観血および非観血的血圧測定値の差異について

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  • The Discrepancy between Invasive and Noninvasive Blood Pressure

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To clarify the discrepancy between invasive （IBP） and noninvasive （NIBP） blood pressure, we studied the appropriateness of various methods and compared them. All data were collected in simulation studies and from routine clinical work. For IBP monitoring, pressure transducers （DTX or P50, Spectramed, USA） were used. NIBP was monitored in three ways; BP-308 （Colin, Japan） and Dynamap 8100 （Criticon, USA） for the oscillometric method, CBM-2000 （Colin, Japan） for the tonometric method and Finapres （Ohmeda, USA） for the zero transmural pressure method. IBP: In our estimation, small invisible air bubbles in the catheter make for a sharp, not dull pressure wave. This phenomenon is explained using frequency response curves. There was more than a 10mmHg difference in systolic pressures （aortic valve to bifurcation） and much greater difference in distal pressures. With a vasodilating condition, the situation is more complex and it is not so easy to get a true IBP. NIBP: Oscillometric pressure is little affected by peripheral vascular conditions and reflects the central pressure well, however, it is not a continuous pressure monitor. Continuous tonometry pressure was useful only when calibrated with oscillometric pressure. Zero transmural pressure is also an easy continuous method and reveals distal arterial conditions well, but is affected by finger cuff fitness. In conclusion, there is no reliable method, neither IBP nor NIBP for continuous blood pressure monitoring. However, we recommend the use of one of the continuous methods together with intermittent oscillometric pressure.

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