胃镜检查中患者血压监测结果分析

方丽1 ，孙雅亭2，孟祥珍1 ，宋丽丽1，宋亚华2 ，马师洋2* ，牛明华2 ，王进海2

（1.安康市人民医院内镜中心，陕西 安康，725000；2.西安交通大学第二附属医院消化内科，陕西 西安，710004）

浏览次数：170次 下载次数：472次

摘要：

目的 探讨行胃镜检查前血压监测的最佳位置及检查过程中患者血压及心率变化情况。方法 选择59 例因上消化道症状 行胃镜检查的患者，使用多导监护仪动态测量胃镜检查前、后及术中患者的血压与心率变化。结果 患者平卧位和侧卧位的左上 肢血压均显著高于右上肢血压（P<0.05）。平卧位的左上肢收缩压较右上肢升高（4.66±10.07）mmHg（t=3.56，P<0.05），舒张压升高
（2.85±8.22）mmHg（t=2.66，P<0.05）；侧卧位时左上肢收缩压较右上肢升高（11.92±11.22）mmHg（t=8.15，P<0.05），舒张压升高 （17.29±15.10）mmHg（t=8.79，P<0.05）。左上肢左侧卧位时的收缩压较平卧位降低（5.36±12.64）mmHg（t=3.26，P<0.05），舒张压基本没有变化（t=0.80，P=0.426）；右上肢左侧卧位收缩压较平卧位降低（12.61±2.61）mmHg （t=11.73，P<0.05），舒张压下降 （13.46±3.46）mmHg（t=12.16，P<0.05）。所有患者均完成检查，胃镜检查平均时间（5.17±4.56）min，无1 例并发症出现。检查开始后
1 min 的收缩压、舒张压、平均动脉压、心率达到峰值与术前比较，差异显著（P<0.05）。检查结束后收缩压、心率均升高（P<0.05）， 检查前与检查后的舒张压和平均动脉压无明显差异（P>0.05）。结论 患者体位改变对上消化道症状患者右侧上肢血压有较大影 响，宜选择左侧测量；胃镜受检者血压与心率在术程第1 分钟内升高明显，应引起重视，注意观察患者表现，提高胃镜检查安全性。

关键词：胃镜；血压；心率；动态监测

中图分类号：R573文献标志码：A文章编号：2096-1413(2018)02-0012-03

Results analysis of blood pressure monitoring in patients with gastroscopy
FANG Li 1, SUN Ya-ting2, MENG Xiang-zhen 1, SONG Li-li 1, SONG Ya-hua2, MA Shi-yang2 *, NIU Ming-hua2, WANG Jin-hai 2


(1. Endoscopy Center, the People``s Hospital of Ankang, Ankang 725000; 2. Gastroenterology Department,
the Second Affiliated Hospital of Xi``an Jiaotong University, Xi``an 710004, China)

ABSTRACT: Objective To explore the best location of blood pressure monitoring before gastroscopy and the variety of the patient``s blood pressure and heart rate during the procedure. Methods A total of 59 cases of gastroscopy due to upper gastrointestinal symptoms were selected, and the changes of blood pressure and heart rate in patients before and after gastroscopy with multi-monitor monitor dynamic were measured. Results The left upper limb blood pressure in supine and left lateral position were significantly higher than those of the right upper limb blood pressure (P<0.05). The systolic pressure of the left upper limb in the supine position increased (4.66±10.07) mmHg than that of the right upper limb (t=3.56, P<0.05), and the diastolic pressure increased (2.85±8.22) mmHg (t=2.66, P<0.05). The systolic pressure of the left upper limb in the left lateral position increased (11.92±11.22) mmHg than that of the right upper limb (t=8.15, P<0.05), and the diastolic pressure increased (17.29±15.10) mmHg (t=8.79, P<0.05). The systolic pressure in the left upper limb of left lateral position decreased (5.36±12.64) mmHg than that of the supine position (t=3.256, P<0.05), while the diastolic blood pressure did not change (t=0.802, P=0.426). The systolic pressure in the right upper limb of left lateral position decreased (12.61±2.61) mmHg than that of the supine position (t=11.73，P<0.05), while the diastolic blood pressure decreased (13.46± 3.46) mmHg (t=12.16, P<0.05). The systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate peaked at 1 min after examination were significantly different from those before examination (P<0.05). The systolic blood pressure and heart rate increased after examination (P<0.05), there was no significant difference in the diastolic blood pressure and mean arterial pressure before and after examination (P>0.05). Conclusion Patients with changes in upper gastrointestinal symptoms have great impact on the right upper limb blood pressure, who should choose the left measurement; gastroscopy subjects blood pressure and heart rate increase significantly in the first minute of the procedure, which should be taken seriously, pay attention to observe the performance of patients and improve gastroscopy safety.
KEYWORDS: gastroscopy; blood pressure; heart rate; dynamic monitoring

参考文献：
[1] 李敏,汪文生,张国旺.胃镜检查中心率、血压、血氧饱和度呼吸的监测[J].安徽医学,2003,2(5):328-329.
[2] 黄晔,邓兰芳.85 例胃镜受检者心率、血压动态监测结果分析[J].内科临床研究,2009,4(3):371.
[3] 余珊,王志敏,殷红.胃镜检查的并发症及防治[C]//2005 国际内镜医师学术大会论文集,2005:220-221.
[4] 肖建国,李闻,杨云生.内镜检查和治疗前病人的评估及准备[J].中国消化内镜,2007,1(2):1-5.
[5] 董申琴,邵小青,靳春艳,等.心脑血管病高危人群自我管理能力的影响因素及健康教育效果[J].中华现代护理杂志,2011,17(34):4096-4099.
[6] 彭聚宝.正常人两上肢血压的差异及其临床意义[J].徐州医学院学报,1986,8(1):52-53.
[7] 陈浩然,任军凤.左右臂血压的差异及其临床意义[J].临床心血管病杂志,2005,21(6):372.
[8] 栗鹏,刘成义,刘琳,等.胃镜受检者血压动态变化监测结果分析[J].包头医学院学报,2012,28(6):60-61.
[9] 李晓环,赵梅平.侧卧位血压变化的研究[J].中华现代护理杂志,2006,12(25):2372-2373.
[10] 郝晓鸣,王黎明,梁升禄,等.体位对肱动脉间接血压测量值的影响[J].护理研究,2005,19(1):43-45.
[11] 彭德富,张莉,王雪云,等.胃镜检查过程中心肺功能监测的临床价值[J].中华消化内镜杂志,2002,19(2):99-100.
[12] 谢文晖.综合护理干预对首次胃镜受检者的HR 及BP 的影响[J].国际护理学杂志,2013,32(12):2890-2891.
[13] 付万发,张翼,郑曦,等.老年高血压病患者胃镜检查时生命体征的监测分析[J].实用老年医学,2011,25(4):324-326.