A prevalência da hipertensão arterial aumenta a cada ano, é uma doença silenciosa, influenciada por fatores de risco, alguns decorrentes de hábitos e estilo de vida. Ao considerar a atual proposta mundial de tornar o paciente agente do seu próprio cuidado, participando a família do seu processo saúde-doença, faz-se necessário considerar esse contexto para propor estratégias de baixo custo, que contribuam para a redução dos valores de pressão arterial. O objetivo deste estudo foi avaliar o efeito da associação entre MRPA e intervenção de ensino (IE) na redução dos valores de pressão arterial. Foi realizado estudo piloto, para identificar as dificuldades e facilitar a operacionalização da coleta de dados, assim como propor estratégias para a melhor execução do planejamento do estudo. Foi realizado estudo clínico randomizado e definiu-se como variáveis a serem estudadas: \"MRPA\", \"IE\" e \"MRPA+IE\". A pressão arterial (PA) foi aferida antes e pós as intervenções. O fato de que todas as comparações realizadas no estudo não apontaram diferenças entre o grupo que participou da pesquisa e o que tendo recusado, teve suas características anotadas, foi o principal resultado. E quando comparou-se a magnitude do efeito da intervenção entre os grupos que receberam a associação das intervenções (grupo 1) e o grupo 2, que recebeu somente a intervenção de ensino, evidenciou-se uma diferença (p = 0,0155) entre eles, o que mostra que o grupo 1 teve uma melhora nos valores de pressão arterial sistólica (PAS) enquanto que no grupo 2 foi observado uma piora nos valores de PAS. O grupo 1 teve uma melhora nos valores de PAS enquanto que no grupo 4, novamente foi observado uma piora nestes valores (p = 0,0040). O grupo 1 foi o único que apresentou redução dos valores de PA tanto na PAS quanto na pressão arterial diastólica (PAD). Assim a associação da MRPA com uma IE sobre a doença hipertensão arterial sistêmica (HAS) é recomendada, pois resultou em consequências positivas na implementação de cuidados de saúde, o que leva a crer ser uma adequada estratégia para redução dos valores de PA em pessoas com HAS em tratamento. Essa sugestão é baseada na análise do efeito e da efetividade das intervenções apresentadas nesse estudo, que evidenciou redução nos valores de PAS e PAD quando aplicada a associação das duas intervenções propostas nesse estudo onde os resultados se diferenciaram significativamente do grupo controle, o qual não sofreu nenhuma intervenção. Tais resultados permitem afirmar que a MRPA associada à IE reduz os valores de PA e que tal associação, poderá contribuir sobremaneira para a melhoria do controle dos valores de PA entre indivíduos com hipertensão arterial em tratamento nas ESF / The prevalence of hypertension is increasing every year , and know that it is a silent disease , influenced by habits and lifestyle . Considering the new global proposal to make the patient agent of their own care, attending to your family health-disease process , it is necessary to propose low-cost strategies that contribute to the reduction of blood pressure values . The aim of this study was to evaluate the association between HBPM and teaching intervention in reducing blood pressure levels . Pilot study , where it was possible to identify the difficulties in the operationalization of data collection and propose strategies for the implementation of the project was conducted . In the methodology it was decided to conduct a randomized clinical trial . We defined the variables to be studied : \" HBP \" , \" EI \" and \" HBP + EI \" , which will be the interventions of the study . The PA variable was measured before and after the interventions . The main result of the fact that all comparisons showed no differences between the group that participated in the survey and who has refused , had noted its features appear . And when we compare the magnitude of the effect of the intervention between the groups who received the combination of interventions (group 1 ) and group 2 , which received only the educational intervention , we observed a difference ( p = 0.0155 ) between them , showing that the group 1 had an improvement in SBP while in group 2 a worsening was observed in these values . When the magnitude of the effect of the intervention compared between groups and 1 control group ( 4 ) evidenced a difference ( p = 0.0040 ) between them , showing that group 1 had an improvement in SBP while in group 4 , was again observed a worsening in these values . Group 1 was the only one that showed a reduction in BP values in both SBP and DBP . Association of HBPM with IE on the disease , its consequences and health care as a strategy for reducing the pressure values is recommended. This suggestion is based on analysis of the effect and effectiveness of interventions presented in this study, which showed a reduction in SBP and DBP when applied to combination of both interventions proposed in this study where the results differed significantly from the control group, which did not suffer no intervention. These results allow us to affirm that HBPM associated with IE reduces the values of PA and that this association may contribute greatly to improving the control of blood pressure values among individuals with hypertension in treatment in the FHS

