不同角度侧卧位对血压测量值的影响

目的观察不同角度侧卧位对血压测量值的影响。方法测量60例ICU患者,平卧位（右侧0。侧卧）、右侧30°和右侧90°卧位时左上肢肱动脉的收缩压（SBP）和舒张压（DBP）,并进行自身配对方差分析和多个样本均数的两两比较。结果从平卧位到右侧30°、90°卧位,左上肢肱动脉的SBP和DBP测量值逐步下降,三种角度侧卧位的SBP和DBP测量值差异有统计学意义（均P〈0．01）。结论侧卧的角度改变对SBP和DBP测量结果有显著影响,对于须连续监测血压的卧床患者,尤其是在临界状态下,更应注意避免侧卧角度对血压值的影响。     

老年血液透析患者肱动脉和足背动脉血压值比较

目的探讨老年维持性血液透析(MHD)患者血液透析过程中肱动脉与踝部足背动脉血压值的差异性及其相关性,为临床护理提供参考。方法将58例老年MHD患者按血压正常与否分为正常血压组30例和高血压组28例,测量其平卧位右侧肱动脉及足背动脉血压,作自身对照分析。结果两组肱动脉收缩压及舒张压均显著低于足背动脉血压(均P0.01),二者具有显著相关性和线性依存关系(均P0.01)。结论对血液透析过程中只能测量足背动脉血压的患者,行内瘘穿刺前先测量同侧肱动脉和足背动脉血压,计算出差值作参考;透析过程中将足背动脉血压换算后替代肱动脉血压,可确保血压监测的有效性。     

30°侧卧更换体位法预防压疮效果观察

目的 探讨30°侧卧更换体位法预防难免性压疮患者发生压疮的效果.方法 将187例Norton评分为5～8分的难免性压疮患者随机分为观察组94例、对照组93例.对照组采用常规预防方法,即采取右侧90°卧位→平卧位→左侧90°卧位→平卧位的循环方式;观察组采用右侧30°卧位→左侧30°卧位→平卧位的顺序更换体位.两组均每2小时更换1次卧位.结果 观察组发生压疮1例,占1.06%;对照组发生压疮12例,占12.90%.两组比较,差异有显著性意义(P＜0.01).结论 30°侧卧更换体位法可有效缓解骨突部位压力,提高预防压疮的效果.     

成人心脏术后常用卧位下中心静脉压差异及压力零点位置研究

目的探讨成人心脏术后患者3种常用卧位(头高30°、头高30°左侧45°和右侧45°)测量中心静脉压(CVP)的差异及压力零点位置,为临床获取正确监测结果提供参考。方法选择成人心脏术后患者100例,在同一时段分别采用头高30°、头高30°左侧45°和右侧45°三种常用卧位测得CVP,并与平卧位测量值进行比较;当侧卧位时沿标准零点位置上下移动传感器,标记与平卧位CVP值相同时的压力零点胸壁位置,同时记录心率(HR)、平均动脉压(MAP)、呼吸(RR)、血氧饱和度(SpO2)变化。结果头高30°卧位与平卧位时CVP值比较,差异无统计学意义(P0.05);头高30°左侧45°卧位较平卧位时CVP值低,与平卧位CVP值相同的压力零点位于右侧腋后线与第四肋间交点(-0.15±0.49)cm;头高30°右侧45°卧位较平卧位时CVP值高,与平卧位CVP值相同的压力零点位于右侧腋前线与第四肋间交点(0.18±0.54)cm。3种常用卧位与平卧位时的HR、MAP、RR、SpO2比较差异无统计学意义(均P0.05)。结论心脏术后成人常用头高30°卧位下测得的CVP存在一定差异,且压力零点位置与平卧位不同。确定成人心脏术后患者临床3种常用卧位测量CVP的差异和压力零点位置的变化,有助于护理人员采取对应措施确保CVP测量值准确。     

同体肱动脉与桡动脉血压值比较的研究

目的探讨肱动脉血压与桡动脉血压值差别。方法采用台式血压仪监测169名观察对象,取右侧上肢分别测 量肱动脉血压与桡动脉血压,并将所测血压值进行比较。结果169名同体肱动脉血压和桡动脉血压值差异无显著 性意义(P>0.05)。结论必要时可采用测量桡动脉血压代替肱动脉血压值。     

