Measurement hell. Rules and methods for measuring blood pressure. General rules for measuring blood pressure

One of the most important indicators of the functional state of the human body is the pressure in large arteries, that is, the force with which blood presses on their walls during the work of the heart. It is measured at almost any visit to the general practitioner, whether it is a program of preventive examinations or treatment of complaints of well-being.

A word about pressure

The blood pressure level is expressed as two numbers written as a fraction. The numbers mean the following: at the top - systolic pressure, which is popularly called the top, at the bottom - diastolic, or bottom. Systolic is fixed when the heart contracts and pushes blood out, diastolic - when it is maximally relaxed. The unit of measurement is a millimeter of mercury. The optimal pressure level for adults is 120/80 mm Hg. pillar. Blood pressure is considered elevated if it is more than 139/89 mm Hg. pillar.

Why you need to know your blood pressure

Even a slight increase in blood pressure increases the risk of developing a heart attack, stroke, ischemia, heart and kidney failure. And the higher it is, the greater the risk. Very often, hypertension in the initial stage proceeds without symptoms, and the person does not even know about his condition.

Measurement of blood pressure is the first thing to do when complaining of frequent headaches, dizziness, weakness.

Hypertensive patients should measure blood pressure every day and monitor its level after taking the pills. People with high blood pressure should not be drastically reduced with medications.

Methods for measuring blood pressure

You can determine the level of blood pressure in a direct and indirect way.

Straight

This invasive method is highly accurate, but it is traumatic, since it consists in the direct insertion of a needle into a vessel or cavity of the heart. The needle is connected to the manometer by a tube containing an anticoagulant. The result is a blood pressure fluctuation curve recorded by a scribe. This method is most often used in cardiac surgery.

indirect methods

Usually, pressure is measured on the peripheral vessels of the upper extremities, namely on the elbow bend of the arm.

Nowadays, two non-invasive methods are widely used: auscultatory and oscillometric.

The first one (auscultatory), proposed by the Russian surgeon N. S. Korotkov at the beginning of the 20th century, is based on clamping the shoulder artery with a cuff and listening to the tones that appear when air is slowly released from the cuff. Upper and lower pressures are determined by the appearance and disappearance of sounds that are characteristic of turbulent blood flow. Measurement of blood pressure according to this technique is carried out using a very simple device, consisting of a pressure gauge, a phonendoscope and a cuff with a pear-shaped balloon.

When measuring blood pressure in this way, a cuff is placed on the shoulder area, into which air is pumped until the pressure in it exceeds systolic. The artery at this moment is completely clamped, the blood flow in it stops, the tones are not heard. When air is released from the cuff, the pressure decreases. When the external pressure compares with systolic pressure, blood begins to flow through the squeezed area, noises appear that accompany the turbulent flow of blood. They are called Korotkov's tones, and they can be heard with a phonendoscope. At the moment when they occur, the value on the pressure gauge is equal to the systolic blood pressure. When the external pressure is compared with the arterial pressure, the tones disappear, and at this moment the diastolic pressure is determined by the manometer.

The microphone of the measuring device picks up the Korotkov tones and converts them into electrical signals that are fed to the recording device, on the display of which the values ​​\u200b\u200bof the upper and lower blood pressure appear. There are other devices in which the emerging and disappearing characteristic noises are determined using ultrasound.

The method of measuring blood pressure according to Korotkov is officially considered the standard. It has both pros and cons. Among the advantages can be called high resistance to hand movement. There are a few more disadvantages:

• Sensitive to noise in the room where the measurement is taken.
• The accuracy of the result depends on whether the location of the phonendoscope head is correct and on the individual qualities of the person who measures blood pressure (hearing, vision, hands).
• Skin contact with the cuff and microphone head is required.
• It is technically complicated, which causes measurement errors.
• It requires special preparation.

Oscillometric
With this method, blood pressure is measured with an electronic tonometer. The principle of this method is that the device registers pulsations in the cuff that appear when blood passes through the squeezed portion of the vessel. The main disadvantage of this method is that the hand must be motionless during the measurement. There are quite a few advantages:

• For carrying out special training is not required.
• The individual qualities of the measurer (vision, hands, hearing) do not matter.
• Resistant to indoor noise.
• Determines blood pressure with weak Korotkoff tones.
• The cuff can be put on a thin jacket, while this does not affect the accuracy of the result.

Types of tonometers

Today, aneroid (or mechanical) and electronic devices are used to determine blood pressure.

The former are used to measure pressure using the Korotkoff method in a medical institution, since they are too complicated for home use, and untrained users receive measurement errors with errors.

The electronic device can be automatic and semi-automatic. These blood pressure monitors are designed for daily home use.

General rules for measuring blood pressure

Pressure is most often measured in a sitting position, but sometimes it is done in a standing and lying position.

Since the pressure depends on the condition of the person, it is important to provide the patient with a comfortable environment. The patient himself needs not to eat, not to engage in physical labor, not to smoke, not to drink alcoholic beverages, not to be exposed to cold for half an hour before the procedure.

During the procedure, you can not make sudden movements and talk.

It is recommended to take measurements more than once. If a series of measurements is taken, a break of about one minute (at least 15 seconds) and a change of position are needed between each approach. During the break, it is recommended to loosen the cuff.

The pressure on different hands can vary significantly, in connection with this, it is better to take measurements on the one where the level is usually higher.

There are patients whose pressure in the clinic is always higher than when measured at home. This is due to the excitement that many experience at the sight of medical workers in white coats. For some, this can happen at home, this is a reaction to the measurement. In such cases, it is recommended to take measurements three times and calculate the average value.

The procedure for determining blood pressure in different categories of patients

In the elderly

In this category of persons, unstable blood pressure is more often observed, which is associated with disturbances in the blood flow regulation system, a decrease in vascular elasticity, and atherosclerosis. Therefore, elderly patients need to take a series of measurements and calculate the average value.