Orientador: José Luiz Tatagiba Lamas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T09:28:07Z (GMT). No. of bitstreams: 1 Ribeiro_CristianeCrispMartins_M.pdf: 1660243 bytes, checksum: b1c293fa846917ea92dcae35dc10c534 (MD5) Previous issue date: 2014 / Resumo: As síndromes hipertensivas específicas da gestação são uma das mais importantes causas de mortalidade materna e perinatal no Brasil e no mundo. Surgem, geralmente, após a 20ª semana de gestação e se caracterizam por hipertensão arterial e proteinúria, sendo esta condição denominada de pré-eclâmpsia, e na ocorrência de crise convulsiva, eclâmpsia. Medir a pressão, entretanto, a despeito de sua grande utilidade para o diagnóstico de hipertensão, pode resultar em conclusões inapropriadas se normas técnicas básicas e indispensáveis não forem obedecidas. Este estudo teve como objetivo comparar as medidas da pressão arterial na posição sentada e em decúbito lateral esquerdo, em ambos os braços, de gestantes normotensas do último trimestre. Trata-se de um estudo transversal, cuja amostra foi composta por 70 gestantes, com idade média de 25 anos, em acompanhamento pré-natal em uma Unidade Básica de Saúde, e com idade gestacional entre 28 e 39,5 semanas. Foram realizadas medidas de pressão arterial em ambas as posições e braços utilizando-se manômetro de mercúrio. Os dados foram analisados por meio de análise estatística descritiva e inferencial e para as comprarações entre as posições e braços, foram propostos modelos lineares de efeitos mistos. Os resultados mostraram diferenças estatisticamentes significativas (p< 0,05) para as comparações entre o mesmo braço em posições diferentes (sentado e lateral esquerdo), e entre os braços no decúbito lateral esquerdo. Em decúbito lateral esquerdo a pressão foi maior quando medida no braço esquerdo. Além disso, a variação da pressão arterial na posição sentada para o decúbito lateral esquerdo foi maior no braço direito em relação ao esquerdo. Conclui-se que, em decúbito lateral esquerdo, a pressão arterial de gestantes do último trimestre apresenta valores menores para o braço direito e que o braço esquerdo apresenta valores mais próximos aos obtidos na posição sentada / Abstract: The hypertensive disorders originated from pregnancy are one of the leading causes of mother and preborn mortality in Brazil and worldwide. Usually, arise after the 20th week of pregnancy and are characterized by arterial hypertension and proteinuria, being this condition defined as pre-eclampsia or eclampsia, in the appearance of seizures. Blood pressure measurement is the most important way of hypertension diagnosis, however, it can lead to inadequate conclusions if essential technical standards are not followed. This study is aimed on comparing the blood pressure measures in the sitting position and in the left lateral recumbent position, on both arms for normotensive pregnant women in the last trimester of pregnancy. This is a cross-sectional study, which samples consisted of 70 pregnant women averaging the age of 25, with gestational age between 28 and 39.5 weeks, receiving prenatal care in a public health service. Blood pressure was measured on both arms and positions using a mercury manometer. The data were analyzed by using descriptive and inferential statistical analysis and for the comparison between positions and arms, linear mixed-effects models were used. The results showed statistically significant differences (p < 0.05) for comparisons between the same arm in different positions (sitting and left lateral recumbent), and between both arms in the left lateral recumbent position. In the left lateral recumbent position the blood pressure was higher when measured in the left arm. Furthermore, the blood pressure variation for the sitting position to left lateral recumbent position was higher on the right arm than on the left. It was concluded that, in the left lateral recumbent, the blood pressure for normotensive pregnant women on their last trimester present lower values for the right arm and that the left arm present similar values to the one that was produced on the sitting position / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde

Direct measurement of blood pressure using a fluid-filled catheter and an electromechanical transducer is widely accepted in clinical practice. However, errors associated with the measurement are often not appreciated and these catheter-manometer systems are frequently unable to accurately reproduce applied pressures. To assess the accuracy of catheter-manometer systems used for invasive arterial blood pressure measurements, in vitro and in vivo evaluations were performed. The frequency response (described in terms of damped natural frequency and damping factor) for a variety of cannulae, pressure tubing and stopcocks (and combinations thereof) and their dependence on various parameters (catheter length, lumen diameter, fluid temperature and catheter material) were measured using an hydraulic pressure generator. The design and construction details of the pressure generator are presented. It was found that the damped natural frequency of the catheter-manometer system is directly proportional to lumen diameter of the pressure tubing/catheter. Furthermore, damping factor is inversely related to the damped natural frequency and stiffer catheter material (for identical radius ratios) results in higher damped natural frequency. Catheter length is inversely related to damped natural frequency and the resonant frequency decreases for an increase in fluid operating temperature. It was established that all catheter-manometer systems tested were under-damped (0.15 < β < 0.37) and that the damped natural frequency ranged from 10.5 Hz for 1500 mm to 27.0 Hz for pressure tubing of 300 mm in length. Furthermore, catheter-manometer systems which had pressure tubing in excess of 300 mm in length did not comply with the bandwidth requirements for accurate dynamic blood pressure measurement. For the in vivo assessment of the catheter-manometer system, the blood pressure waveform was analysed in the time and frequency domains. It was established that in 60 percent of the cases, the systolic pressure peak was higher when measured by a narrow bandwidth catheter-manometer system compared to that measured by a wide bandwidth system. Furthermore, values of dp/dt maximum were lower for wide bandwidth catheter-manometer systems than those measured by narrow bandwidth systems for heart rates above 90 beats per minute. In the frequency domain analysis, artifact was sometimes found to occur at frequencies higher than the bandwidth of the catheter-manometer system. This high frequency artifact was found to distort the blood pressure waveform and resulted in false high dp/dt and peak systolic pressures.

