[Comparison of invasive and non-invasive blood pressure in critically ill patients].

Objective: To investigate the difference of invasive and noninvasive blood pressure in systolic, diastolic and mean blood pressure (SBP, DBP and MAP) levels in critically ill patients. Methods: A total of 197 critically ill patients were enrolled in the intensive care unit of Peking Union Medical College Hospital in this prospective observative study. There were 113 males and 84 females with a mean age of (59±17) years. With Pearson correlation and Bland-Altman analysis, the difference and agreement of invasive and noninvasive blood pressure in SBP, DBP and MAP levels were investigated. Results: Invasive blood pressure monitoring was significantly correlated with noninvasive blood pressure (the correlation coefficients of SBP, DBP and MAP was 0.908, 0.861 and 0.888, respectively, all P<0.001). The mean bias and 95% confidence interval (CI) in SBP(invasive)-SBP(noninvasive), DBP(invasive)-DBP(noninvasive), MAP(invasive)-MAP(noninvasive) respectively was as following: SBP (14.5±11.9) mmHg (-8.8-37.8 mmHg); DBP (1.0±7.2) mmHg(-13.2-15.2 mmHg); MAP (10.5±8.3) mmHg (-5.9-26.8 mmHg). Moreover, there was a significant positive correlation between the bias of SBP(invasive)-SBP(noninvasive) and the value of SBP; when the SBP(invasive)≥143 mmHg was used to predict a value of bias≥20 mmHg, the sensitivity was 72.4% and specificity was 81.3%, and the area under the receiver operating characteristic curve was 0.808 (95% CI: 0.745-0.870). Conclusions: There is a good agreement between invasive and noninvasive blood pressure in critically ill patients, the bias of invasive-noninvasive blood pressure measurement is positively correlated to the value of blood pressure.目的： 比较重症患者有创血压和无创血压监测在收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)三个水平的一致性和差异。 方法： 前瞻性纳入2016年6月至2017年1月北京协和医院重症医学科已建立有创动脉血压监测的197例患者[男113例，女84例，平均年龄(59±17)岁]，同时进行有创血压与无创血压的测量，应用Pearson相关、Bland－Altman等方法分析有创和无创血压的相关性、一致性和区别等。 结果： Pearson相关性分析提示有创与无创血压呈显著正相关(SBP(有创)－SBP(无创)、DBP(有创)－DBP(无创)、MAP(有创)－MAP(无创)间相关系数R分别为0.908、0.861、0.888，均P<0.001)。Bland－Altman一致性分析显示，SBP(有创)－SBP(无创)、DBP(有创)－DBP(无创)、MAP(有创)－MAP(无创)的平均偏差以及95%可信区间(CI)分别为(14.5±11.9) mmHg(－8.8～37.8 mmHg)、(1.0±7.2) mmHg(－13.2～15.2 mmHg)和(10.5±8.3) mmHg(－5.9～26.8 mmHg)。有创与无创血压测量的偏差大小与血压数值高低呈显著正相关，当SBP(有创)≥143 mmHg时，预测SBP(有创)－SBP(无创)偏差值≥20 mmHg的敏感性为72.4%，特异性为81.3%，受试者工作特征曲线下面积为0.808(95% CI：0.745～0.870)。 结论： 重症患者有创血压和无创血压之间具有较好的一致性，两者偏差的大小与血压数值高低呈显著正相关。.