头静脉原位转流治疗腋杖致腋肱动脉闭塞一例

患者女,58岁.因“右上肢冷痛1d,加重伴麻木4h”于2010年3月5日入院.既往因小儿麻痹症致右下肢行走障碍,使用双侧腋杖40余年.查体:心率86次/min,律齐,左上肢血压120/63 mm Hg(1 mmHg=0.133 kPa);右上肢血压未测出,右侧尺、桡动脉搏动消失,皮温较对侧低,肌力Ⅳ级.彩超提示:右侧腋肱动脉闭塞.右上肢CT 血管成像(CTA)提示:右腋肱动脉节段性闭塞(图1).术前诊断:右侧腋肱动脉急性栓塞.急诊行右肱动脉切开取栓术.     

不同体位肱动脉峰流速差值对产妇腰麻后仰卧位低血压综合征的预测作用

目的通过超声测量产妇不同体位肱动脉峰流速的变化,探讨其预测腰麻后发生仰卧位低血压综合征(supine hypotension syndrome,SHS)的有效性。方法拟在腰麻下行择期剖宫产的单胎产妇,ASAⅠ或Ⅱ级,根据腰麻后是否发生SHS(上肢SBP下降30 mm Hg或下降至80 mm Hg以下)分为SHS组和非SHS组。记录麻醉前仰卧位与左侧卧位的HR、SBP、DBP,同时超声测量肱动脉峰流速。并计算变换体位前后上述指标的差值(Δ),对组间比较有统计学意义的指标绘制受试者工作特征(ROC)曲线,评价各指标对腰麻后发生SHS的预测作用。结果纳入196例产妇,有89例(45.4%)腰麻后发生了SHS。SHS组ΔSBP、ΔDBP、肱动脉峰流速最小值差值(ΔVpmin)、肱动脉峰流速变异度差值(ΔΔVp)明显高于非SHS组(P0.05),ΔSBP、ΔDBP、ΔVpmin、ΔΔVp的受试者工作特征曲线下面积(AUC)分别为0.711(95%CI 0.575~0.846)、0.573(95%CI 0.419~0.727)、0.948(95%CI0.895~0.987)、0.864(95%CI 0.770~0.958),诊断界值分别为17.5 mm Hg、7.6 mm Hg、17.8 cm/s、13.1%。结论产妇不同体位下超声测量肱动脉峰流速差值可有效预测腰麻后SHS的发生,其中ΔVpmin≥17.8 cm/s有较好的预测作用。     

不同体位对心脏术后气管插管患者生命体征的影响

目的研究体位交替更换对心脏术后气管插管患者生命体征的影响,了解其可行性,以确保体位护理在此类患者中的有效实施。方法对35例气管插管时间>24h的心脏手术后患者于清醒后实施半卧位,左、右侧卧位各1h交替及晨、晚间仰卧位各1h的体位护理,比较不同体位HR、SBP、SaO2值及不适情况。结果不同体位对HR、SBP无显著影响(均P>0.05);半卧位,左、右侧卧位即刻及30min时SaO2值均比仰卧位高(均P<0.05);半卧位和左、右侧卧位不同时间SaO2值比较,差异无显著性意义(均P>0.05)。不适症状除腰痛外,伤口胀痛、胸闷和紧张发生率仰卧位均显著高于其他卧位(均P<0.05)。结论体位改变对患者的生命体征无负面影响,可促进肺氧合功能,增加患者舒适度。     

头抬高后仰位联合60°气管拔管对患者拔管期应激反应的影响

目的观察头抬高后仰位联合60°气管拔管对患者拔管期应激反应的影响。方法选择全麻下行大隐静脉高位结扎手术的患者90例,男33例,女57例,年龄18~40岁,体重45~75kg,ASAⅠ或Ⅱ级。按照随机数字表法均分为三组,每组30例。A组患者平卧位,气管导管拔管角度为90°(拔管方向与地面夹角呈90°),B组患者平卧位,拔管角度为60°(拔管方向与地面夹角呈60°),C组患者头抬高后仰位,拔管角度为60°。记录手术结束时(T_0)、拔管前1 min(T_1)、拔管后1 min(T_2)、5min(T_3)的SBP、DBP及HR,记录拔管的力度,观察呛咳、咽痛、声音嘶哑发生情况。结果与T_0时比较,T_2时三组SBP、DBP明显升高,HR明显增快(P0.05),T_3时A、B组SBP、DBP明显升高,HR明显增快(P0.05);T_2、T_3时B、C组SBP、DBP明显低于,HR明显慢于,拔管力度明显小于A组(P0.05);T_2、T_3时C组SBP、DBP明显低于,HR明显慢于,拔管力度明显小于B组(P0.05)。B、C组呛咳发生率[3例(10.0%),2例(6.6%)]明显低于A组的[12例(40.0%)](P0.05)。结论头抬高后仰位联合60°拔除气管导管能明显减轻患者拔管期应激反应。     