L'hypertension artérielle (HTA) est un problème de santé sérieux qui affecte 22% des canadiens et dont les complications sont nombreuses. Ces complications peuvent être diminuées par un diagnostic précoce et un traitement efficace et plusieurs auteurs affirment que l'exactitude de la mesure de la pression artérielle (PA) est la pierre angulaire pour établir le diagnostic et assurer un suivi adéquat. Quoique cette mesure soit réalisée très fréquemment, des études réalisées ailleurs qu'au Québec indiquent que les connaissances des infirmières à l'égard de la mesure de la PA sont insuffisantes pour des éléments reconnus comme ayant une influence significative sur les résultats de la mesure de la PA. À notre connaissance, aucune étude concernant les connaissances des infirmières n'a été publiée au Canada. Cette étude a donc pour but de décrire les connaissances théoriques et pratiques des infirmières pour la mesure de la PA en regard des recommandations du Programme éducatif canadien pour le contrôle de l'hypertension artérielle (2004) et comparer les relations entre ces variables. Une enquête par questionnaire auto administré pour décrire les connaissances théoriques ainsi qu'une observation directe par échantillonnage exhaustif pour décrire les connaissances pratiques ont été utilisées pour un premier échantillon de 50 infirmières. Une enquête postale transversale par échantillonnage aléatoire a été utilisée pour décrire les connaissances théoriques auprès d'un deuxième échantillon de 307 infirmières. Les outils ont été testés pour leur validité et leur fidélité dans le cadre de cette étude. L'étude a été approuvée par le comité d'éthique du centre de recherche clinique du CHUS. Les résultats quant aux données sociodémographiques démontrent que les infirmières ayant participé à l'une ou l'autre partie de l'étude sont semblables aux autres infirmières du Québec à l'égard du genre, de l'âge, du type d'emploi et de l'expérience. Elles sont toutefois statistiquement différentes pour le niveau de formation. Le score obtenu par les infirmières des deux échantillons pour le questionnaire sur les connaissances théoriques est de moins de 60%. On peut donc conclure qu'il existe des lacunes importantes en regard des connaissances théoriques acquises. Par ailleurs, ces infirmières croient dans de très fortes proportions posséder les connaissances théoriques et pratiques nécessaires à une mesure exacte de la PA. Pour les connaissances pratiques, le score global des infirmières est de 38%. Force est de croire que malgré le processus de mise à jour annuel et d'implantation des recommandations canadiennes, les connaissances pratiques des infirmières ne sont pas équivalentes au contenu de ces recommandations. Les infirmières qui détiennent un niveau de formation supérieur, celles qui ont lu les recommandations et celles qui ont suivi une formation continue sur la mesure de la PA obtiennent de résultats légèrement supérieurs aux autres infirmières. Considérant la fréquence avec laquelle les infirmières mesurent la PA et l'impact que peut avoir une mesure inexacte, il est important d'entreprendre dès maintenant des actions concrètes pour améliorer cette situation en mettant en place des formations continues régulières sur le sujet et en s'assurant que les programmes de formation initiale incluent une formation théorique et pratique fondée sur les recommandations en vigueur. Il semble également crucial de stimuler l'implantation des recommandations du PECH auprès des infirmières et d'évaluer l'impact de ces mesures par la suite.

