这样测量血压是错误的!

2016-10-19 郭艺芳 郭艺芳心前沿

关于血压的规范化测量,我国指南均有详细介绍。但在临床工作中,医护人员对于血压规范化测量的重视程度仍不够。如果血压测量数据不准确,会对正确的诊疗方案的制定产生很大影响。对于临床上常见的影响血压测量结果的因素,我们的研究生以老年高血压患者为基础进行了研究,其主要发现如下(各种体位时均测量右上肢血压,本文所提供的数值均为收缩压的差异):1. 坐位法血压值较卧位法降低约 3 mmHg;立位测量较坐位降低约

关于血压的规范化测量,我国指南均有详细介绍。但在临床工作中,医护人员对于血压规范化测量的重视程度仍不够。如果血压测量数据不准确,会对正确的诊疗方案的制定产生很大影响。


对于临床上常见的影响血压测量结果的因素,我们的研究生以老年高血压患者为基础进行了研究,其主要发现如下(各种体位时均测量右上肢血压,本文所提供的数值均为收缩压的差异):


1. 坐位法血压值较卧位法降低约 3 mmHg;立位测量较坐位降低约 5 mmHg,较卧位降低 8 mmHg。即卧位>坐位>立位。以上差异均具有统计学显著性。


2. 右侧卧位较平卧位增高 5 mmHg,左侧卧位较平卧位降低 16 mmHg。均达到统计学显著性差异。


3. 听诊器胸件置于袖带内时收缩压较标准坐位法降低 4 mmHg,差异有统计学意义。


4. 隔薄衣(厚度 <1 mm,如薄衬衣)法血压值与标准坐位法测量值无显著差异。


5. 电子血压计(臂式)与台式汞柱血压计(标准坐位法)测得数值无统计学差异。


6. 臂围 ≤26cm 的老年高血压患者用常规袖带测量较用大号袖带测量增高 5 mmHg,臂围 ≥27cm 的老年患者用大号袖带测量较常规袖带测量值降低 4 mmHg。二者相比差异有统计学意义。


7. 以 30 例行冠状动脉造影术的老年患者为对象进行的研究显示,无创血压较有创血压降低约 9 mmHg,达到统计学显著性差异。


上述研究表明,卧位、立位、左侧卧位、右侧卧位、袖带过松或过紧、肥胖患者不使用大号袖带、听诊器胸件置于袖带内等不规范的血压测量方法均可显著影响所测得数值,临床工作中应予避免。门诊环境下,为方便患者,可以允许患者穿着薄衣物(如厚度 <1 mm 的薄衬衣或薄秋衣)进行测量,这对所得结果影响不大。


【附:血压的规范化测量方法】


1. 选择符合计量标准的水银柱血压计,或者经过验证的电子血压计。


2. 使用大小合适的气囊袖带,气囊至少应包裹 80% 上臂。肥胖者或臂围大者应使用大规格气囊袖带;儿童应使用小规格气囊袖带。


3. 测血压前,受试者应至少坐位安静休息 5 分钟,30 分钟内禁止吸烟或饮咖啡,排空膀胱。


4. 受试者取坐位,最好坐靠背椅,裸露上臂,上臂与心脏处在同一水平。首次就诊时应测量左、右上臂血压,以后通常测量较高读数一侧的上臂血压。特殊情况下可以取卧位或站立位。老年人、糖尿病患者及出现体位性低血压情况者,应加测站立位血压。站立位血压应在卧位改为站立位后 1 分钟和 5 分钟时测量。


5. 将袖带紧贴缚在被测者的上臂,袖带的下缘应在肘弯上 2.5cm。将听诊器探头置于肱动脉搏动处。


6. 使用水银柱血压计测压时,快速充气,使气囊内压力达到桡动脉搏动消失后,再升高 30mmHg,然后以恒定的速率(2-6mmHg/秒)缓慢放气。心率缓慢者,放气速率应更慢些。获得舒张压读数后,快速放气至零。


7. 在放气过程中仔细听取柯氏音,观察柯氏音第Ⅰ时相(第一音)和第V时相(消失音)水银柱凸面的垂直高度。收缩压读数取柯氏音第Ⅰ时相,舒张压读数取柯氏音第V时相。<12 岁以下儿童、妊娠妇女、严重贫血、甲状腺功能亢进、主动脉瓣关闭不全及柯氏音不消失者,可以柯氏音第IV时相(变音)为舒张压。


