20.500.12556/DKUM-60868 OSCILOMETRIČNO MERJENJE KRVNEGA TLAKA MED TRANSPORTOM KRITIČNO BOLNIH IN POŠKODOVANIH OSCILLOMETRIC BLOOD PRESSURE MEASUREMENT DURING THE TRANSPORT OF CRITICALLY ILL OR INJURED PATIENTS Teoretična izhodišča. Merjenje krvnega tlaka med transportom kritično bolnega ali poškodovanega bolnika je bistvenega pomena za postavitev pravilne diagnoze in zdravljenje. Hrup, premikanje vozila in neprimeren položaj bolnika so lahko vzrok za napačno izmerjene vrednosti. Odstopanje vrednosti krvnega tlaka lahko vpliva na rezultate zdravljenja in preživetje bolnika. Med reševalnimi prevozi se večinoma uporabljajo samodejni oscilometrični merilniki. Natančnost teh merilnikov med prevozom bolnikov še ni raziskana. Raziskovalna metodologija. Za ugotavljanje zanesljivosti samodejne oscilometrične metode merjenja krvnega tlaka smo uporabili prospektivno eksperimentalno metodo. Oseminštiridesetim bolnikom smo pred, med in po urgentnem prevozu merili krvni tlak z aparatom za merjenje vitalnih funkcij Lifepak 12. Hkrati smo z aplikacijo na mobilnem telefonu merili pospeške, ki so delovali na bolnika. Z analizo rezultatov smo želeli ugotoviti, ali izmerjene vrednosti krvnega tlaka med transportom odstopajo od bolnikovega dejanskega krvnega tlaka, izmerjenega pred in po prevozu. S statističnim T testom smo ugotavljali, ali so napačno izmerjene vrednosti povezane s pospeški, ki nastajajo med reševalnim prevozom. Rezultati. Dvaindvajsetim bolnikom (45,8%) se je krvni tlak med prevozom spremenil za več kot 10 mm Hg, zato smo jih izločili iz raziskave. 67,2% izmerjenih vednosti odstopa v sistoličnem, diastoličnem ali vrednosti srednjega arterijskega tlaka več kot 10%, kar lahko vodi k napačni obravnavi bolnikov. Z analizo posameznih tlakov smo ugotovili, da najmanj odstopajo vrednosti sistoličnih tlakov, saj je bilo takšnih, ki so odstopali manj kot 10 mm Hg, 71,3%. Pravilno izmerjenih diastoličnih tlakov je bilo 52,5% in srednjih arterijskih tlakov 46,7%. Ugotovili smo, da so napačno izmerjeni iii krvni tlaki povezani s pospeški, ki delujejo v bočni smeri (p<0,05), niso pa povezani s pospeševanjem vozila, zaviranjem vozila ter pospeški, ki delujejo v vertikalni smeri. Zaključki. Vrednosti krvnega tlaka, izmerjene s samodejnim oscilometričnim merilnikom med prevozom bolnika, so zelo nezanesljive, zato ostaja invazivno arterijsko merjenje edina zanesljiva meritev za natančno sprotno spremljanje bolnikovega krvnega tlaka. Med vrednostmi, izmerjenimi s samodejnim oscilometričnim merilnikom, so najnatančnejše vrednosti sistoličnih krvnih tlakov. S prilagojenim načinom vožnje, predvsem med zavijanjem levo in desno, lahko napako zmanjšamo. Theoretical basis. Blood pressure measurement during the transport of a critically ill or injured patient is essential for the correct diagnosis and treatment. The reasons for incorrect measurement values can be: noise, moving vehicles and unsuitable patient position. Deviation in the measured blood pressure values may affect the treatment and survival of the patient. During the transportation of a patient, automatic oscillometric devices are most commonly used. The advantage of these devices is that they are not sensitive to noise and allow the operator to carry out different procedures at the same time. The accuracy of these metering devices during the transportation of patients has not yet been defined. Research methodology. To determine the accuracy of automatic oscillometric method of measuring blood pressure, we used a prospective experimental method. 48 patients were measured their blood pressure before, during and after an emergency transport by using LIFEPAK 12 physio control monitor. At the same time we measured accelerations, which affected the patient, with a mobile phone app. By analyzing the results we wanted to determine, whether the blood pressure values, measured during the transport, deviate from the patient's actual blood pressure measurements, carried out before and after transportation. A connection between the incorrectly measured pressure and the accelerations was determined by a statistical T-test. Results. During transportation, the blood pressure of 22 (45.8%) patients has changed by more than 10 mm Hg, so they have been excluded from the survey. 67.2% of the systolic, diastolic or mean arterial pressure values deviated for more than 10%, which may lead to incorrect patient treatment. By analyzing the individual types of pressure, we found that the systolic pressure values deviated the least. 71.3% deviated less than 10 mm Hg. The rate of correctly measured diastolic blood pressure was 52.5% and of the mean arterial pressure 46.7%. We found that the incorrectly measured blood pressure v values are connected to the acceleration, functioning in the lateral direction (p>0.05), but are not connected to vehicle acceleration, braking of the vehicle and the acceleration, functioning in the vertical direction. Conclusion. Blood pressure values measured with an automatic oscillometric device during the transport of critically ill or injured patients are very unreliable, therefore the invasive arterial measurement remains the only reliable measurement method for an accurate real-time monitoring of the patient's blood pressure. During patient transportation, the systolic blood pressure measurement values are the most accurate. With adjusting the style of driving, especially when turning left or right, the errors can be reduced. krvni tlak samodejni oscilometrični merilnik nujna medicinska pomoč transport bolnikov pospeški med prevozom blood pressure automatic oscillometric measurement device emergency medical assistance patient transport accelerations during transport true true false [D. Kac] Slovenski jezik Angleški jezik Magistrsko delo 2016-07-07 00:07:24 2017-01-04 08:54:10 2022-06-25 03:06:25 2019-07-11 12:01:08 2016 0 Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 591.112.3:616-083.98(043.2) 2294948 URN:SI:UM:DK:IWZ8M3ZN MAG_Kac_David_2016.pdf MAG_Kac_David_2016.pdf 1 25A2357015AAFFE7E903D1FB2080B30E 40f3031e2e338398e455eb52dc63ca19063175681d98a44f6bf0dc7c5aaa21fe defd5d27-7c0d-11eb-bb7a-00155d0001ca https://dk.um.si/Dokument.php?lang=slv&id=108424 Fakulteta za zdravstvene vede 0 0 0