In addition, they need to have their blood pressure measured while standing and sitting, as they often experience sudden drops in blood pressure when changing positions, such as getting out of bed and sitting up.

In children

Children are recommended to measure blood pressure with a mechanical sphygmomanometer or an electronic semi-automatic device, while using a children's cuff. Before you measure your child's blood pressure yourself, you need to consult a pediatrician about the amount of air injected into the cuff and the time of measurement.

In pregnant women

By blood pressure, you can judge how well the pregnancy is proceeding. For expectant mothers, it is very important to constantly monitor blood pressure in order to start treatment on time and avoid serious complications in the fetus.

Pregnant women need to measure the pressure in a semi-recumbent state. If its level exceeds the norm or, conversely, is much lower, you should immediately contact your doctor.

With cardioarrhythmia

People who have a broken sequence, rhythm and heart rate need to measure blood pressure several times in a row, discard obviously incorrect results and calculate the average value. In this case, the air from the cuff must be released at a lower speed. The fact is that with cardioarrhythmia, its level can vary significantly from stroke to stroke.

Algorithm for measuring blood pressure

Measurement of blood pressure should take place in the following order:

1. The patient is seated comfortably on a chair so that his back is adjacent to the back, that is, he has support.
2. The hand is freed from clothing and laid on the table with the palm up, placing a towel roller or the patient's fist under the elbow.
3. A tonometer cuff is applied to the bare shoulder (two or three centimeters above the elbow, approximately at the level of the heart). Two fingers should pass between the arm and the cuff, its tubes pointing down.
4. The tonometer is at eye level, its arrow is at zero.
5. Find the pulse in the cubital fossa and apply a phonendoscope to this place with a slight pressure.
6. A valve is screwed on the pear of the tonometer.
7. The pear-shaped balloon is compressed and air is pumped into the cuff until the pulsation in the artery ceases to be heard. This occurs when the pressure in the cuff exceeds 20-30 mm Hg. pillar.
8. The valve is opened and air is released from the cuff at a rate of about 3 mm Hg. pillar, while listening to Korotkov's tones.
9. When the first constant tones appear, the pressure gauge readings are recorded - this is the upper pressure.
10. Continue to release air. As soon as the weakening Korotkoff tones disappear, the readings of the pressure gauge are recorded - this is the lower pressure.
11. Release air from the cuff, listening to tones, until the pressure in it becomes equal to 0.
12. The patient is allowed to rest for about two minutes and the blood pressure is measured again.
13. The cuff is then removed and the results recorded in a diary.

Wrist Blood Pressure Technique

To measure blood pressure at the wrist with an electronic device with a cuff, you must follow the following instructions:

• Remove watches or bracelets from your arm, unbutton the sleeve and fold it back.
• Position the cuff of the tonometer above the hand by 1 centimeter with the display facing up.
• Place the arm with the cuff on the opposite shoulder, palm down.
• With the other hand, press the "Start" button and put it under the elbow of the arm with the cuff.
• Remain in this position until the air is automatically released from the cuff.

This method is not suitable for everyone. It is not recommended for people with diabetes mellitus, atherosclerosis and other circulatory disorders and changes in the vascular walls. Before using such a device, you need to measure the pressure with a tonometer with a cuff on the shoulder, then with a cuff on the wrist, compare the values ​​\u200b\u200band make sure that the difference is small.

Possible errors in measuring blood pressure

• Mismatch between cuff size and arm circumference.
• Wrong hand position.
• Inflating the cuff too fast.

What to consider when measuring pressure

• Stress can significantly change the readings, so you need to measure it in a calm state.
• Blood pressure rises with constipation, immediately after eating, after smoking and drinking alcohol, with excitement, in a sleepy state.
• It is best to carry out the procedure one to two hours after eating.
• It is necessary to measure blood pressure immediately after urination, since it is elevated before urination.
• The pressure changes after taking a shower or bath.
• A nearby mobile phone can change the readings of the tonometer.
• Tea and coffee can change blood pressure.
• To stabilize it, you need to take five deep breaths.
• It increases when you are in a cold room.

Conclusion

Determination of blood pressure at home follows the same principle as in a medical institution. The algorithm for measuring blood pressure remains approximately the same, but when using an electronic tonometer, the execution technique is noticeably simplified.

How to measure blood pressure

Causes and treatment of arterial hypertension

Normal - systolic 120-129, diastolic 80-84

High normal - systolic 130-139, diastolic 85-89

Arterial hypertension of the 1st degree - systolic 140-159, diastolic 90-99

Arterial hypertension of the 2nd degree - systolic 160-179, diastolic 100-109

Arterial hypertension of the 3rd degree - systolic above 180, diastolic above 110

Isolated systolic hypertension - systolic above 139, diastolic less than 90

Clinical picture

Symptoms of this disease are usually absent for a long time. Up to the development of complications, a person does not suspect about his disease if he does not use a tonometer. The main symptom is a persistent increase in blood pressure. The word "persistent" is paramount here, because. a person's blood pressure can also increase in stressful situations (for example, white coat hypertension), and after a while it normalizes. But, sometimes, the symptoms of arterial hypertension are headache, dizziness, tinnitus, flies before the eyes.

Other manifestations are associated with damage to target organs (heart, brain, kidneys, blood vessels, eyes). Subjectively, the patient may notice a deterioration in memory, loss of consciousness, which is associated with damage to the brain and blood vessels. With a long course of the disease, the kidneys are affected, which can be manifested by nocturia and polyuria. Diagnosis of arterial hypertension is based on the collection of anamnesis, measurement of blood pressure, detection of target organ damage.

