean bias between the two methods was - 12 ± 17, 3 ± 12, and - 1 ± 11 mmHg for the SBP, diastolic blood pressure, and MAP, respectively.
CONCLUSIONS: In patients under general anesthesia in the lateral position, ankle blood pressure measurements are not interchangeable with the corresponding invasive measurements. However, an ankle MAP > 86 mmHg can exclude hypotension with 99% accuracy, and an ankle SBP < 144 mmHg can exclude hypertension with 95% accuracy.
摘要：
背景：这项研究旨在评估踝关节血压测量与侧卧位有创血压相关的准确性。
方法：这项前瞻性观察研究纳入了在侧卧位全身麻醉下择期非心脏手术的成年患者。使用GECarescapeB650监测仪在侧卧位记录成对的桡动脉有创和踝关节无创血压读数。主要结果是踝关节平均动脉压（MAP）检测低血压（MAP<70mmHg）的能力，使用受试者工作特征曲线下面积（AUC）分析。次要结果是踝关节收缩压（SBP）检测高血压（SBP>140mmHg）的能力以及偏倚（有创测量-无创测量），并使用Bland-Altman分析在两种方法之间达成一致。
结果：我们分析了来自30例患者的415个配对读数。踝关节MAP检测低血压的AUC（95％置信区间[CI]）为0.88（0.83-0.93）。踝关节MAP≤86mmHg的阴性和阳性预测值（95％CI）为99（97-100）％和21（15-29）％，分别,用于检测低血压。踝关节SBP检测高血压的AUC（95％CI）为0.83（0.79-0.86），阴性和阳性预测值（95％CI）为95（92-97）％和36（26-46）％，分别,截止值>144mmHg。两种方法之间的平均偏差为SBP的-12±17，3±12和-1±11mmHg，舒张压,还有MAP,分别。
结论：在侧卧位全身麻醉的患者中，踝关节血压测量值与相应的侵入性测量值不可互换.然而,踝关节MAP>86mmHg可以排除低血压，准确率为99%，踝关节SBP<144mmHg可以排除高血压，准确率为95%。
方法：这项前瞻性观察研究纳入了在侧卧位全身麻醉下择期非心脏手术的成年患者。使用GECarescapeB650监测仪在侧卧位记录成对的桡动脉有创和踝关节无创血压读数。主要结果是踝关节平均动脉压（MAP）检测低血压（MAP<70mmHg）的能力，使用受试者工作特征曲线下面积（AUC）分析。次要结果是踝关节收缩压（SBP）检测高血压（SBP>140mmHg）的能力以及偏倚（有创测量-无创测量），并使用Bland-Altman分析在两种方法之间达成一致。
结果：我们分析了来自30例患者的415个配对读数。踝关节MAP检测低血压的AUC（95％置信区间[CI]）为0.88（0.83-0.93）。踝关节MAP≤86mmHg的阴性和阳性预测值（95％CI）为99（97-100）％和21（15-29）％，分别,用于检测低血压。踝关节SBP检测高血压的AUC（95％CI）为0.83（0.79-0.86），阴性和阳性预测值（95％CI）为95（92-97）％和36（26-46）％，分别,截止值>144mmHg。两种方法之间的平均偏差为SBP的-12±17，3±12和-1±11mmHg，舒张压,还有MAP,分别。
结论：在侧卧位全身麻醉的患者中，踝关节血压测量值与相应的侵入性测量值不可互换.然而,踝关节MAP>86mmHg可以排除低血压，准确率为99%，踝关节SBP<144mmHg可以排除高血压，准确率为95%。