8. 应相隔 1-2 分钟重复测量,取 2 次读数的平均值记录。如果收缩压或舒张压的 2 次读数相差 5mmHg 以上,应再次测量,取 3 次读数的平均值记录。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1707951, encodeId=59721e07951b5, content=<a href='/topic/show?id=b801961353c' target=_blank style='color:#2F92EE;'>#量血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96135, encryptionId=b801961353c, topicName=量血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e7a531519171, createdName=ms5768352621950538, createdTime=Sat Apr 22 00:09:00 CST 2017, time=2017-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154821, encodeId=4b3815482187, content=动态血压监测如何质控, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ff901728138, createdName=1dedfe95m66(暂无匿称), createdTime=Thu Nov 10 15:47:17 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151181, encodeId=90651511812a, content=好。简单易实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=712c1945140, createdName=心不在烟, createdTime=Tue Oct 25 20:55:01 CST 2016, time=2016-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150022, encodeId=5875150022a6, content=简单实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Thu Oct 20 22:45:45 CST 2016, time=2016-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=149999, encodeId=735a14999932, content=好文章!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=d85d1636106, createdName=lietome2, createdTime=Thu Oct 20 19:51:01 CST 2016, time=2016-10-20, status=1, ipAttribution=)]
    2016-11-10 1dedfe95m66(暂无匿称)

    动态血压监测如何质控

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1707951, encodeId=59721e07951b5, content=<a href='/topic/show?id=b801961353c' target=_blank style='color:#2F92EE;'>#量血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96135, encryptionId=b801961353c, topicName=量血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e7a531519171, createdName=ms5768352621950538, createdTime=Sat Apr 22 00:09:00 CST 2017, time=2017-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154821, encodeId=4b3815482187, content=动态血压监测如何质控, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ff901728138, createdName=1dedfe95m66(暂无匿称), createdTime=Thu Nov 10 15:47:17 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151181, encodeId=90651511812a, content=好。简单易实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=712c1945140, createdName=心不在烟, createdTime=Tue Oct 25 20:55:01 CST 2016, time=2016-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150022, encodeId=5875150022a6, content=简单实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Thu Oct 20 22:45:45 CST 2016, time=2016-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=149999, encodeId=735a14999932, content=好文章!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=d85d1636106, createdName=lietome2, createdTime=Thu Oct 20 19:51:01 CST 2016, time=2016-10-20, status=1, ipAttribution=)]
    2016-10-25 心不在烟

    好。简单易实用

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1707951, encodeId=59721e07951b5, content=<a href='/topic/show?id=b801961353c' target=_blank style='color:#2F92EE;'>#量血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96135, encryptionId=b801961353c, topicName=量血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e7a531519171, createdName=ms5768352621950538, createdTime=Sat Apr 22 00:09:00 CST 2017, time=2017-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154821, encodeId=4b3815482187, content=动态血压监测如何质控, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ff901728138, createdName=1dedfe95m66(暂无匿称), createdTime=Thu Nov 10 15:47:17 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151181, encodeId=90651511812a, content=好。简单易实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=712c1945140, createdName=心不在烟, createdTime=Tue Oct 25 20:55:01 CST 2016, time=2016-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150022, encodeId=5875150022a6, content=简单实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Thu Oct 20 22:45:45 CST 2016, time=2016-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=149999, encodeId=735a14999932, content=好文章!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=d85d1636106, createdName=lietome2, createdTime=Thu Oct 20 19:51:01 CST 2016, time=2016-10-20, status=1, ipAttribution=)]
    2016-10-20 1e128d2fm65(暂无匿称)

    简单实用

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1707951, encodeId=59721e07951b5, content=<a href='/topic/show?id=b801961353c' target=_blank style='color:#2F92EE;'>#量血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96135, encryptionId=b801961353c, topicName=量血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e7a531519171, createdName=ms5768352621950538, createdTime=Sat Apr 22 00:09:00 CST 2017, time=2017-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154821, encodeId=4b3815482187, content=动态血压监测如何质控, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ff901728138, createdName=1dedfe95m66(暂无匿称), createdTime=Thu Nov 10 15:47:17 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151181, encodeId=90651511812a, content=好。简单易实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=712c1945140, createdName=心不在烟, createdTime=Tue Oct 25 20:55:01 CST 2016, time=2016-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150022, encodeId=5875150022a6, content=简单实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Thu Oct 20 22:45:45 CST 2016, time=2016-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=149999, encodeId=735a14999932, content=好文章!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=d85d1636106, createdName=lietome2, createdTime=Thu Oct 20 19:51:01 CST 2016, time=2016-10-20, status=1, ipAttribution=)]
    2016-10-20 lietome2

    好文章!!!

    0

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这样测量血压是错误的

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