One should not forget about the possibility of symptomatic arterial hypertension and exclude diseases that could cause it. Mandatory minimum examinations: complete blood count with hematocrit determination, general urinalysis (determination of protein, glucose, urinary sediment), blood sugar test, determination of cholesterol, HDL, LDL, triglycerides, uric acid and creatinine in blood serum, sodium and potassium blood serum, ECG. There are additional examination methods that the doctor may prescribe if necessary.

Differential diagnosis of arterial hypertension

Differential diagnosis of arterial hypertension is between symptomatic and essential. This is necessary to determine the tactics of treatment. It is possible to suspect secondary arterial hypertension on the basis of certain features:

1. from the very beginning of the disease, high blood pressure is established, characteristic of malignant hypertension
2. high blood pressure is not amenable to medical treatment
3. hereditary history is not burdened by hypertension
4. acute onset of the disease

Arterial hypertension and pregnancy

Arterial hypertension in pregnant women can occur both during pregnancy (gestational) and before it. Gestational hypertension occurs after the 20th week of pregnancy and disappears after delivery. All pregnant women with hypertension are at risk for preeclampsia and placental abruption. In the presence of such conditions, the tactics of conducting childbirth change.

Treatment of the disease

Methods of treatment of arterial hypertension are divided into drug and non-drug. First of all, you need to change your lifestyle (do physical education, go on a diet, give up bad habits). What is the diet for hypertension?

It includes restriction of salt (2-4 g) and liquid, it is necessary to reduce the intake of easily digestible carbohydrates, fats. Food must be taken fractionally, in small portions, but 4-5 times a day. Drug therapy includes 5 groups of drugs for the correction of blood pressure:

• Diuretics
• Beta blockers
• ACE inhibitors
• calcium antagonists
• Angiotensin II receptor antagonists

All drugs have different mechanisms of action, as well as their contraindications. For example, thiazide diuretics should not be used during pregnancy, severe chronic renal failure, gout; beta-blockers are not used for bronchial asthma, COPD, severe bradycardia, atrioventricular blockade of 2.3 degrees; angiotensin-2 receptor antagonists are not prescribed in cases of pregnancy, hyperkalemia, bilateral stenosis of the renal arteries).

Very often, drugs are produced in a combined state (the following combinations are considered the most rational: diuretic + ACE inhibitor, beta-blocker + diuretic, angiotensin-2 receptor antagonists + diuretic, ACE inhibitor + calcium antagonist, beta-blocker + calcium antagonist). There are new drugs for the treatment of hypertension: imidazoline receptor antagonists (they are not in the international recommendations for treatment).

Prevention

People who are predisposed to this disease are especially in need of prevention of arterial hypertension. As a primary prevention, it is necessary to lead an active lifestyle, go in for sports, as well as eat right, avoid overeating, excessive consumption of fats and carbohydrates, and give up bad habits.

All this is the most effective method of preventing hypertension.

Intraventricular hemorrhage (IVH) in newborns: causes, degrees, manifestations, prognosis

Neurological pathology in newborns and children of the first years of life is a very serious problem, and, unfortunately, brain damage in babies is by no means uncommon. IVH is intraventricular hemorrhage, which is very characteristic of the neonatal period and often accompanies the pathological course of childbirth.

Intraventricular hemorrhages are also found in adults, representing one of the forms of stroke with high mortality. As a rule, blood at the same time penetrates into the ventricular system from intracerebral hematomas when they break through into the brain cavity.

Hemorrhage into the ventricles of the brain in children is usually isolated, not associated with parenchymal hematomas, that is, it can be considered as an independent separate disease.

The significance of the problem of intraventricular hemorrhage in newborns is due not only to the difficulties of diagnosing and treating pathology, because many drugs are contraindicated for babies, and immature nervous tissue is extremely sensitive to any adverse circumstances, but also to a prognosis that can not always reassure young parents.

In addition to children born during the abnormal course of the birth period, IVH is diagnosed in preterm infants, and the shorter the gestation period at which the premature birth occurred, the greater the likelihood of IVH and the more severe the degree of ischemic-hypoxic brain damage.

In babies born prematurely, half of the hemorrhages in the ventricles occur already on the first day of life, up to 25% of IVH occurs on the second day after birth. The older the child, the less the likelihood of circulatory disorders in the brain, even under the condition of an abnormal course of childbirth.

To date, the arsenal of neonatologists has highly informative research methods that allow timely diagnosis of intraventricular hemorrhage, but problems with classification, determining the stage of pathology have not yet been resolved. A unified classification of IVH has not been developed, and when formulating the stages, the features of the topography of the lesion are taken into account rather than the clinical severity and prognosis.

Causes of intraventricular hemorrhages in newborns

The causes of IVH in young children are fundamentally different from those that cause hemorrhages in adults. If in the latter vascular factors come to the fore - hypertension, atherosclerosis underlying strokes, and the very penetration of blood into the ventricles is secondary to intracerebral hematoma, then in newborn babies the situation is somewhat different: hemorrhage immediately occurs inside the ventricles or under their lining , and the reasons are somehow related to pregnancy and childbirth:

• state of prematurity;
• Long waterless period;
• Severe hypoxia in childbirth;
• Obstetric injuries (rare);
• Birth weight less than 1000 g;
• Congenital disorders of blood coagulation and vascular structure.

In premature babies, the presence of the so-called germinal (embryonic matrix) is considered as the main cause of intraventricular hemorrhages, which should gradually disappear as the fetal brain and vascular system mature. If the birth occurred prematurely, then the presence of this structure creates the prerequisites for IVH.

The germinal matrix is ​​a region of nervous tissue around the lateral ventricles containing immature cells that migrate to the brain and become neurons or neuroglia when they mature. In addition to cells, this matrix carries immature capillary-type vessels, the walls of which are single-layered, therefore they are very fragile and can break.

