准确测量血压(BP)在管理患病的早产儿中极为重要。这项研究的主要目的是比较无创血压测量(NIBP)与使用外周动脉插管(PAC)的有创血压测量(IBP)在新生儿重症监护病房中<37周的早产儿。
前瞻性地将需要PAC的早产儿纳入研究。在与外周动脉线相同的肢体中进行NIBP测量。最初使用相同的监测器记录IBP,然后在1分钟内记录NIBP。这些被称为成对测量,因为它们在彼此的1分钟内进行。
在最终分析中纳入了73名早产儿和1703个配对测量值(中位胎龄32周,IQR30-34周,中位出生体重1540克,IQR1160-2100g)。在未接受血管活性剂的早产儿中(n=51,1428配对测量,Bland-Altman分析有创平均血压(MBP)和无创平均血压之间的一致性显示偏差为-2.9123mmHg(SD7.8074)。95%的协议限值为-18.2157至12.3893mmHg。在低血压的早产儿中,我们检测到侵入性MBP和非侵入性MBP之间的偏差为-3.9176mmHg(SD5.1135).95%的一致性限值为-13.9401至6.1048mmHg。在接受血管活性剂的血压正常的早产儿中,我们检测到侵入性MBP和非侵入性MBP之间的偏差为-0.7629mmHg(SD8.0539)。95%的一致性限值为-16.5485至15.02274mmHg。
在患病的早产儿中,IBP和NIBP测量值之间的一致性较差,导致高估或低估血压。与收缩期BP测量相比,平均BP测量值的偏倚较小,与低血压新生儿相比,血压正常的新生儿的偏倚也较小。因此,NIBP可用作血流动力学稳定的早产儿的筛查方法。但血流动力学不稳定且需要开始使用血管活性药物的婴儿应进行IBP监测.
Accurate measurement of blood pressure (BP) is extremely important in the management of sick preterm newborns. The primary objective of this
study was to compare non-invasive blood pressure measurement (NIBP) with invasive blood pressure measurement (IBP) using peripheral arterial cannulation (PAC) in preterm neonates < 37 weeks in the neonatal intensive care unit.
Preterm neonates needing PAC were prospectively enrolled in the
study. NIBP measurements were taken in the same limb as that of peripheral arterial line. Initially IBP was recorded followed by NIBP within 1 min using the same monitor. These were called as paired measurements since they are taken within 1 min of each other.
Seventy-three preterm infants with 1703 paired measurements were included in the final analysis (median gestational age 32 weeks, IQR 30-34 weeks, median birth weight 1540 g, IQR 1160-2100 g). In preterm infants not receiving vasoactive agents (n = 51, 1428 paired measurements, Bland-Altman analysis for agreement between invasive mean blood pressure (MBP) and non-invasive mean BP revealed a bias of -2.9123 mmHg (SD 7.8074). The 95% limits of agreement were from -18.2157 to 12.3893 mmHg. In preterm infants with hypotension, we detected a bias of -3.9176 mmHg (SD 5.1135) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from -13.9401 to 6.1048 mmHg. In normotensive preterm infants receiving vasoactive agents, we detected a bias of -0.7629 mmHg (SD 8.0539) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from -16.5485 to 15.02274 mmHg.
There is poor level of agreement between IBP and NIBP measurements in sick preterm neonates, leading to overestimation or underestimation of blood pressure. The bias was less for mean BP measurements as compared with systolic BP measurements and also for normotensive neonates as compared with hypotensive neonates. Hence, NIBP may be used as a screening method in haemodynamically stable preterm infants, but infants who are haemodynamically unstable and need to be commenced on vasoactive agents should have IBP monitoring.