使用指套技术进行连续无创脉搏波分析以监测围术期和重症监护医学中的动脉血压和心输出量：系统评价和荟萃分析。

Continuous noninvasive pulse wave analysis using finger cuff technologies for arterial blood pressure and cardiac output monitoring in perioperative and intensive care medicine: a systematic review and meta-analysis.

机构信息

Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA.

Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Br J Anaesth. 2020 Jul;125(1):25-37. doi: 10.1016/j.bja.2020.03.013. Epub 2020 May 29.

DOI:10.1016/j.bja.2020.03.013

PMID:32475686

Abstract

BACKGROUND

Finger cuff technologies allow continuous noninvasive arterial blood pressure (AP) and cardiac output/index (CO/CI) monitoring.

METHODS

We performed a meta-analysis of studies comparing finger cuff-derived AP and CO/CI measurements with invasive measurements in surgical or critically ill patients. We calculated overall random effects model-derived pooled estimates of the mean of the differences and of the percentage error (PE; CO/CI studies) with 95%-confidence intervals (95%-CI), pooled 95%-limits of agreement (95%-LOA), Cochran's Q and I (for heterogeneity).

RESULTS

The pooled mean of the differences (95%-CI) was 4.2 (2.8 to 5.62) mm Hg with pooled 95%-LOA of -14.0 to 22.5 mm Hg for mean AP (Q=230.4 [P<0.001], I=91%). For mean AP, the mean of the differences between finger cuff technologies and the reference method was ≤5±8 mm Hg in 9/27 data sets (33%). The pooled mean of the differences (95%-CI) was -0.13 (-0.43 to 0.18) L min with pooled 95%-LOA of -2.56 to 2.23 L min for CO (Q=66.7 [P<0.001], I=90%) and 0.07 (0.01 to 0.13) L min m with pooled 95%-LOA of -1.20 to 1.15 L min m for CI (Q=5.8 [P=0.326], I=0%). The overall random effects model-derived pooled estimate of the PE (95%-CI) was 43 (37 to 49)% (Q=48.6 [P<0.001], I=63%). In 4/19 data sets (21%) the PE was ≤30%, and in 10/19 data sets (53%) it was ≤45%.

CONCLUSIONS

Study heterogeneity was high. Several studies showed interchangeability between AP and CO/CI measurements using finger cuff technologies and reference methods. However, the pooled results of this meta-analysis indicate that AP and CO/CI measurements using finger cuff technologies and reference methods are not interchangeable in surgical or critically ill patients.

CLINICAL TRIAL NUMBER

PROSPERO registration number: CRD42019119266.

摘要

背景

手指套技术可实现连续无创动脉血压（AP）和心输出量/指数（CO/CI）监测。

方法

我们对比较手指套衍生的 AP 和 CO/CI 测量值与手术或危重症患者的有创测量值的研究进行了荟萃分析。我们计算了总体随机效应模型得出的差异平均值和百分比误差（PE；CO/CI 研究）的汇总估计值，以及 95%-置信区间（95%-CI）、汇总 95%-一致性界限（95%-LOA）、Cochran's Q 和 I（用于异质性）。

结果

AP 的平均差异（95%-CI）汇总平均值为 4.2（2.8 至 5.62）mmHg，AP 的汇总 95%-LOA 为 -14.0 至 22.5 mmHg（Q=230.4[P<0.001]，I=91%）。对于平均 AP，在 27 个数据集（33%）中的 9 个数据集中，手指套技术与参考方法之间的差异平均值小于等于 5±8 mmHg。CO 的差异平均值（95%-CI）为 -0.13（-0.43 至 0.18）L min，CO 的汇总 95%-LOA 为 -2.56 至 2.23 L min（Q=66.7[P<0.001]，I=90%），CI 的差异平均值（95%-CI）为 0.07（0.01 至 0.13）L min m，CI 的汇总 95%-LOA 为 -1.20 至 1.15 L min m（Q=5.8[P=0.326]，I=0%）。PE（95%-CI）的总体随机效应模型汇总估计值为 43（37 至 49）%（Q=48.6[P<0.001]，I=63%）。在 19 个数据集（21%）中的 4 个数据集中，PE 小于等于 30%，在 19 个数据集（53%）中的 10 个数据集中，PE 小于等于 45%。