Hemorrhage into the germinal matrix is ​​not yet IVH, but it most often leads to the penetration of blood into the ventricles of the brain. A hematoma in the nervous tissue adjacent to the wall of the ventricle breaks through its lining, and blood rushes into the lumen. From the moment of the appearance of even a minimal volume of blood in the ventricle of the brain, one can speak of the onset of an independent disease - intraventricular hemorrhage.

Determining the stages of IVH is necessary to assess the severity of the disease in a particular patient, as well as to determine the prognosis in the future, which depend on the amount of blood that has entered the ventricles and the direction of its spread towards the nervous tissue.

Radiologists base IVH staging on the results of computed tomography. They highlight:

• IVH of the 1st degree - subependymal - blood accumulates under the lining of the ventricles of the brain, without destroying it and without entering the ventricle. In fact, this phenomenon cannot be considered a typical IVH, but at any time a breakthrough of blood into the ventricles can occur.
• IVH of the 2nd degree is a typical intraventricular hemorrhage without expansion of its cavity, when blood exits from the subependymal space. On ultrasound, this stage is characterized as IVH with less than half of the volume of the ventricle filled with blood.
• IVH grade 3 - blood continues to flow into the ventricle, filling more than half of its volume and expanding the lumen, which can be seen on CT and ultrasound.
• IVH of the 4th degree is the most severe, accompanied not only by the filling of the ventricles of the brain with blood, but also by its spread further into the nervous tissue. CT shows signs of IVH of one of the first three degrees along with the formation of foci of parenchymal intracerebral hemorrhage.

Based on structural changes in the brain and its cavities, three stages of IVH are distinguished:

1. At the first stage, the ventricles are not completely filled with blood contents, they are not dilated, spontaneous cessation of bleeding and the preservation of normal liquorodynamics are possible.
2. Continued filling of the lateral ventricles with possible expansion when at least one of the ventricles is filled with blood by more than 50%, and the blood spreads to the 3rd and 4th ventricles of the brain occurs in the second stage.
3. The third stage is accompanied by the progression of the disease, the ingress of blood under the choroid of the cerebellum, medulla oblongata and spinal cord. High risk of fatal complications.

The severity of IVH and its manifestations will depend on how quickly the blood penetrated into the brain tissue and its cavity, as well as on its volume. Hemorrhage always spreads along the course of the flow of cerebrospinal fluid. In severely premature babies, as well as those who have undergone deep hypoxia, disturbances in the blood coagulation system occur, so clots in the brain cavities do not appear for a long time, and liquid blood “spreads” freely through the brain regions.

At the heart of the CSF circulation disorder and the subsequent increase in hydrocephalus is the penetration of blood into the ventricle, where it mixes with the cerebrospinal fluid, but does not immediately clot. Part of the liquid blood penetrates into other cavities of the brain, but as it coagulates, its clots begin to block the narrow zones through which the CSF circulates. The blockage of any of the openings of the brain entails a blockade of the CSF pathway, expansion of the ventricles and hydrocephalus with characteristic symptoms.

IVH manifestations in young children

Up to 90% of all hemorrhages in the ventricular system occur in the first three days of a baby's life, and the lower its weight, the higher the likelihood of pathology. After the first week of a child's life, the risk of hemorrhage is significantly reduced, which is associated with the adaptation of the vascular system to new conditions and the maturation of the structures of the germ cell matrix. If the child was born prematurely, then for the first days he should be under the close supervision of neonatologists - for 2-3 days the condition may deteriorate sharply due to the onset of IVH.

Small subependymal hemorrhages and grade 1 IVH may be asymptomatic. If the disease does not progress, then the condition of the newborn will remain stable, and neurological symptoms will not even occur. With multiple hemorrhages under the ependyma, signs of brain damage will appear closer to the year with leukomalacia.

A typical intracerebral hemorrhage is manifested by symptoms such as:

• Decreased muscle tone;
• Flaccid tendon reflexes;
• Respiratory disorders up to a stop (apnea);
• convulsions;
• Focal neurological symptoms;
• Coma.

The severity of the course of the pathology and the features of the symptoms are associated with the volume of blood that has entered the ventricular system and the rate of pressure increase in the cranial cavity. Minimal IVH, which does not cause obstruction of the CSF tract and changes in ventricular volume, will be accompanied by an asymptomatic course, and it can be suspected by a decrease in the hematocrit number in the baby's blood.

A spasmodic flow is observed with moderate and submassive IVH, which are characterized by:

1. Oppression of consciousness;
2. Paresis or muscle weakness;
3. Oculomotor disorders (histagmus, strabismus);
4. Respiratory disorders.

Symptoms with an intermittent course are expressed for several days, after which they gradually decrease. Both a complete recovery of brain activity and minor deviations are possible, but the prognosis is generally favorable.

The catastrophic course of IVH is associated with severe disorders of the brain and vital organs. Characterized by coma, respiratory arrest, generalized convulsions, cyanosis of the skin, bradycardia, lowering blood pressure, violations of thermoregulation. Intracranial hypertension is evidenced by the bulging of the large fontanel, which is clearly visible in newborns.

In addition to clinical signs of impaired nervous activity, there will be changes in laboratory parameters. The occurrence of IVH in newborns may be indicated by a drop in hematocrit, a decrease in calcium, fluctuations in blood sugar, blood gas disorders (hypoxemia), and electrolyte disturbances (acidosis) are not uncommon.

The complications of IVH include blockade of the CSF pathways by blood clots with the development of acute occlusive hydrocephalus, atrophy of the cerebral cortex, and impaired psychomotor development. Violation of the circulation of cerebrospinal fluid leads to an increase in the size of the ventricles, an increase in intracranial pressure and compression of the cerebral cortex, which already suffers from hypoxia. The result is a convulsive syndrome, depression of consciousness and coma, cardiac and respiratory arrest.