224例右肱动脉压与足背动脉压对比观察

测量血压时,遇上肢外伤、烧伤,动脉炎症、闭锁等情况时,测压较为困难。此时,临床上常测量腘动脉压,有人报道:用上肢袖带缚于大腿测下肢血压不能给临床提供靠数据。因此,为解决这一问题,我们用袖带法非同步测量了224例健康者的右肱动脉压与右足背动脉压,现将结果报告如下: 临床资料1.对象:健康青壮年224人,年龄20～43岁,平均29.08岁,其中男23例,女201例2.方法:按1978年世界卫生组织高血压专家座谈会规定标准,以听诊第一音所示水银柱相对应的数值为收缩期血压(SBP),以声音突然变钝为舒张期血压(DBP)。使用经校正的汞柱血压计,专人测量,于测量前先向被测者讲明测压意义,消除紧张与顾虑,取得配合,于每晨起床前个卧位测量。肱动脉测压法按《医疗护理技术操作常规》测     

Effect of lateral versus supine wedged position on development of spinal blockade and hypotension

Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. They were then given spinal anaesthesia in the left lateral position and randomised to be turned to the right lateral or the supine wedged position, after which speed of onset and spread of blockade to cold sensation were measured every 2 min for 10 min and mean arterial pressure and ephedrine requirement were recorded every minute for 20 min. Baseline mean arterial pressure was 9 mmHg (95% CI 3 to 14) lower in the left lateral (measured in the upper arm) than in the sitting position; those in the supine wedged and tilted positions were intermediate. Following spinal anaesthesia, hypotension (defined as a reading 相似文献   

Accuracy of the CNAP monitor,a noninvasive continuous blood pressure device,in providing beat-to-beat blood pressure readings in the prone position

Study ObjectiveTo assess the accuracy of a noninvasive continuous arterial pressure (CNAP) monitor in patients who are positioned prone in the operating room.DesignProspective study.SettingOperating room at a children's hospital.Patients20 pediatric patients, aged 13.8 ± 2 years, and weight 63.7 ± 18.8 kg, scheduled for surgery in the prone position, and for which arterial catheter placement was planned.InterventionsMeasurements were recorded with an arterial line (AL) and a new noninvasive continuous blood pressure (BP) monitor.MeasurementsSystolic (SBP), diastolic (DBP), and mean arterial (MAP) pressure readings were captured from an arterial cannula and the CNAP device every minute during anesthesia.Main ResultsThe study cohort consisted of analysis of 4104 pairs of SBP, DBP, and MAP values, which showed an absolute difference between the AL and CNAP device readings of 7.9 ± 6.3 mmHg for SBP, 5.3 ± 4.3 mmHg for DBP, and 4.6 ± 3.9 mmHg for MAP. Bland-Altman analysis of MAP values showed a bias of 0.26 mmHg, with upper and lower limits of agreement of 12.18 mmHg and -11.67 mmHg, respectively. CNAP readings deviated from arterial values by ≤ 5 mmHg in 67% of MAP values, 59% of DBP values, and 43% of SBP readings. The difference was ≤ 10 mmHg for 94% of MAP readings, 90% of DBP values, and 73% of SBP readings.ConclusionsDuring prone positioning, the CNAP monitor provided clinically acceptable accuracy for MAP values, similar to those reported in adults in the supine position.     

