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2019.1.

15 ICU

2019 1 15 ICU
,

,
,

ICU 2012 10 16
,
ICU 2012 10 16
NIBP A-line

,
ICU 2012 10 16
INTENSIVIST 2011; Vol.3, No.2
http://medica.sanyonews.jp/article/4523/
http://medica.sanyonews.jp/article/4523/
1733 Stephen Hales

2.5m
.

Proc R Soc Med 1977; 70: 793-9.


http://www.blood-pressure-hypertension.com
Hales 100
1733 Hales
1856 Faivre
1876 Marey Oscillometric
1896 Riva-Rocci
1905 Korotkov

Miller’s Anesthesia, 8th edition.


NIBP

Oscillometric method
1896 Riva Rocci
Gaz Med Torino 1896; 47: 981

,
, sBP .

MAP dBP .

Miller’s Anesthesia, 8th edition.


auscultation method
1905 Korotkoff

Korotkoff 1 sBP
4 5
dBP .

,
gold standard .

Miller’s Anesthesia, 8th edition.


Oscillometric method
1876 Marey

MAP

sBP dBP


Hypertension 2005; 45(1): 142.
NIBP

ABP

Oscillometric

Anesth Analg 2018;127:408–11


Oscillometry

NIBP .
Miller’s Anesthesia, 8th edition.
ABP

ABP

INTENSIVIST 2011; Vol.3, No.2


ABP

NIBP

Miller’s Anesthesia, 8th edition.


ABP

1. Systolic upstroke 4. Dicrotic notch

2. Systolic peak pressure 5. Diastolic runoff


3. Systolic decline 6. End-diastolic pressure

Miller’s Anesthesia, 8th edition.


1 ,

2016;
A
B
C

Miller’s Anesthesia, 8th edition.


A
B ,
2

Miller’s Anesthesia, 8th edition.


,
,
.
Crit Care 2015; 19: 101.

, SSCG2016
MAP≧65mmHg ,
.
Crit Care Med 2017; 45(3): 486-552.
MAP 65
,
MAP 60 65mmHg
.
Intensive Care Med 2005; 31(8).
Intensive Care Med 2009; 35(7): 1225-1233.

, MAP 75mmHg AKI


.
Intensive Care Med 2009; 35(7): 1225-1233.
Crit Care 2011; 15(3): R135.
Crit Care 2013; 17(6).
SEPSISPAM trial 29
776
Open-label RCT
2010 3 2011 12

MAP 80 85mmHg
vs.
MAP 65 70mmHg
70 75

N Engl J Med 2014; 370(17): 1583-1593.


RRT

N Engl J Med 2014; 370(17): 1583-1593.


65mmHg ,

N Engl J Med 2014; 370(17): 1583-1593.


INPRESS study

9 298
2012 12 2016 8

sBP 80mmHg or ≦ 40% sBP 10%


ephedorine 6mg Noradrenaline

Primary outcome SIRS 1 day7

JAMA 2017; 318(14): 1346-1357.


JAMA 2017; 318(14): 1346-1357.
ICU 2017 11 21
JAMA 2017; 318(14): 1346-1357.
ICU 2017 11 21
JAMA 2017; 318(14): 1346-1357.
ICU 2017 11 21
JAMA 2017; 318(14): 1346-1357.
ICU 2017 11 21
JAMA 2017; 318(14): 1346-1357.
ICU 2017 11 21
etc…
meta-analysis

Stroke 2015; 46(7): 1883-9.


Stroke 2018; 49: e46-e99.
ICU 2013 6 4
, sBP
160mmHg Stroke 2012; 43(6): 1711-37.

Stanford B sBP100 120mmHg

2011

, ,

, sBP
ABP NIBP
NIBP

, , ,
Korotcoff ↓ ↑

↑ sBP
dBP

Miller’s Anesthesia, 8th edition.


ABP

INTENSIVIST
Miller’s Anesthesia, 8th edition.
,
,
1 2
3. Systolic upstroke
Systolic pressure peak
dicrotic notch
dyastolic pressure wave
systolic upstroke

Miller’s Anesthesia, 8th edition.


,

10 15Hz

50Hz

A , ,
,

Under-damping ↑
Miller’s Anesthesia, 8th edition.
, NIBP ABP

Gold standard
ABP
24225

1 NIBP NIBP
15310 63% 8915 37%

sBP, dBP, MAP ,


ABP NIBP
NIBP ABP

Anesthesiology 2011; 115: 973-978.


7 ICU
2001 2007
ABP NIBP

ABP NIBP, NIBP ABP


MAP
Crit Care Med 2013; 41(1): 34-40.
, AKI
, NIBP sBP AKI ↑, MAP
Crit Care Med 2013; 41(1): 34-40.
.
.

, MAP sBP dBP


, MAP
.

Best ,
.
,
.

,
.

MAP .

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