A medida da pressão arterial é um procedimento simples e imprescindível na avaliação do sistema cardiovascular, porém sua realização sofre influências de diversos fatores que podem comprometer os valores obtidos. As estratégias de ensino da técnica de medida da pressão arterial utilizam as aulas expositivas e filmes de treinamento, porém o ambiente digital ainda não foi explorado. O ambiente digital de aprendizagem tem-se constituído em uma poderosa ferramenta do processo de ensino aprendizagem, pois acrescenta significado e concretude aos conteúdos que precisam ser aprendidos. A graduação em enfermagem tem sido beneficiada pelo uso da tecnologia de informação no ensino de seus procedimentos e técnicas, embora as iniciativas nesta área sejam ainda incipientes. O objetivo deste trabalho foi construir uma hipermídia educacional para o ensino da técnica de medida da pressão arterial para graduandos de enfermagem e descrever as etapas do processo de construção. O referencial pedagógico adotado para nortear a elaboração do conteúdo foi de Robert Gagné, e seguiu-se o modelo em três fases proposto por Price para a construção da hipermídia. O produto final contou com quatro tópicos, agrupando 12 módulos, no qual se apresenta todas as questões que envolvem a realização do procedimento de medida da pressão arterial, discorrendo sobre aspectos fisiológicos, métodos e técnica de medida. A hipermídia utiliza os recursos de áudio, vídeo, animações bidimensionais, fotos, ilustrações e simulações. A avaliação foi realizada simultaneamente por três grupos de juízes técnicos em informática; docentes de enfermagem e profissionais da saúde; e por alunos de graduação em enfermagem, utilizando instrumentos de avaliação específicos para cada grupo. Estas avaliações foram analisadas separadamente, os resultados apresentaram semelhanças entre os grupos que se detiveram em questões organizacionais, estéticas e informacionais. De maneira geral, os grupos avaliaram bem a hipermídia, com comentários positivos a respeito da estratégia e da qualidade final do ambiente desenvolvido. O uso da hipermídia e do ambiente digital de aprendizagem pode representar uma importante estratégia para o ensino da enfermagem, porém o desenvolvimento de ferramentas educacionais adequadas a este ambiente é um campo novo em franca expansão que necessita de avaliação e adequação periódicas / Arterial blood pressure measurement is a simple and essential conduct to evaluate the condition of the cardiovascular system; however, it is afected by several factors that can change the obtained results. Lectures and training movies are used as teaching strategies of blood pressure measurement technique, but digital environment has not been explored so far. Digital teaching environment is a powerful tool for the teaching-learning process, because it adds meaning and concreteness to the subjects to be learned. The use of information technology in the teaching of nursing procedures and techniques has benefit Nursing Undergraduate courses, although the iniciatives in this area are still incipients. This work intended to build an educational hypermedia to the arterial blood pressure measurement teaching for undergraduate nursing students, and to describe the steps of the building process. The development of the content used a pedagogical reference by Robert Gagné as guidance, and followed the three-phase model proposed by Price for the hypermedia construction. The final product has 12 modules within 4 topics, and presents all questions concerning the procedure to the arterial blood pressure measurement, considering methods, measurement technique and physiological aspects. Hypermedia uses resources as audio, video, two-dimensional animations, photos, pictures and simulations. The evaluation was made simultaneously by three groups of judges: computer science technicians; teachers of nursing and health professionals´ courses, and nursing undergraduate students, using specific evaluation tools for each group. The evaluations were analysed on an individual basis; the results showed some similarities, mainly in organizational, aesthetical and informational issues. On the whole, the groups made an approving evaluation of the hypermedia, with positive comments about the strategy and final quality of the developed environment. The use of hypermedia and digital learning environment can represent an important strategy to nursing teaching; however, the development of teaching tools that are suitable to this environment is a new and expanding field that requires periodical evaluation and adjustments

