重症患者中心和外周动脉血压梯度的比较:系统综述与元分析》。

Q4 Medicine Critical care explorations Pub Date : 2024-05-24 eCollection Date: 2024-06-01 DOI:10.1097/CCE.0000000000001096
Daisuke Hasegawa, Ryota Sato, Abhijit Duggal, Mary Schleicher, Kazuki Nishida, Ashish K Khanna, Siddharth Dugar
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引用次数: 0

摘要

目的:从不同的解剖部位测量血压通常被认为是可以互换的,尽管它们代表了全身循环的不同部位。我们旨在对重症患者中心动脉插管和外周动脉插管的血压差异进行系统回顾和荟萃分析:我们使用医学主题词表(MeSH)术语和关键词检索了从开始到 2023 年 12 月 26 日的 MEDLINE、Cochrane Central Register of Controlled Trials 和 Embase:对重症监护室和手术室中同时接受中心(股动脉、腋动脉或锁骨下动脉)和外周(桡动脉、肱动脉或足背动脉)动脉导管置入术的成年患者进行观察研究:我们独立筛选并提取了一式两份的研究报告。我们使用修订后的诊断准确性研究质量评估工具评估了偏倚风险:共纳入了 24 项研究,共计 1598 名患者。研究发现,中心血压(平均动脉压 [MAP] 和收缩压 [SBP])明显高于外周血压,平均梯度分别为 3.5 毫米汞柱和 8.0 毫米汞柱。不过,中心或外周舒张压(DBP)在统计学上没有明显差异。亚组分析进一步突出表明,在心脏手术的心肺旁路阶段、肝移植的再灌注阶段以及非手术重症患者中,MAP阶差较高。SBP或DBP梯度未显示出任何亚组特异性变化:通过中心动脉插管获得的 SBP 和 MAP 均高于外周动脉插管;但是,SBP 相差 8.0 mm Hg 和 MAP 相差 3.5 mm Hg 的临床意义仍不明确。我们目前首选外周动脉插管的临床实践无需改变。
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Comparison of Central and Peripheral Arterial Blood Pressure Gradients in Critically Ill Patients: A Systematic Review and Meta-Analysis.

Objectives: Measurement of blood pressure taken from different anatomical sites, are often perceived as interchangeable, despite them representing different parts of the systemic circulation. We aimed to perform a systematic review and meta-analysis on blood pressure differences between central and peripheral arterial cannulation in critically ill patients.

Data sources: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase from inception to December 26, 2023, using Medical Subject Headings (MeSH) terms and keywords.

Study selection: Observation study of adult patients in ICUs and operating rooms who underwent simultaneous central (femoral, axillary, or subclavian artery) and peripheral (radial, brachial, or dorsalis pedis artery) arterial catheter placement in ICUs and operating rooms.

Data extraction: We screened and extracted studies independently and in duplicate. We assessed risk of bias using the revised Quality Assessment for Studies of Diagnostic Accuracy tool.

Data synthesis: Twenty-four studies that enrolled 1598 patients in total were included. Central pressures (mean arterial pressure [MAP] and systolic blood pressure [SBP]) were found to be significantly higher than their peripheral counterparts, with mean gradients of 3.5 and 8.0 mm Hg, respectively. However, there was no statistically significant difference in central or peripheral diastolic blood pressure (DBP). Subgroup analysis further highlighted a higher MAP gradient during the on-cardiopulmonary bypass stage of cardiac surgery, reperfusion stage of liver transplant, and in nonsurgical critically ill patients. SBP or DBP gradient did not demonstrate any subgroup specific changes.

Conclusions: SBP and MAP obtained by central arterial cannulation were higher than peripheral arterial cannulation; however, clinical implication of a difference of 8.0 mm Hg in SBP and 3.5 mm Hg in MAP remains unclear. Our current clinical practices preferring peripheral arterial lines need not change.

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