血压脉搏检查

血压、脉搏检查

血压检查

BloodPressure

U.S.DepartmentofHealthandHumanServicesNationalInstitutesofHealthNationalHeart,Lung,andBloodInstituteNationalHeart,Lung,andBloodInstitute

NationalHighBloodPressureEducationProgram

TheSeventhReportofthe

JointNationalCommitteeon

Prevention,Detection,

Evaluation,andTreatmentofHighBloodPressure(JNC7)BPMeasurementTechniquesMethodBriefDescriptionIn-officeTworeadings,5minutesapart,sittinginchair.Confirmelevatedreadingincontralateralarm.AmbulatoryBPmonitoringIndicatedforevaluationof“white-coat”HTN.Absenceof10–20%BPdecreaseduringsleepmayindicateincreasedCVDrisk.Self-measurementProvidesinformationonresponsetotherapy.Mayhelpimproveadherencetotherapyandevaluate“white-coat”HTN.Self-MeasurementofBPProvidesinformationon:ResponsetoantihypertensivetherapyImprovingadherencewiththerapyEvaluatingwhite-coatHTNHomemeasurementof>135/85mmHgisgenerallyconsideredtobehypertensive.Homemeasurementdevicesshouldbecheckedregularly.OfficeBPMeasurementUseauscultatorymethodwithaproperlycalibratedandvalidatedinstrument.Patientshouldbeseatedquietlyfor5minutesinachair

(notonanexamtable),feetonthefloor,andarmsupportedatheartlevel.Appropriate-sizedcuffshouldbeusedtoensureaccuracy.Atleasttwomeasurementsshouldbemade.Cliniciansshouldprovidetopatients,verballyandinwriting,specificBPnumbersandBPgoals.间接测量方法及步骤1、病人仰卧位，右上肢裸露并伸直轻度外展，肘部与心脏同一水平。2、袖带缚于上臂，袖带下缘距肘弯横纹上约2-3cm。3、听诊器胸件置于肘窝肱动脉上（不能压在袖带下面）。4、最高充气压的确定向袖带内充气，边充气边听诊，待肱动脉搏动消失，再将汞柱升高20-30mmHg。间接测量方法及步骤5、收缩压的确定：缓慢放气，两眼平视汞柱缓慢下降，按Korotkoff分期法，听到第一声响的汞柱数值为收缩压（第一期）。6、舒张压的确定：最终声响消失时的汞柱数值为舒张压（第五期）。7、记录：收缩压/舒张压mmHg如126/88mmHg。8、脉压差：收缩压-舒张压9、平均动脉压：舒张压加1/3脉压。血压标准根据1999年10月中国高血压联盟参照了WHO/ISH指南（1999）公布的中国高血压防治指南新标准，规定如下:Purpose

WhyJNC7?Publicationofmanynewstudies.Needforanew,clear,andconciseguidelineusefulforclinicians.NeedtosimplifytheclassificationofBP.

下肢血压测量方法与上肢测量血压方法基本相同不同点病人采取俯卧位选用较宽的袖带袖带缚于腘窝上3～4cm处听诊器胸件置于腘窝处腘动脉上。血压测量方法血压变动的临床意义4、上下肢血压差异常：正常下肢血压高于上肢血压20-40mmHg。如下肢血压等于或低于上肢血压见于主动脉缩窄，胸腹主动脉型大动脉炎，闭塞性动脉硬化，髂动脉或股动脉栓塞等。5、脉压改变：脉压>40mmHg为脉压增大，见于主动脉瓣关闭不全、动脉导管未闭、动静脉瘘、甲亢和严重贫血，老年主动脉硬化症。若脉压<30mmHg为脉压减少，见于主动脉瓣狭窄，心衷，低血压，心包积液，缩窄性心包炎等。动态血压监测两种方法：袖带麦克风感知柯氏音法和振荡法设定间期24小时记录血压，白天每（6am-10pm）每15分钟测血压一次，晚上（10pm-次晨6am）每30分钟记录一次。正常上限参考标准：24小时平均血压<130/80mmHg白昼平均<135/85mmHg夜间平均<125/75mmHg白昼血压两个高峰，上午8am-10am,下午4pm-6pm.夜间血压较白昼下降>10%是杓型，为正常昼夜节律。血管杂音静脉杂音临床多见于：颈静脉营营音：听诊在颈根部近锁骨处，甚至在锁骨下，特点为低调柔和的连续性杂音，坐位和立位明显腹壁静脉营营音：肝硬化时，由于门静脉高压，腹壁侧枝循环静脉曲张，血流增快所致腹部连续性杂音动脉杂音多见于周围动脉甲状腺功能亢进：颈部血管杂音，为连续性。多发性大动脉炎：根据累及部位不同，杂音部位不同。肾动脉狭窄：上腹部和腰背部听到收缩期杂音。周围动静脉瘘：病变相应部位听到连续性杂音肺内动静脉瘘：胸部相应部位听到连续性杂音BenefitsofLoweringBP

