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

腹腔镜手术中无创连续血压监测与有创动脉压监测的一致性李雨泽;陈小杏;招伟贤;洪庆雄;邵兰【期刊名称】《广东医学》【年(卷),期】2016(037)001【摘要】目的：在腹腔镜胃肠癌切除手术中观察无创连续血压监测（ CNAP）与动脉有创血压监测（ IBP）的一致性。

方法选择20例择期在腹腔镜下实施胃肠癌手术的患者进行观察。

采用CNAP血压监测仪和Philips MP60监护仪连接FloTrac传感器分别连续监测无创和桡动脉有创血压，并以麻醉诱导期（ T1）、气腹手术期（ T2）、术毕拔管期（T3）以及低血压（Low）、正常血压（Nor）和高血压（Hi）等不同时期和血压状态对比分析两种血压监测方法的一致性。

结果20例血压监测获得匹配数据3721对。

两种方法测得的收缩压、舒张压和平均压对比差异均有统计学意义（P＝0.000），Bias和95％置信区间分别为（－6.7±21.3）（－35.0～48.4）、（8.4±10.8）（－29.6～12.7）和（3.8±13.0）（－29.2～21.6） mmHg。

CNAP在T1和T3的收缩压及在T2的平均压与IBP 对比，差异均无统计学意义（P＞0.05）。

Bias及95％置信区间分别为（2.8±23.7）（－49.3～36.2）、（3.6±31.8）（－65.9～48.7）和（1.7±13.3）（－27.8～20.3） mmHg。

两种血压监测在3种血压状态时的监测值均差异有统计学意义（ P＝0.012～0.000），其Bias平均值及95％置信区间变异较大。

结论腹腔镜胃肠癌手术中不同麻醉手术阶段或不同血压状态下，CNAP与IBP血压值均存在较大的偏离性。

CNAP监测的可靠性尚有待进一步提高。

%Objective To investigate the degree of consistency between continuous non-invasive arterial pres-sure( CNAP) and invasive blood pressure monitoring duringlaparoscopic resection of gastrointestinal cancer.Methods Twenty cases of elective laparoscopic resection of gastrointestinal cancer were enrolled in the study.Continuous noninva-sive blood pressure with CNAP monitor and invasive radio-artery blood pressure with FloTrac sensor and Philips MP60 Monitor were recorded respectively.Consistency between the two methods was compared and analyzed at the following peri-ods, induction of anesthesia (T1), during pneumoperitoneum (T2), extubation (T3), hypotension (Low), normal blood pressure ( Nor) and hypertension( Hi) .Results 3 721 pairs of matching data of blood pressure were obtained from the 20 cases.The systolic, diastolic and mean blood pressure, when compared between the two monitoring methods, showed statistically significant difference ( P=0.000 ) , with bias and 95% confidence interval being ( -6.7 ±21.3 ) (-35.0~48.4), (8.4 ±10.8) ( -29.6 ~12.7) and (3.8 ±13.0) ( -29.2 ~21.6) mmHg respectively.In the comparison of CNAP with IBP, no significant differences were found in the systolic blood pressure in T1 and T3 and the mean pressure in T2, with Bias and 95% confidence interval being (2.8 ±23.7) ( -49.3 ~36.2), (3.6 ±31.8) (-65.9~48.7) and (1.7 ±13.3)(-27.8~20.3) mmHg respectively.Statistically significant differences between the two methods were found in the Low, Nor and Hi blood pressure states (P=0.012~0.000), with significant variance in Bias and 95%confidence interval.Conclusion Significant inconsistency exists between CNAP and invasive blood pres-sure pressure measurement in different surgical stages of laparoscopic gastrointestinal cancer resection or different bloodpressure states.The reliability of CNAP monitoring requires further improvement.【总页数】4页(P27-30)【作者】李雨泽;陈小杏;招伟贤;洪庆雄;邵兰【作者单位】广州中医药大学第二附属医院麻醉科广州510120;广州中医药大学第二附属医院麻醉科广州510120;广州中医药大学第二附属医院麻醉科广州510120;广州中医药大学第二附属医院麻醉科广州510120;广州中医药大学第二附属医院麻醉科广州510120【正文语种】中文【相关文献】1.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 [J], 赵鹏;卫娜;王倩梅;李平方;尹文2.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 [J], 程本春3.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 [J], 程本春4.危重症患者床旁无创与有创血压监测的一致性评价及相关性分析 [J], 杨晓军;冯涛;李桂芳;李元贵;柳明;周文杰5.无创和有创血压监测在手术中的应用 [J], 蔡莉萍;王警卫;陈晓茜;曹艳因版权原因，仅展示原文概要，查看原文内容请购买。