The progression of bleeding leads to the spread of blood from the ventricles into the cisterns of the brain and nervous tissue. Parenchymal intracerebral hematomas are accompanied by gross focal symptoms in the form of paresis and paralysis, sensory disturbances, generalized convulsive seizures. When IVH is combined with intracerebral hemorrhage, the risk of an unfavorable outcome is extremely high.

Among the long-term consequences of IVH, ischemic-hypoxic damage and residual changes in the brain in the form of cysts, periventricular leukomalacia, white matter gliosis, and cortical atrophy are noted. By about a year, a developmental lag becomes noticeable, motor skills suffer, the child cannot walk and perform the correct movements of the limbs in due time, does not speak, and lags behind in mental development.

Diagnosis of IVH in infants is based on an assessment of symptoms and examination data. The most informative is CT, neurosonography and ultrasound. CT is accompanied by radiation, so it is preferable for premature babies and newborns of the first days of life to conduct an ultrasound examination.

Treatment and prognosis

Children with IVH are treated by neurosurgeons and neonatologists. Conservative therapy is aimed at restoring the functioning of vital organs and blood counts. If the child did not receive vitamin K at birth, then it must be introduced. Deficiency of coagulation factors and platelets is replenished by transfusion of plasma components. When breathing stops, artificial ventilation of the lungs is performed, but it is better to establish it as planned if there is a risk of respiratory disorders.

Medical therapy includes:

• Normalization of blood pressure to prevent a sharp decrease or jumps that aggravate hypoxia and damage to the nervous tissue;
• oxygen therapy;
• anticonvulsants;
• Blood clotting control.

To reduce intracranial pressure, the introduction of magnesium sulfate intravenously or intramuscularly is indicated, diacarb, furosemide, veroshpiron are used for full-term children. Anticonvulsant therapy consists in the appointment of diazepam, valproic acid preparations. To relieve symptoms of intoxication, infusion therapy is carried out, acidosis (acidification of the blood) is eliminated by using a solution of sodium bicarbonate intravenously.

In addition to medication, surgical treatment of IVH is carried out: evacuation of blood from the ventricles of the brain by means of their puncture under ultrasound control, the introduction of fibrinolytic agents (actelyse) into the lumen of the ventricles to prevent thrombosis and occlusive hydrocephalus. Perhaps a combination of puncture with the introduction of fibrinolytic drugs.

In order to remove tissue decay products and eliminate the symptoms of intoxication, liquor filtration, liquor sorption and intraventricular lavage with artificial cerebrospinal fluid preparations are indicated.

With blockage of the cerebrospinal fluid and hydrocephalic syndrome, temporary drainage of the ventricles is established with the evacuation of blood and clots until the cerebrospinal fluid is cleared and the obstruction of its outflow pathways is eliminated. In some cases, repeated lumbar and ventricular punctures, external ventricular drainage, or temporary internal drainage with implantation of artificial drainage under the skin are used.

If hydrocephalus has acquired a persistent and irreversible character, and there is no effect from fibrinolytic therapy, then neurosurgeons provide permanent drainage by surgery:

1. Installation of permanent shunts with CSF outflow into the abdominal cavity (a silicone tube passes under the skin from the head to the abdominal cavity, the shunt can be removed only if the child's condition stabilizes and there is no progression of hydrocephalus);
2. Endoscopic imposition of anastomoses between the ventricles of the brain and the basal cisterna.

The most common method of surgical treatment of occlusive hydrocephalus associated with IVH is ventriculoperitoneal drainage. It is affordable, allows drugs to be injected into the ventricles, has a low likelihood of infection, can be carried out for a long time, while caring for a child is not accompanied by difficulties. The use of alteplase, which accelerates the dissolution of blood clots in the ventricles, can reduce mortality and maximize brain function.

The prognosis for IVH is determined by the stage of the disease, the amount of hemorrhage, and the location of brain tissue damage. In the first two degrees of IVH, blood clots resolve themselves or under the influence of treatment, without causing significant neurological disorders, therefore, with small hemorrhages, the child can develop normally.

Massive intraventricular hemorrhages, especially if they are accompanied by damage to the brain tissue, can lead to the death of the infant in a short time, and if the patient survives, then it is problematic to avoid neurological deficit and gross violations of psychomotor development.

All children with intracranial hemorrhages are subject to careful observation in intensive care and timely surgical treatment. After installing a permanent shunt, the disability group is determined, and the baby should be regularly shown to a neurologist.

To avoid the severe changes described, it is important to observe measures to prevent brain damage in newborns and very premature babies. Expectant mothers need to undergo the necessary preventive examinations and examinations in a timely manner, and with the threat of premature birth, the task of obstetrician-gynecologists is to prolong the pregnancy as much as possible with medications until such a time when the risk of hemorrhages becomes minimal.

If the child is still born prematurely, then he is placed in the intensive care unit for observation and treatment. Modern methods of diagnosis and therapy of IVH can not only save the lives of babies, but also significantly improve their quality, even if this requires a surgical operation.

To adequately assess the state of the cardiovascular system, it is important to know the algorithm for measuring blood pressure. The correctness of the final indicators depends on the correctness of the preparation for the procedure, knowledge about the operation of the tonometer and the behavior of the patient during the diagnosis. Blood pressure control will allow you to respond in time to possible health problems and take appropriate therapeutic measures.

Measurement methods

Methods for determining blood pressure:

• Invasive - the most accurate manipulation, used in cardiac surgery, based on the introduction of a transducer catheter directly into the artery. The data is transmitted through the tube to the pressure gauge. The result is displayed on the pressure fluctuation curve.
• Non-invasive methods for measuring blood pressure:
  • Dr. Korotkov's method (using a mechanical tonometer);
  • oscillometric (measurement by an automatic electronic device);
  • palpatory (based on squeezing and relaxing the hand in the area of ​​​​the proximity of a large artery to the skin and subsequent probing of the pulse).

