【作者】 黄文；

【导师】 陈晓平；

【作者基本信息】 四川大学 ， 内科学（专业学位）， 2021， 硕士

【摘要】 目的:研究不同高海拔处电子血压计与水银血压计的测量读数相关性及是否有差异性并探讨差异性的影响因素。方法:于四川省炉霍县县城、卡娘乡、上罗柯马乡纳入居住时间大于3个月的人群,使用通过检定的水银血压计和通过验证的爱安德电子血压计(UA-651A),分别采用同臂间断血压测量法和同臂同时血压测量法进行血压测量。结果:本研究最终共纳入257人,根据海拔不同共分为3组,3200米组(n=87),3400米组(n=85),3600米组(n=85),均进行了同臂间断血压测量和同臂同时血压测量两种方法测量血压。两种方法的电子血压计测量的血压与水银血压计测量的血压之间均有强相关性。三组使用同臂间断测量法进行电子血压计及水银血压计的比较均有统计学意义。电子血压计可能会低估被检测者的血压。而三组使用同臂同时测量法对水银血压计和电子血压计进行比较时,收缩压读数差异具有统计学意义,3200米组及3600米组舒张压读数差异存在统计学意义。此时,电子血压计可能会高估被检测者的收缩压,低估被检测者的舒张压。通过克鲁斯卡尔-沃利斯秩和检验和曼-惠特尼U检验比较不同海拔之间电子血压计与水银血压计读数差值绝对值。同臂间断测量法在3600米处的血压读数差值绝对值与其他两组血压读数差值绝对值存在统计学意义。在3600米处血压读数差值绝对值最小。同臂同时测量法中,三组的收缩压读数差值绝对值无统计学意义,而3400米组的舒张压差值绝对值与3200米组及3600米组相比,具有统计学意义。对同臂间断测量法的血压差值绝对值以10mm Hg进行分段,在3200米组、3400米组、3600米组分别有85.4%、81.6%、90.6%的收缩压差值绝对值在10mm Hg以内,分别有62.8%、60%、84.7%的舒张压差值绝对值在10mm Hg以内。以10mm Hg为血压差值绝对值的界限,大于10mm Hg认为水银血压计与电子血压读数差异有临床意义,否则认为两者差异无临床意义。以读数差异有无临床意义作为因变量做二元Logistic回归分析,在校正了其他因素后,采用同臂间断法测量法进行检验的电子血压计与水银血压计读数差异有临床意义,且与海拔相关。结论:1.高海拔处电子血压计与水银血压计的读数有强相关性。2.电子血压计在高海拔处使用时,舒张压测值不可靠,电子血压计可能会低估被检测者的血压。3.电子血压计在高海拔地区使用的可靠程度,与性别、动脉僵硬度增加、肥胖、海拔相关。更多还原

【Abstract】 Objective:To learn the correlation and difference of mercury sphygmomanometers and electronic sphygmomanometers at different altitude and to explore the factors affecting the difference between the two measurement methods.Methods:Include people who have lived for more than 3 months in Luhuo County,Kagniang Township and Shangluokoma Township of Sichuan Province.Using a certified mercury sphygmomanometer and a verified A&D electronic sphygmomanometer(UA-651A),the same arm intermittent blood pressure measurement and the same arm simultaneous blood pressure measurement were used for blood pressure measurement.Results:A total of 257 people were enrolled in this study,who were divided into 3 groups according to different altitudes,including 3200 meter group(n=87),3400 meter group(n=85),and 3600 meter group(n=85).All underwent the same arm intermittent blood pressure measurement and the same arm simultaneous blood pressure measurement.There is a strong correlation between the blood pressure measured by the electronic sphygmomanometer and that by the mercury sphygmomanometer.The comparison of electronic sphygmomanometer and mercury sphygmomanometer using the same arm intermittent measurement method in the three groups was statistically significant.Electronic sphygmomanometer may underestimate the blood pressure of the person being tested.The difference of systolic blood pressure reading was statistically significant using the same arm simultaneous measurement method,and the difference of diastolic blood pressure reading between 3200 meter group and 3600 meter group was statistically significant.At this point,the electronic sphygmomanometer may overestimate the systolic blood pressure and underestimate the diastolic blood pressure.The absolute values of the difference between electronic sphygmomanometer and mercury sphygmomanometer at different altitude were compared by KruskalWallis rank sum test and Mann-Whitney U test.There was statistical significance between the absolute value of blood pressure reading difference at 3600 meter group and that of the other two groups in the same arm intermittent measurement.The absolute difference of blood pressure reading is the smallest at 3600 meter group.In the same arm simultaneous measurement method,the absolute value of systolic blood pressure reading difference of the three groups was not statistically significant,but the absolute value of diastolic blood pressure difference of 3400 meter group was statistically significant compared with 3200 meter group and 3600 meter group.The absolute value of the blood pressure difference of the same arm intermittent measurement method was segmented by 10 mm Hg.In the 3200 meter group,3400 meter group and 3600 meter group,the absolute values of systolic blood pressure difference were 85.4%,81.6% and 90.6% respectively,and the absolute values of diastolic blood pressure difference were 62.8%,60% and 84.7% respectively within10 mm Hg.Taking 10 mm Hg as the limit of absolute difference of blood pressure,which is greater than 10 mm Hg,it is considered that the difference between mercury sphygmomanometer and electronic sphygmomanometer reading has clinical significance,otherwise it is considered that the difference between them has no clinical significance.Taking the clinical significance of the reading difference as the dependent variable to do binary Logistic regression analysis,the reading difference between electronic sphygmomanometer and mercury sphygmomanometer tested by the same arm disconnection method has clinical significance and is related to altitude.Conclusion:1.There is a strong correlation between electronic sphygmomanometer and mercury sphygmomanometer at high altitude.2.When the electronic sphygmomanometer is used at high altitude,the diastolic blood pressure is unreliable,and the electronic sphygmomanometer may underestimate the blood pressure of the person being tested.3.The reliability of electronic sphygmomanometers used in high altitude areas is related to gender,increased arterial stiffness,obesity,and altitude.更多还原