The significance of dural sinus pressure in neurological surgery-- correlation with surgical position

A study was made of the significance of confluens sinus pressure in various surgical positions and of various factors influencing confluens sinus pressure. The following findings were obtained: Confluens sinus pressure in various positions was follows: Reverse jackknife position (supine position with upper and lower halves of the body elevated ca 20 degrees) 1.3 +/- 0.8 (Mean +/- SD) cmH2O Sea lion position (prone position with upper and lower halves of the body elevated ca 10 degrees with neck hyperextended) 2.7 +/- 0.6 cmH2O Prone position 5.8 +/- 0.9 cmH2O Supine position 5.9 +/- 1.7 cmH2O Right lateral position 6.9 +/- 0.7 cmH2O Left lateral position 9.6 +/- 1.2 cmH2O Since confluens sinus pressure is strongly affected by gravity, the determination point, the height of the right atrium, and the central venous pressure were referred to when measuring the surgical position. When the upper half of the body was raised (at angle ranging from--10 degrees to +90 degrees) confluens sinus pressure became zero in adults when the angle was +25 degrees or thereabouts. When the angle was +90 degrees, a marked negative pressure of -12.7 +/- 3.0 cmH2O, was observed, suggesting the danger of air embolism. In 4 children under 6 years of ago, however, negative pressure was not observed even at an angle of +90 degrees, although some changes due to different angles were noted. This suggests some specificity of dural sinus pressure. Intrathoracic negative pressure at inspiration, the contraction of skeletal muscles, and profuse hemorrhage, and sympathetic nervous strain were surmised as other factors influencing dural sinus pressure.     

Pulmonary Blood Flow Does Not Redistribute in Dogs with Reposition from Supine to Left Lateral Position

Background: Recent studies have questioned the classical gravitational model of pulmonary perfusion. Because the lateral position is commonly used during surgery, the authors studied the redistribution of pulmonary blood flow in the left lateral decubitus position using a high spatial resolution technique.

Methods: Distributions of pulmonary blood flow were measured using intravenously injected 15-[micro sign]m diameter radioactive-labeled microspheres in eight halothane-anesthetized dogs, which were studied in the supine and left lateral decubitus positions in random order. Lungs flushed free of blood were air-dried at total lung capacity and sectioned into 1,498-2,396 (1.7 cm3) pieces per animal. Radioactivity was measured by a gamma counter, and signals were corrected for piece weight and normalized to mean flow.

Results: Blood flow to the dependent left lung did not increase, and blood flow to the nondependent right lung did not decrease in the lateral position. The left lung received 39.3 +/- 7.0% and 39.2 +/- 8.8% (mean +/- SD) of perfusion in the supine and left lateral positions, respectively. Detailed assessment of the spatial distributions of pulmonary blood flow revealed the lack of a gravitational gradient of blood flow in the lateral position. The distributions of blood flow did not differ in the supine and left lateral decubitus positions.     

Posture and epidural block in pregnant women at term

Upper and lower limb blood flow was measured in 4 fullterm pregnant women in the left lateral and supine positions before and after epidural block. Radial artery mean blood pressure was recorded in 6 full term pregnant women under the same conditions. Before epidural block there was a much greater reduction in lower limb blood flow (39-1%) than in upper limb blood flow (13-5%) when women moved from the lateral to the supine position; this was probably the result of aortic compression. Mean radial artery pressure increased slightly by 4-6% due to maternal overcompensation in the upper part of the body. After epidural block, patients in the lateral position had a mean rise in lower limb blood flow of 25% and a reduction in upper limb blood flow of 37-2%. The mean arterial pressure remained unchanged. In the supine position there was no further reduction of upper limb blood flow; this was accompanied on average by a 9% fall in mean radial arterial pressure indicating decompensation in the mother. The leg blood flow fell less, 26-9% than before epidural block. In the supine position, a greater flow to the legs, associated with a decreased mean arterial pressure, would be expected to lead to a diminution in placental perfusion, which is the probable mechanism for foetal decompensation. Therefore the supine position should be avoided with an epidural block. In other patients it would be wise not to rely upon maternal compensatory mechanisms.     