Korotkov method

The standard type of blood pressure determination in any medical institution is the Korotkoff method.

Enter your pressure

Move the sliders

The technique was invented in 1905. Otherwise, the method is called auscultation. The device for diagnostics is a mechanical tonometer, consisting of:

• cuffs;
• gauge-manometer;
• air blower;
• phonendoscope.

Measurement of blood pressure according to the method proposed by Korotkov is based on compressing the brachial artery with a cuff and listening to the heart pulsation through a stethoscope. Advantages:

• cheapness and availability of mechanical devices for measuring blood pressure;
• the accuracy of the results.

Among the shortcomings that the procedure involves, it is difficult to measure the pressure with a mechanical device for oneself. In outpatient clinics, this is usually done by a nurse. Also, devices of this type are very sensitive to sound and noise, any violation of silence during diagnostics can distort the result. The skill level of the nurses who take the measurement can also affect the result.

Oscillometric

The procedure for measuring blood pressure by the oscillometric method involves the use and automatic counting of the pulse under the cuff when the artery is compressed. These devices are intended for home use. The presence of a nurse for the diagnosis is not required. The disadvantages include the fact that electromagnetic waves affect the operation of the electronic tonometer, and the battery may also be discharged. A number of advantages of the method:

• noise does not affect the result of the study;
• special knowledge and skills are not required to perform the algorithm;
• no need to bare your arm to measure blood pressure.

Before taking a measurement, it is important:

• sleep well;
• empty the bladder;
• do not eat 2 hours before the diagnosis;
• do not smoke for at least an hour;
• do not drink coffee;
• do not take alcoholic beverages on the day of diagnosis;
• do not use drugs that constrict blood vessels - eye drops, nose drops;
• rest and relax for 10 minutes;
• maintain the temperature in the room 20-23 degrees.

The arm on which the measurement will be taken should not be squeezed by tight cuffs of the sleeves, bracelets, bandages, watches, otherwise the blood circulation will be disturbed and the result will be incorrect. There should be no wounds, abrasions, scars on the limbs that interfere with blood circulation. Measurement of blood pressure is always desirable to carry out in the morning after sleep. During manipulation, you can not move, talk with a nurse, hunch over, cross your legs - the accuracy of blood pressure measurement depends on this.

Flowchart for Non-Invasive Blood Pressure Measurement

Algorithm of the auscultatory method:

1. Relaxed and rested for 5-10 minutes, the patient is placed on a chair with a back.
2. The patient's hand lies freely on a flat surface.
3. The forearm is freed from foreign objects and clothing.
4. The cuff is applied over the elbow bend with the tubes down.
5. The phonendoscope membrane is tightly applied to the inner side of the elbow bend.
6. The valves on the pear are closed.
7. Inflate the cuff with air, squeezing the pear until the arrow on the pressure gauge reaches 200-220 mm Hg. (in some cases - up to 300).
8. Slowly release the air by opening the valve.
9. The purpose of listening is to notice the pulsation that has begun.
10. The beginning of listening to beats is the value of systolic pressure.
11. The lower pressure is recorded when the heart rhythm through the phonendoscope is no longer audible.
12. Next, the air is completely released from the cuff.
13. If necessary, repeat all over again after 10-15 minutes.

The preferred position for measuring pressure is sitting, but it is possible to measure lying down if the person's arm is along the body at the same level as the heart muscle.

Before measuring, carefully read the instructions for using the tonometer.

To measure blood pressure with an electronic tonometer, the principle of operation and the algorithm for preparing for manipulation are the same as with a mechanical device. It is important to put on the cuff correctly - the bottom edge should be located 2 fingers above the elbow bend. During the measurement, it is better to keep mobile phones and other electronics away from the automatic device. It is strictly forbidden to move and talk (the results will be greatly distorted). It is better to take measurements on both hands several times. The technique for measuring blood pressure on the wrist differs in the location of the cuff (at a distance of 1 finger from the hand). The palm of the examined hand must be placed on the shoulder of the other hand, the hand of which, after pressing the start button, is placed under the elbow of the examined.

Equipment: tonometer, phonendoscope, guard temperature sheet, pen.

Algorithm for performing manipulation:

1. Establish a trusting relationship with the patient, explain the purpose and course of the manipulation, obtain his consent.

2. Wash, dry your hands.

3. Prepare everything you need.

4.Sit the patient to the table or give a comfortable position, lying on his back.

5. Place the patient's arm in an extended position, palm up.

6. Place the hand of his free hand clenched into a fist or a towel rolled into a roller under the elbow.

7. Release the patient's shoulder from the clothing sleeve.

8. Place the cuff of the tonometer on the bare shoulder 2-3 cm above the elbow (at the level of the heart) so that 1-2 fingers pass between it and the shoulder.

9. Point the cuff tubes down.

10. Check the position of the arrow of the tonometer (should coincide with the "0" mark), place it at eye level.

1. Palpate the pulse in the cubital fossa on the brachial or radial artery.

12. Attach a phonendoscope to the site of arterial pulsation, pressing lightly.

13. Close the valve on the pear-shaped balloon of the tonometer.

14. Inject air into the cuff (squeezing the pear-shaped balloon) until the pressure in the cuff, according to the pressure gauge, does not exceed 20-30 mm. rt. Art. the level at which the pulsation of the artery ceases to be determined (listened to).

15. Open the valve of the pear-shaped balloon and at a constant speed of 2-3 mm Hg. st let out air from the cuff, at the same time listen to Korotkov's tones (noises) with a phonendoscope.

16. Note the readings of the manometer at the time of the appearance of the first consecutive tones - this corresponds to the value of systolic blood pressure.

18. Note the moment of disappearance (and not their muting) of Korotkov's tones - this corresponds to the value of diastolic blood pressure.