AveragePercentReduction Strokeincidence 35–40%

Myocardialinfarction 20–25% Heartfailure 50%AmbulatoryBPMonitoringABPMiswarrantedforevaluationof“white-coat”HTNintheabsenceoftargetorganinjury.AmbulatoryBPvaluesareusuallylowerthanclinicreadings.Awake,individualswithhypertensionhaveanaverageBPof>135/85mmHgandduringsleep>120/75mmHg.BPdropsby10to20%duringthenight;ifnot,signalspossibleincreasedriskforcardiovascularevents.Self-MeasurementofBPProvidesinformationon:ResponsetoantihypertensivetherapyImprovingadherencewiththerapyEvaluatingwhite-coatHTNHomemeasurementof>135/85mmHgisgenerallyconsideredtobehypertensive.Homemeasurementdevicesshouldbecheckedregularly.脉搏检查脉搏（1）检测方法：触诊：主要方法脉搏计描记波形床边监护仪检测血管：浅表的动脉桡动脉：常用其他：颞动脉、颈动脉、肱动脉、股动脉、足背动脉脉律是心搏节律的反应正常人：规整或稍有不整（吸气时增快，呼气时减慢—窦律不齐）病理：心律失常，如房颤、早搏、II°AVB脉搏短绌：见于房颤、频发早搏脱落脉：见于II°AVB紧张度与血压高低（主要是收缩压）有关检查方法：

检查者以食指、中指、环指置于桡动脉上，以近端手指按压桡动脉，此时所施的压力及感知的血管壁弹性情况，即为脉搏的紧张度动脉壁的状态正常人光滑、柔软，有一定弹性动脉硬化程度不同，动脉壁改变也不同早期硬化仅可能触知动脉壁弹性消失，呈索条状，严重时动脉壁有钙质沉着，动脉壁硬、迂曲、呈结节状强弱决定于心输出量、脉压和周围血管阻力大小洪脉或跳脉：见于高热、甲亢、主动脉瓣关闭不全细脉或丝脉：见于心衰、主动脉瓣狭窄、休克波形(1)正常脉搏：见图a水冲脉：脉搏骤起骤落,有如潮水冲涌.（见图b）检查方法：握紧患者手腕掌面，将其前擘高举超过头部，可明显感知犹如水冲的脉搏。见于：主动脉瓣关闭不全、动脉导管未闭、甲亢、严重贫血迟脉：见图c。见于：主动脉瓣狭窄重搏脉：见图d。见于：伤寒、长期发热、波形(2)交替脉：节律正常而强弱交替出现的脉搏。（见图e）意义：左室衰竭的重要体征。见于：高血压心脏病、急性心肌梗塞、主动脉瓣关闭不全等奇脉：平静吸气时脉搏明显减弱甚至消失的现象.（见图f）见于：心包积液、缩窄性心包炎、心包填塞脉搏消失：见于严重休克、多发性大动脉炎各种脉搏波形AlgorithmforTreatmentofHypertensionNotatGoalBloodPressure(<140/90mmHg)

(<130/80mmHgforthosewithdiabetesorchronickidneydisease)InitialDrugChoicesDrug(s)forthecompellingindicationsOtherantihypertensivedrugs(diuretics,ACEI,ARB,BB,CCB)

asneeded.WithCompelling

IndicationsLifestyleModificationsStage2Hypertension

(SBP>160orDBP>100mmHg)

2-drugcombinationformost(usuallythiazide-typediureticand

ACEI,orARB,orBB,orCCB)Stage1Hypertension

(SBP140–159orDBP90–99mmHg)

Thiazide-typediureticsformost.

MayconsiderACEI,ARB,BB,CCB,

orcombination.WithoutCompelling

IndicationsNotatGoal

BloodPressureOptimizedosagesoraddadditionaldrugs

untilgoalbloodpressureisachieved.

Considerconsultationwithhypertensionspecialist.PublicHealthChallenges

andCommunityProgramsPublichealthapproachescanachieveadownwardshiftinthedistributionofapopulation’