Xiang Xiaoyan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references. / Abstracts in English and Chinese. / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background of Hypertension --- p.1 / Chapter 1.1.1 --- Definition of Blood Pressure --- p.1 / Chapter 1.1.2 --- Hypertension and Its Prevalence --- p.2 / Chapter 1.2 --- Blood Pressure Measurement Techniques --- p.5 / Chapter 1.2.1 --- Invasive Blood Pressure Measurement Techniques --- p.5 / Chapter 1.2.2 --- Non-invasive Blood Pressure Measurement Techniques --- p.6 / Chapter 1.3 --- Accurate BP Measurements --- p.12 / Chapter 1.3.1 --- Error Source for BP Measurement by Conventional Techniques --- p.12 / Chapter 1.3.2 --- Accurate BP Measurement --- p.13 / Chapter 1.4 --- Objectives of the Thesis --- p.15 / Chapter 1.5 --- Organization of the Thesis --- p.16 / References --- p.17 / Chapter Chapter 2 --- Current Standards for the Conventional Blood Pressure Measurement Devices --- p.20 / Chapter 2.1 --- Introduction --- p.20 / Chapter 2.2 --- Current Standards for the Cuff-based BP Measurement Devices --- p.21 / Chapter 2.2.1 --- AAMI Standard --- p.21 / Chapter 2.2.2 --- BHS Protocol --- p.22 / Chapter 2.2.3 --- Other Protocols --- p.23 / Chapter 2.3 --- Comparison of the 2002 AAMI and 1993 BHS Protocols - Protocol Setup --- p.25 / Chapter 2.4 --- Comparison of the 2002 AAMI and 1993 BHS Protocols 一 Accuracy Criteria --- p.29 / Chapter 2.5 --- Relationship between the AAMI Accuracy Criteria and the BHS Grading System --- p.31 / Chapter 2.5.1 --- Theoretical Mapping Relationship --- p.31 / Chapter 2.5.2 --- Application of the Mapping Model: Estimate the BHS Grades from the Reported Sample ME and SD --- p.34 / Chapter 2.5.3 --- Application of the Mapping Model: Explain the Evaluation of the Results from the Clinical Survey by the ESH --- p.36 / Chapter 2.6 --- Discussion --- p.36 / References --- p.40 / Chapter Chapter 3 --- Distribution Analysis of the Blood Pressure Measurement Errors --- p.42 / Chapter 3.1 --- Introduction --- p.42 / Chapter 3.2 --- Error Distribution Estimated from the Published Data --- p.43 / Chapter 3.2.1 --- Methodology --- p.43 / Chapter 3.2.2 --- Data Analysis --- p.44 / Chapter 3.2.3 --- Session Summary --- p.46 / Chapter 3.3 --- Error Distribution Estimated from the Experimental Data --- p.46 / Chapter 3.3.1 --- BP Measurement Error Obtained from Automatic BP Meter --- p.46 / Chapter 3.3.2 --- Distribution Analysis by the Normal Quantile-Quantile Plot --- p.47 / Chapter 3.3.3 --- Background of Student's t Distribution --- p.48 / Chapter 3.3.4 --- Parameter Estimation - Maximum Likelihood Method --- p.50 / Chapter 3.3.5 --- Goodness-of-fit Test - Kolmogorov-Smirnov Test --- p.53 / Chapter 3.3.6 --- Goodness-of-fit Test ´ؤ Chi-Square Test --- p.56 / Chapter 3.4 --- Discussion --- p.63 / References --- p.65 / Chapter Chapter 4 --- A Model Based Study of the Parameters Used by Existing Standards --- p.67 / Chapter 4.1 --- Introduction --- p.67 / Chapter 4.2 --- Background of Method Comparison Study --- p.68 / Chapter 4.2.1 --- Four Areas in Method Comparison Study --- p.68 / Chapter 4.2.2 --- Analysis of Previous Methodology and Statistical Parameters --- p.70 / Chapter 4.3 --- Theoretical Mapping Relationship: Based on the General t Distribution --- p.72 / Chapter 4.3.1 --- "Relationship among CP5, CP10 and CP15 in Each Grade for the 1993 BHS Protocol" --- p.76 / Chapter 4.3.2 --- Relationships between the Criteria in Each Grade for the 1993 BHS Protocol and the AAMI Standard --- p.77 / Chapter 4.3.3 --- Comparison of Parameters --- p.80 / Chapter 