19. Release air from the cuff, listening to Korotkoff's tones, to the level of pressure in the cuff equal to "0".

20. Allow the patient to rest for 1-2 minutes.

21. Measure blood pressure again.

22. Remove the cuff, give the patient a comfortable position (sitting or lying down).

23. Write down the data obtained in the sentry temperature sheet (fraction), inform the patient.

24. Wash, dry hands.

Blood pressure (BP) indicators play an important role in diagnosing pathologies of the heart muscle, vascular system, and the degree of their damage. Timely detection of diseases helps to prevent disability, disability, the development of complications, irreparable consequences, and death. Patients at risk may benefit from information on how to measure blood pressure correctly and what factors contribute to inaccurate results.

Methods for measuring blood pressure indicators

Examination of the condition of patients with pathologies of the heart and vascular system includes regular, systematic measurement of blood pressure. Its indicators allow doctors to prevent acute diseases and prescribe effective treatment for diseases. A single determination of indicators of systolic, diastolic blood pressure cannot reflect the real clinical picture of the patient's condition and reflects the situation only in a certain period. To examine the work of the heart muscle and circulatory system, different measurement methods are used. These include:

• Palpation measurement of blood pressure, which is based on the use of a pneumatic cuff and the determination of pulse beats after pressing the fingers of the radial artery. The mark on the manometer at the first and last pulsating contraction of the blood vessel will indicate the value of the upper and. The method is often used to examine young children in whom it is difficult to determine blood pressure, which reflects the state of blood vessels, the work of the heart muscle.
• The auscultatory method of measuring blood pressure is based on the use of a simple device consisting of a cuff, a manometer, a phonendoscope, a pear-shaped balloon to create compression of the artery by injecting air. Indicators of the process of squeezing the walls of arteries and veins under the influence of obstructed blood circulation are determined by characteristic sounds. They appear during decompression after the release of air from the cuff. The mechanism for measuring blood pressure by the auscultatory method is as follows:

1. Placing the cuff in the shoulder area and forcing air masses leads to pinching of the artery.
2. During the subsequent release of air, the external pressure decreases, and the possibility of normal transport of blood through the squeezed portion of the vessel is restored.
3. Emerging noises, called Korotkoff's tones, accompany the turbulent movement of plasma with suspended leukocytes, erythrocytes, and platelets. They are easily heard with a phonendoscope.
4. The reading of the pressure gauge at the time of their appearance will indicate the value of the upper pressure. With the disappearance of noises characteristic of turbulent blood flow, the value of diastolic blood pressure is determined. This moment indicates the alignment of the values ​​of external and arterial pressure.

• The oscillometric method is popular for determining an important indicator of the state of the circulatory system and human health in general. It provides for the use of semi-automatic, automatic blood pressure monitors and is widely used by people without medical education.

The principle of the method of arterial oscillography is based on recording changes in tissue volume under conditions of dosed compression and decompression of the vessel, due to the presence of an increased amount of blood during the period of a pulse impulse. To obtain compression, the cuff located in the shoulder area is filled with air automatically or by injecting air masses with a pear-shaped balloon. The decompression process, which begins after the release of air, leads to a change in the volume of the limb. Such moments are invisible to the eyes of others.

The inner surface of the cuff is a kind of sensor and recorder of these changes. The information is transmitted to the device and after processing the analog-to-digital converter, numbers are displayed on the screen of the tonometer. They indicate the value of the upper and lower blood pressure. At the same time, the pulse is recorded. The results of its measurement are also visible on the display of the device.

Among the advantageous characteristics of this method of measuring blood pressure, it is necessary to note the simplicity, convenience of conducting an examination, the possibility of self-determination of blood pressure at the workplace, at home, with weak tones, the absence of dependence of the accuracy of the results on the human factor, the need for special skills or training.

• Carrying out daily monitoring of blood pressure (ABPM) refers to functional diagnostic measures that provide an opportunity to assess the functioning of the cardiovascular system in vivo, outside the doctor's office. The procedure involves multiple measurement of pressure during the day using a special device. It consists of a cuff, a connecting tube and a device that records the results of upper and lower pressure, reflecting the state of the blood vessels, the work of the heart muscle. Their determination is carried out every 15 minutes during the day and 30 minutes at night. The case on the harness allows you to conveniently position the device on the patient's shoulder or waist.

The patient during the daily monitoring of blood pressure should record all his actions, including eating and taking medications, driving, moderate physical activity when doing household chores, climbing stairs, emotional stress, the appearance of unpleasant symptoms, and discomfort.

A day later, the device is removed in the doctor's office, who knows how to measure pressure and get accurate results, and transferred for data processing. After decoding the results, the patient and the attending physician receive reliable information about changes in systolic, diastolic pressure during the day and the factors that caused them. Conducting ABPM allows you to determine the effectiveness of drug therapy, the permissible level of physical activity, and prevent the development of hypertension.

Indicators of norm and deviation

Normal blood pressure values ​​(units of measurement - millimeters of mercury) are individual in nature and are within the digits 120/80. The age of the patient plays a decisive role in lowering or increasing the force of blood pressure. Changes within the body affect the readings of blood pressure, the measurements of which are a mandatory diagnostic procedure that allows you to identify pathologies in the work of the heart muscle and vascular system. Indications of normal and pathological values ​​of blood pressure, reflecting the state of blood vessels, the work of the heart muscle can be seen in the table:

Deviations from such norms in the direction of increase or decrease indicate the need to identify the causes of the pathological state of the heart muscle, vascular system and determine ways to eliminate them.

Content

As long as the parameters of blood pressure are within the normal range, a person does not think about health problems. But as soon as the indicators deviate from the norm, dizziness sets in, and the disease progresses. How to measure pressure with a tonometer to get the correct result? Let's try to figure it out together.

