極低體重早產兒周邊血壓與臍動脈血壓之相關性

Relationship between Peripheral Blood Pressure and Umbilical Arterial Blood Pressure in Premature Babies with Extremely Low Body Weight

極低體重早產兒為較不成熟發展階段的出生兒，對於周邊血壓的測量變異程度極大，多數依靠臍動脈導管來測量極低體重早產兒之血壓，但臍動脈導管易影響血循及血栓等合併症。因此，本研究目的為探討極低體重早產兒周邊與臍動脈血壓兩者間之相關性，研究方法以描述相關性研究設計，對象採方便取樣，收集南部某醫學中心新生兒加護病房，置放臍動脈導管的11 位極低體重早產兒，測量工具為臍動脈導管及多功能生理監測器。測量出生後四天內的四肢及臍動脈的血壓，共測得77 次血壓值。統計方法以SPSS version 15.0 進行資料統計分析，結果發現極低體重早產兒周邊與臍動脈血壓有正相關，其中以右上肢之平均血壓與臍動脈血壓的相關性最高（Spearman rho = .74）。臍動脈之平均壓可以右上肢平均壓來推估，其公式為：臍動脈平均壓＝ 10.35 ＋ 0.73x 右上肢平均壓。結論，建議在沒有臍動脈導管可以測量極低體重早產兒之直接血壓時，護理人員可測量右上肢之周邊血壓來推估臍動脈平均壓，並增加平均血壓值之紀錄來提供醫療處置之參考。

The development of premature babies with extremely low body weight (ELBW) is immature. It is difficult to monitor the blood pressure of these babies accurately. Therefore, most physicians rely on umbilical arterial catheter insertion. However, umbilical arterial catheter can lead to complications, such as poor perfusion or necrosis. Research aim: The purpose of this study was to explore the relationship between peripheral blood pressure value and umbilical arterial blood pressure value in premature babies with extremely low body weight. Research method: A descriptive correlational research design with convenience sampling was used to conduct this study. Subjects: Participants were recruited from among premature babies with extremely low body weight who had umbilical arterial catheter performed upon being admitted to the neonatal intensive care unit at a medical center in southern Taiwan. Peripheral blood pressure values and umbilical arterial blood pressure values were taken 4 days after birth. A total of 77 blood pressure values from 11 patients were obtained. Measures: Hewlett Packard Omnicare CMS24 and a Kendall Umbilical artery catheter were used to measure blood pressure values. Statistics: The SPSS version 15.0 was used to analyze data. Results: The results indicate a positive correlation between the peripheral blood pressure of the four limbs and umbilical arterial blood pressure. The mean blood pressure of the right arm (Spearman rho = .74) showed the highest correlation with umbilical arterial blood pressure in comparison to the other limbs. Conclusion: From the results of this study, when an umbilical arterial catheter is unavailable, we suggest measuring the blood pressure in the right arm to estimate the umbilical mean blood pressure of premature babies with extremely low body weight as reasonable method for healthcare practitioners.