4.4 --- Mean of the Absolute Errors (MAE) and Its Estimation --- p.81 / Chapter 4.4.1 --- The Relationship between MAE and Other Parameters --- p.81 / Chapter 4.4.2 --- Analysis of the Example Data --- p.84 / Chapter 4.4.3 --- Estimation of MAEt --- p.84 / Chapter 4.5 --- Discussion --- p.88 / References --- p.90 / Chapter Chapter 5 --- Experimental Study and an Evaluation Protocol Proposed for the Wearable BP Measurement Devices --- p.92 / Chapter 5.1 --- Introduction --- p.92 / Chapter 5.2 --- Description of the Experiment --- p.93 / Chapter 5.3 --- Data Analysis --- p.95 / Chapter 5.3.1 --- Data Used for the Study --- p.95 / Chapter 5.3.2 --- Error Distribution Analysis --- p.96 / Chapter 5.3.3 --- Evaluation of the Automatic BP Meter and the PTT-Based BP Measurement Device by AAMI and 1993 BHS Standards --- p.99 / Chapter 5.3.4 --- Evaluation the Automatic BP Meter and the PTT-Based BP Measurement Device by the Proposed Parameter --- p.101 / Chapter 5.4 --- Proposed Evaluation Procedure --- p.101 / Chapter 5.4.1 --- Introduction --- p.101 / Chapter 5.4.2 --- Determination of Parameters and Criteria --- p.102 / Chapter 5.4.3 --- Proposed Evaluation Procedure --- p.103 / Chapter 5.5 --- Discussion --- p.105 / References --- p.108 / Chapter Chapter 6 --- Conclusion and Future Work --- p.110 / Chapter 6.1 --- Conclusion and Major Contributions --- p.110 / Chapter 6.2 --- Future Works --- p.113 / References --- p.115 / Appendix A Deviation of Some Equations --- p.116 / Chapter A.1 --- CP for Certain Limit of L as a Function of ME and SD --- p.116 / Chapter A.2 --- MAE as a Function of Location and Scale Parameters --- p.119 / Chapter A.3 --- "Relationship between ME, MAE and Root Mean Squared Error (RMSE) if the error distribution is unknown" --- p.121 / Appendix B List of Publications and Awards Related to This Study --- p.123

心血管疾病持續成為世界上第一大死亡原因。在眾多危險因素中，動脈血壓，尤其是夜間血壓和血壓變化率，是心血管疾病發病率和死亡率的關鍵指標。 / 由於需要用到充氣式袖帶，現有的血壓測量技術只能提供瞬時血壓，並且使用起來極不舒適。因此，本文致力於研究另一種無袖帶式血壓測量方法。此方法的原理基於血壓波在血管上的傳導速度，即脈搏波傳導速度（PWV）取決於血壓作用下的血管力學特性。因此，血壓可以從脈搏波傳導速度，或者其倒數：脈搏波傳輸時間（PTT）估計得到。由於脈搏波傳導時間可以方便的從心電信號及光電容積描記信號獲取，這種新型的無袖帶式血壓測量技術近年來備受關注。 / 現有的基於脈搏波傳輸時間的血壓估計方法建立於一個被動的，薄壁的和均質的血管模型。但是，真實的血管卻是由彈性蛋白，膠原纖維和平滑肌共同組成的具有特殊層次結構的管道。事實上，以往許多研究已經表明了血管緊張度（VSM tone），即血管壁平滑肌細胞的激活程度，能顯著改變血管力學特性進而使脈搏波傳輸時間與血壓的關係惡化。特別地，血管緊張度主要受控于自主神經系統，尤其是交感神經系統。因此，本論文的目的在於研究自主神經系統對基於脈搏波傳輸時間的血壓估計的影響。 / 首先，基於血管微結構力學模型和Bramwell-Hill公式，本文建立了一個基於血管組分的脈搏波傳輸時間-血壓模型。并在此基礎上，推導出一個融合了血管結構和功能特性的解析數學公式來表徵脈搏波傳導時間和血壓的關係。仿真結果顯示，隨著血管緊張度增高，脈搏波傳輸時間-血壓曲綫會移向右上方，造成滯變現象（hysteresis）。 / 其次，爲了研究自主神經系統對血壓，脈搏波傳輸時間及心率的調節機制，本文利用時頻分析技術，對來自9個健康測試者跑步運動前後的實驗數據進行了分析。結果顯示，僅心率這一參數表現出運動中首先迷走神經活動減弱，然後交感神經增強的機制。此外，分析結果表明脈搏波傳輸時間與血壓的關係是頻率相關的。 / 爲了進一步研究自主神經系統在吞咽動作過程中對心血管參數的調控作用，本文設計了喝水實驗。對32個健康測試者的實驗數據分析結果表明，在喝水過程中，心率和血壓顯著上升，脈搏波傳輸時間顯著下降。另一方面，基於之前脈搏波傳輸時間與血壓的頻變關係的研究發現，本文設計了一種新的基於脈搏波傳輸時間，利用頻段特定的序列技術，來估計壓力反射敏感性（BRS）的新方法，並利用喝水實驗數據進行了驗證。結果顯示，利用此方法估計和利用傳統的利用血壓計算出的壓力反射敏感性具有高相關性（喝水前，中，后過程中，相關係數分別為0.90，0.70和0.81）。 / 最後，爲了驗證自主神經系統調控下的血管緊張度對脈搏波傳輸時間和血壓關係的影響，本文對來自46名測試者，其中包括17名心血管疾病患者，在人體仰臥姿態下的漸進式腳踏車運動實驗中的數據進行了分析。結果證實了仿真實驗中顯示的脈搏波傳輸時間和血壓的滯變現象。另外，本文提出了兩個新型量化指標衡量此滯變現象，即AreaN和ΔSBP20。結果顯示，相比于健康人，心血管疾病患者的滯變現象幅度顯著減弱，這與此類患者通常伴隨有交感神經系統過度活躍相關。基於以上發現，本文進一步提出利用AreaN和ΔSBP20來評估交感神經系統功能的建議。 / 綜上所述，本論文從理論和實驗的雙重角度研究了自主神經系統對脈搏波傳輸時間和血壓關係的影響。此工作將有利於提高基於脈搏波傳輸時間的血壓估計技術的準確度，并進一步對控制心血管疾病做出貢獻。 / Cardiovascular diseases (CVDs) remain the number one cause of death worldwide. Amongst various risk factors, arterial blood pressure (BP), especially BP measured during nighttime, and BP variability are major indicators of cardiovascular morbidity and mortality. / Most of the state-of-the-art BP meters are designed with an inflatable cuff, which provide snapshots of BP and are uncomfortable during measurements. An alternative cuffless BP measurement approach is therefore studied in this work. The estimation principle is derived based on the fact that velocity of a pressure wave propagating along an artery, i.e., pulse wave velocity (PWV) is related to the pressure-dependent mechanical property of the artery. Thus, BP can be possibly estimated from PWV, or its reciprocal, pulse transit time (PTT), which can be conveniently acquired from electrocardiogram and photoplethysmogram without using an inflatable cuff. / The current PTT-based BP estimation was built on a model that assumes the artery to be a passive, thin-wall and homogeneous tube. However, arterial wall in reality exhibits a specific layered structure and consists of elastin, collagen fibers and smooth muscles. In fact, the PTT-BP relationship was found by many studies to be easily deteriorated by vasoconstriction/dilation, which reflects the vascular smooth muscle (VSM) activation level, i.e., VSM tone. In particular, innervating most blood vessels, the autonomic nervous system (ANS), primarily sympathetic nervous system, plays an important role in determining the arterial mechanical behavior thus PTT-BP relationship via regulating the VSM tone. It is therefore the aim of this thesis to investigate the effects of ANS on the PTT-based BP estimation. / Firstly, a constituent-based PTT-BP model was developed in the thesis, based on the micro-structurally motivated arterial mechanical model and Bramwell-Hill equation. Specifically, analytic PTT-BP relationship incorporating arterial structural and functional properties was deduced. Theoretical effects of various arterial properties on the relationship have been evaluated by simulation. The results revealed that PTT-BP curve will shift to the top right when VSM tone elevates, producing PTT-BP hysteresis. / Next, the mechanism of regulation of BP, PTT as well as heart rate (HR) by ANS was evaluated in 9 normotensive subjects in treadmill exercise by using time-frequency technique. Vagal withdrawal and subsequent sympathetic activity enhancement by exercise have been observed in only HR. In addition, the results indicate a frequency-dependent PTT-BP relationship. / Then we conducted water drinking experiments in a total of 32 healthy subjects to investigate the ANS controlled cardiovascular responses by the act of swallowing. Significant increment in HR and BP, and decrease in PTT were observed during drinking. On the other hand, considering the frequency-dependent nature of PTT-BP relationship, a novel method that estimates baroreflex sensitivity (BRS) from PTT based on the band-specified sequence technique has been proposed. The results showed high correlations between BRS estimated from BP and PTT. (γ=0.90, 0.70 and 0.81 before, during and after drinking respectively). / Lastly, the effects of ANS mediated VSM tone on the PTT-BP relationship were validated in 46 subjects including 17 patients with CVDs in graded bicycle exercise stress test in supine position. The results demonstrated PTT-BP hysteresis as predicted by the simulation. Furthermore, two novel parameters, i.e., AreaN and ΔSBP20 were proposed to evaluate the hysteresis phenomenon. Significant attenuation was observed in CVD patients with sympathetic overactivity. The two quantifications were proposed accordingly to be indices for assessing sympathetic function. / To conclude, this work addressed the effects of ANS on the PTT-BP relationship from both theoretical and experimental aspects. The work can help to improve the accuracy of PTT-based BP estimation and CVD control. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Liu, Qing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese. / Abstract --- p.i / Acknowledgement --- p.v / List of figures --- p.vi / List of tables --- p.x / List of abbreviations --- p.xi / Chapter Chapter 1. --- Introduction --- p.1 / Chapter 1.1. --- Current Status of Blood Pressure Management --- p.1 / Prevalence of Cardiovascular Diseases --- p.1 / Healthcare System Transformation --- p.2 / Blood Pressure A Crucial Role in CVD Control --- p.4 / Chapter 1.2. --- Overview of Blood Pressure Measurement Techniques --- p.7 / Chapter 1.3. --- Motivations and Objectives of the Thesis --- p.15 / Chapter 1.4. --- Organization of the Thesis --- p.16 / References: --- p.17 / Chapter Chapter 2. --- Basics of Cardiovascular System, Autonomic Nervous System and PTT-BP Relationship --- p.20 / Chapter 2.1. --- Cardiovascular System --- p.20 / Heart Physiology --- p.20 / Arterial Physiology --- p.24 / Chapter 2.2. --- Autonomic Nervous System --- p.35 / Autonomic Histology and Pharmacology --- p.35 / Autonomic Nervous Control of Cardiovascular System --- p.37 / Assessment of ANS Activity --- p.41 / Chapter 2.3. --- PWV and Its Relationship with BP --- p.43 / Pulse Wave Velocity --- p.44 / PWV-BP Relationship --- p.50 / Chapter 2.4. --- Section Summary --- p.54 / References: --- p.55 / Chapter Chapter 3. --- A Model-based Study on the Effects of Arterial Properties on the Relationship between Pulse Transit Time and Blood Pressure --- p.62 / Chapter 3.1. --- Introduction to Constitutive Modeling of Arteries --- p.62 / Experimental Methods --- p.63 / Modeling of Mechanical Behavior: Pressure-Radius Relationship --- p.64 / Chapter 3.2. --- A Novel Constitutive Model of the Relationship between PTT and BP --- p.76 / Chapter 3.3. --- Simulation Study of Effects of Arterial Properties on the PTT-BP Relationship --- p.82 / Chapter 3.4. --- Section Summary --- p.93 / References: --- p.94 / Chapter Chapter 4. --- Evaluation Study on the Autonomic Nervous System Control of Heart Rate, Blood Pressure and Pulse Transit Time Before and After Dynamic Exercise --- p.96 / Chapter 4.1. --- Introduction --- p.96 / Chapter 4.2. --- Methodology --- p.98 / Experiment Protocol --- p.98 / Signal Processing and Spectral Estimation --- p.99 / Chapter 4.3. --- Results --- p.101 / Chapter 4.4. --- Discussion --- p.104 / Chapter 4.5. --- Section Summary --- p.108 / References: --- p.110 / Chapter Chapter 5. --- Investigation on Autonomic Nervous System Control of Heart Rate, Blood Pressure and Pulse Transit Time During Water Drinking --- p.113 / Chapter 5.1. --- Responses of HR, BP and PTT during Water Drinking --- p.113 / Chapter 5.1.1. --- Introduction --- p.113 / Chapter 5.1.2. --- Methodology and Results --- p.115 / Chapter 5.1.3. --- Discussion and Conclusion --- p.118 / Chapter 5.2. --- Potential Application of PTT in Baroreflex Sensitivity Assessment --- p.121 / Chapter 5.2.1. --- Introduction --- p.121 / Chapter 5.2.2. --- Methodology --- p.122 / Chapter 5.2.3. --- Discussion and Conclusion --- p.125 / Chapter 5.3. --- Section Summary --- p.127 / References: --- p.129 / Chapter Chapter 6. --- Experimental Validation of the ANS Effects on the Relationship between Pulse Transit Time and Blood Pressure in Human Stress Test --- p.131 / Chapter 6.1. --- Introduction --- p.131 / Chapter 6.2. --- Methodology --- p.133 / Chapter 6.3. --- Results --- p.137 / Chapter 6.4. --- Discussion and Conclusion --- p.139 / Chapter 6.5. --- Section Summary --- p.144 / References: --- p.145 / Chapter Chapter 7. --- Conclusions and Suggestions for Future Work --- p.148 / Chapter 7.1. --- Summary --- p.148 / Chapter 7.1.1. --- A model-based study on the effects of arterial properties on the PTT-BP relationship --- p.148 / Chapter 7.1.2. --- Evaluation study on the ANS control of HR, BP and PTT before and after dynamic exercise --- p.149 / Chapter 7.1.3. --- Investigation on ANS control of HR, BP and PTT during water drinking --- p.150 / Chapter 7.1.4. --- Experimental validation of the ANS mediated VSM tone on the PTT-BP relationship --- p.151 / Chapter 7.2. --- Suggestions for Future Work --- p.152 / Chapter 7.2.1. --- Modifications on the constituent-based PTT-BP model --- p.152 / Chapter 7.2.2. --- Improvement of PTT-based BP estimation by considering VSM tone effects --- p.153 / Chapter 7.2.3. --- Improvement of PTT-based BP estimation by considering the frequency-dependent PTT-BP relationship --- p.154 / Chapter 7.2.4. --- Validation of the PTT-BP hysteresis quantifications to be indicators of sympathetic function --- p.154 / References: --- p.155 / Appendix --- p.156 / List of Publications --- p.156

Zhang Ye. / "October 2001." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 200-224). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Thesis (Ph. D.)--University of Florida, 2003. / Title from title page of source document. Includes vita. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.