Why measure blood pressure

BP is an important indicator of the functioning of the cardiovascular system, different for each category - it differs in children, in the elderly, in pregnant women. If a person is healthy, then blood pressure indicators are always approximately the same, but an unhealthy lifestyle, stressful situations, fatigue and many other external factors change his indicators. As a rule, they change slightly during the day. If pressure surges do not exceed 10 mm for diastolic (lower), 20 mm for systolic (upper), this is considered normal.

Blood pressure is measured in order to reduce high or raise low values ​​in time. It must be understood that persistent changes in blood pressure that go beyond the normal range may indicate diseases, for example, they occur with cardioarrhythmia. Persistently low or persistently high blood pressure should be treated by a specialist. Hypertension can be hidden behind pressure violations, and behind it is hypertension with its terrible consequences. Therefore, it is so important to learn how to independently take measurements for people with problematic blood pressure.

What is blood pressure measured in

If a person is faced with the definition of his pressure for the first time, he may not know how to use an automatic device, and what the mysterious letters “mm Hg” mean. st. Meanwhile, these are millimeters of mercury in which blood pressure is measured. The device was invented several decades ago, but it is still relevant today. The device operates very simply. Under the influence of the force of blood pressure, the mercury column in it is released or rises, showing the unit of pressure in millimeters.

Algorithm for measuring blood pressure

If after measurement the result turned out to be above the norm, do not panic. For accuracy, the pressure should be measured three times: the second time - after 20 minutes, the third - after 3 hours. In addition, in order to get the most truthful results, you will have to follow a certain pressure measurement algorithm:

• You should measure in a comfortable position: sitting and placing your hand on the table with your palm up.
• Place the elbow so that it is at the level of the heart.
• Wrap the cuff around the arm 3 cm above the elbow.
• To correctly determine the pressure, you can not speak during the procedure.
• After 5 minutes, you need to measure the pressure again.
• To avoid errors will allow the measurement of blood pressure on both hands.
• To track the dynamics, you need to measure blood pressure before meals three times a day.

Technique for measuring blood pressure

Measurement of pressure in a person should occur according to a specific plan. Measurement accuracy is guaranteed by the following actions:

• It should be measured 2 hours after eating to eliminate the error.
• Do not smoke, drink alcohol or coffee before the procedure.
• Do not use nasal or eye vasoconstrictor drops.
• You should not work physically or play sports before this.

Measurement of pressure on the legs

Measurement of pressure on the legs is carried out in patients with functional tests. Regardless of the position of the person, the forearm of the hand and the apparatus are placed at the same level. Air is forced into the cuff quickly, until the pulse on the radial artery disappears. The phonendoscope is placed at the pulsation point of the artery, after which air is released. This must be done slowly. The appearance of pulse beats will be systolic pressure, the point of disappearance of beats will be diastolic. As you can see, measuring blood pressure without the help of a specialist is very simple.

Lying pressure measurement

Measurement of pressure lying down should be done correctly. The arm should lie along the body and be raised to the middle of the chest. For this purpose, it is necessary to put a small pillow under the shoulder and elbow. It is required to measure the indicators three times, so each subsequent measurement is carried out in a different position of the body. The interval between procedures is 5-10 minutes. At this time, the cuff on the arm is loosened.

Rules for measuring blood pressure

There are certain rules for measuring pressure that allow you to track the daily state of human blood pressure. They give more accurate readings. What can not be done before the measurement procedure, we have already written above. The first time you need to measure in the morning, an hour after waking up. The second time - an hour after lunch. The third - in the evening, if necessary, if there is weakness, headache or other ailment.

Blood pressure monitors

There are three types of blood pressure measurement methods. Indirect method - mechanical technique according to Korotkov. It is also called the auscultatory method. Measurement is carried out by means of a manometer, a cuff with a pear and a phonendoscope. Another sister method is oscillometric. It involves the use of electronic tonometers. The third is an invasive method, carried out by catheterization of one of the arteries, followed by connection to the measuring system. It is used by doctors for major surgical interventions.

How to measure pressure correctly

The correct measurement of blood pressure is carried out strictly according to the above rules. However, often when blood pressure is measured by a doctor, the values ​​\u200b\u200bare often higher by 20-40 mm Hg. Art. This is due to the stress that the body receives when measuring by a nurse. In some patients, this is also observed with home measurement. For this reason, it is recommended to carry out repeated measurements at intervals of several minutes.

How to measure blood pressure with an electronic sphygmomanometer

Measurement of pressure with a tonometer is carried out according to a certain scenario. An electronic device must be used according to the instructions, and a child can handle it. It is important to properly wear the sleeve - cuff. It should be placed 3 cm above the elbow at the level of the heart. The rest of the automatic device will do itself. When the measurement is completed, the results will appear on the screen. Improved devices remember previous indicators, which helps to compare the dynamics of changes in blood pressure.

How to measure blood pressure with a manual sphygmomanometer

A mechanical blood pressure monitor requires little effort and is easy to perform at home. It is necessary to put on the cuff, pump air into it using a pear-shaped pump, squeezing and unclenching it in your hand. The device should show 40 mm Hg. Art. above the expected result. Slowly deflate the cuff and blood flow through the artery will be restored. Write the results on a piece of paper with a fraction, and after 15-20 minutes repeat the procedure and compare. That's all, you know how to measure blood pressure correctly.

Many patients complain about their automatic devices, believing that they give incorrect readings. However, according to experts, the problem lies not in blood pressure monitors, but in the correctness of measuring blood pressure, which is why it is so important to start preparing for the procedure in a few hours. You need to calm down and do everything strictly according to the instructions. Doctors recommend purchasing an omron or other brand of semi-automatic device for home use with a cuff on the shoulder, and not on the wrist. The cuff must be tried on before buying.

Discuss

Blood pressure measurement - algorithm of actions. Blood Pressure Monitors and Procedure Technique