不同穿刺体位在腰-硬联合麻醉剖宫产术中的比较

目的比较不同穿刺体位在腰-硬联合麻醉(CSEA)剖宫产术中的效果。方法拟行剖宫产术的足月妊娠产妇90例,随机分为两组,每组45例。选择L3~4椎间隙作为穿刺点。R组右侧穿刺腰麻后保持穿刺体位2 min后左倾30°仰卧至手术开始,L组左侧穿刺腰麻后仰卧位,并调整手术床左倾30°直至手术开始。腰麻药物均为1.0%罗哌卡因1.5 ml+10%葡萄糖0.5 ml。观察腰麻药物注入后15 min内产妇感觉阻滞效应及不良反应情况,记录新生儿Apgar评分,检测脐动脉血p H值。结果 R组产妇最终阻滞平面明显低于L组,达到最终阻滞平面所需时间明显短于L组(P0.05)。R组麻黄碱用量为0(0~6)mg,明显低于L组的6(0~12)mg(P0.05)。R组脐动脉血p H值明显高于L组(P0.05)。两组新生儿Apgar评分差异无统计学意义。结论剖宫产术采用右侧卧位穿刺注药后保持穿刺体位2 min后30°仰卧,其麻醉效果优于左侧卧位穿刺后30°仰卧体位。     

Effect of blood pressure instrument and cuff side on blood pressure reading in pregnant women in the lateral recumbent position

BACKGROUND: Hydrostatic forces affect non-invasive blood pressure measurement in the lateral position. This study assessed the extent of this effect with the mercury column sphygmomanometer and Dinamap oscillometric instrument as well as different recommendations for comparing supine and lateral blood pressure measurements. METHOD: Thirty-two term pregnant women were studied in the antenatal clinic. Blood pressure was recorded from both arms in the right lateral and supine recumbent positions, using the sphygmomanometer and Dinamap. RESULTS: Blood pressure in the uppermost arm while lateral was lower than supine by a mean 10 mmHg or more. Systolic, mean and diastolic pressures in the dependent arm while lateral were higher than supine by a mean (SD) 3.1 (6.8)mmHg, 5.6 (6.8)mmHg, and 6.9 (8.7)mmHg using the sphygmomanometer and 3.8 (8.1)mmHg, 3.2 (7.1)mmHg, and 1.9 (5.3)mmHg using the Dinamap. Systolic, mean and diastolic pressure values calculated as the average taken from both arms in the lateral position were lower than supine by a mean (SD) 3.5 (7.5)mmHg, 3.9 (4.7) mmHg, and 4.1 (5.8)mmHg using the sphygmomanometer and 4.6 (6.0)mmHg, 4.9 (4.4)mmHg, and 4.8 (4.4)mmHg using the Dinamap. Corresponding blood pressure readings were always higher using the Dinamap than the sphygmomanometer. CONCLUSIONS: In normotensive non-labouring term pregnant women, the use of the dependent arm or an average blood pressure from both arms while in the lateral position will give a closer reading to supine blood pressure than the use of the uppermost arm. However, use of the dependent arm is simpler.     

Hemodynamic changes with right lateral decubitus body positioning in the tilted porcine heart

Background. In beating-heart coronary surgical procedures, exposure of posterior vessels through sternotomy causes cardiac function to deteriorate. We hypothesized that turning the subject to the right lateral decubitus position before cardiac retraction improves exposure of posterior vessels and preserves cardiac pump function on displacement.

Methods. Eight 80-kg open-chest pigs were instrumented with catheter-tip manometers. After a stepwise 60-degree turn to the right lateral decubitus position of the body, the heart was retracted anteriorly to 90 degrees with a suction stabilizer.

Results. Right lateral body positioning caused an approximately 45-degree right deviation of the apex, thereby exposing the left atrial groove. Stroke volume, mean arterial pressure, right atrial pressure, and right ventricular end-diastolic pressure increased to 106% ± 5% (mean ± standard error of the mean, p = 0.31), 106% ± 3% (p = 0.01), 129% ± 8% (p = 0.001), and 171% ± 14% (p = 0.002), respectively, compared with control values. In contrast, left atrial pressure decreased to 73% ± 6% (p = 0.007), whereas left ventricular preload remained unchanged (110% ± 8%, p = 0.26). Additional anterior displacement to 90 degrees fully exposed the posterior vessels, and stroke volume decreased to 90% ± 3% (p = 0.01) and mean arterial pressure to 93% ± 5% (p = 0.07) at the expense of further increased right ventricular preload (256% ± 28%, p < 0.001).

Conclusions. By placing the subject in the right lateral decubitus position, exposure through sternotomy of posterior vessels in the beating porcine heart was facilitated while mean arterial pressure was maintained.