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。

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。

有创性血压和无创性血压的对比分析
刘丽萍;陈建昌;徐卫亭;江建良;罗小雨
【期刊名称】《中国误诊学杂志》
【年(卷),期】2007(7)24
【摘要】目的:探讨柯氏音听诊法测量血压的准确性。

方法:选取于我院行冠脉造影的68例患者,同时测量同侧肢体的有创性血压和无创性血压。

结果:测得肱动脉的有创性血压比无创性血压值高,收缩压约高10 mm Hg,舒张压约高12 mm Hg,差异都具有显著性(P<0.05)。

结论:无创性血压与血压真实值有一定的差异,在重度低血压时,可选择直接有创测量法。

【总页数】2页(P5738-5739)
【关键词】血压测定/方法;人类
【作者】刘丽萍;陈建昌;徐卫亭;江建良;罗小雨
【作者单位】苏州大学附属第二医院心内科
【正文语种】中文
【中图分类】R44
【相关文献】
1.有创血压和无创血压相关性及一致性分析 [J], 董志英
2.重症心脏病人术后有创血压与无创血压监测的对比性探讨 [J], 王晓玲
3.无创性动态血压与诊室血压对比评价单纯性收缩期高血压 [J], 简明;刘国仗;刘力生
4.有创血压与无创血压在心脏手术后血压监测方面的对比分析 [J], 宋稳丹
5.新生儿血压测定:3种无创性监护示波器显示的血压值与有创性血压测定值间的对比研究[J], Dannevig I.;Dale H.C.;Liestφl K.;Lindemann R.;李开
因版权原因，仅展示原文概要，查看原文内容请购买。

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
【相关文献】
1.危重患者有创血压与无创血压监测的比较
2.术中同测有创血压与无创血压值对比认识
3.成人有创血压及无创血压测量值的比较
4.严重创伤患者有创动脉血压和无创血压监测的比较及对病死率的影响
5.5种无创血压测量仪测量值比较
因版权原因，仅展示原文概要，查看原文内容请购买。

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。

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 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.。

有创动脉压与无创动脉压在新生儿应用中的效果对比摘要：目的：研究危重新生儿有创血压监测(IBP)和无创血压监测(NBP)的效果。

2020年6月至2021年12月，我院NICU16名新生儿被选为研究对象，比较了有创血压监测与无创血压监测的差异。

利用多重线性回归分析比较了轻度低温、心律失常、新生儿休克、RDS、HIE和新生儿窒息对有创血压监测和无创血压监测的影响，并分析了相关因素。

通过有创血压监测的收缩压高于通过无创血压监测的收缩压(P<0.05)。

在多元线性回归分析中，影响新生儿UPS收缩期血压的因素有新生儿休克、HIE和新生儿窒息症(P<0.05)。

影响新生儿OBO平均血压的因素是心律失常和RDS(P<0.05)。

在多元线性回归分析中，影响NBP收缩期血压的因素为新生儿休克(P<0.05)。

持续的有创血压监测要比重症监护室的无创血压监测更准确、更大众化、临床应用。

关键词：有创动脉压；无创动脉压；新生儿引言目前，ＣＡＰ测量方法分为有创法和无创法两种。

有创测量法可以准确反映主动脉根部的压力，是测量CAP波形的“金标准”，但是具有高侵入性、大创伤性、高成本等缺点，导致其临床应用场景较窄。

为弥补有创法的不足，无创CAP的测量方法被相继提出，主要包括直接替代法、广义传递函数法、Ｎ点移动平均法和自适应传递函数法等。

这些方法主要利用人体外周信号通过函数转换和脉搏波分析间接推算CAP的波形和参数，如中心收缩压（CASP）、中心舒张压（CADP）和中心脉压（CPP）等。

尽管间接法在精度上不如有创的直接法，但其具有低成本、低风险、易操作等优势，已成为CAP检测的研究热点。

1资料与方法1.1一般资料从2020年6月到2021年12月，我院重症监护室接受有创血压监测和无创血压监测的16名新生儿被选为研究对象，不能进行有创血压监测的新生儿除外。

新生儿的所有观察都是根据临床治疗的需要进行的，对新生儿没有额外负担，这是回顾性分析。