血压测量方法的 多中心对照研究 西安交通大学第一医院 山西医科大学第一医院 南京医科大学第一附属医院 浙江大学医学院附属第一医院 福建医科大学附属第一医院 贵阳医学院诊断学教学组 问题的提出 中心血压与外周血压是否有差异?差异如何? 袖带加压法的舒张压以Korotkoff分期法第四期(变调)还是第五期(消失)更可靠? 老年人舒张压的判断有何特殊性? Textbooks DBP Readings Record Mosbys Guide to Physical Examination (4th ed. 1999) phase 4 Phase 4 of Korotkoff sound is considered to be the closest approximation of direct diastolic arterial pressure. The AHA mends recording three values for the BP: the SBP and both diastolic measurement (110/76/68). If only two values are recorded, they are the systolic and the second diastolic pressure (110/68). Clinical Examination (2nd ed. 1997) phase 4 or phase 5 In fact, it is the point of muffling of the sound (phase 4) which corresponds most closely to the diastolic pressure as measured by an indwelling arterial cannula but phase 5 readings have proved to be more reproducible among different observers. Most authorities would accept a phase 5 diastolic pressure on repeated measurement as defining a hypertensive population. BP measurement Current Diagnosis and Treatment in Cardiology (1995) phase 5 Although this is the best approach in most case, there are exceptions. For example, in patients whom the DBP drops to near zero, the point of muffling of the sounds is usually recorded as the DBP. Repeated measurements under the same conditions. DeGowins Diagnostic Examination (7th ed. 2000) phase 4 or 5 ? Record the 3 readings thus: 130/80/75. The disagreement is prevalent as to whether the 2nd sound or 3rd value represents the closest approximation to the intraarterial DBP。 AHA mends the phase 5 for DBP in most instances. Occasionally, the sound persist to 0 as in aortic regurgitation. In such cases, accept the 2nd value as DBP. Pocket Guide to Physical Diagnosis phase 5 Recoprd phase V as DBP. In patients whose Korotkoff sounds muffle never pletely, record phase I, VI, and V together, for instance, 130/70/0。 Heart Disease, a Textbook of Cardiovascular Medicine 5th ed. 1997 phase 5
