SFIGMOMANOMETRIYA (Greek sphygmos pulse, a pulsation + manos rare, leaky + metreo to measure, measure) — group of methods of indirect measurement of arterial pressure on pressure in a compression cuff, to corresponding change of character of pulsations distally the located artery or the sound phenomena in it, synchronous to pulse.
For the first time measurement of the systolic ABP in a beam artery on disappearance of its pulse at a certain extent of compression of an artery a special cylinder was carried out in 1881 by S. Basch. In the subsequent began to apply the special compression cuffs imposed on a circle of a shoulder, hip, shin etc. to an external prelum of an artery. Measurement of ADT depending on a kind of a way, is made in the mode of a compression of an artery (smooth build-up of pressure in a compression cuff to the level of the systolic ABP) or in the mode of a decompression — smooth pressure decrease in a cuff after preliminary creation in it of pressure exceeding systolic the ABP. The way of measurement of the systolic ABP in the mode of a decompression offered in 1896 S. Riva-Rocci was the simplest option C.; he designed the device for measurement of the ABP (Reeve-Rochchi device). The method consisted in comparison of pressure in the compression cuff imposed on a shoulder with the moment of emergence of the pulse on a beam artery defined palpatorno. More precisely this moment is determined at objective pulse recording with the help sfigmografiya (see).
The auskultativny method C. offered in 1905 by the Russian doctor N. S. Korotkov became the most valuable to medical practice (see t. 25, additional materials). Determine by this ABP method in the mode of a decompression by auscultation distalny cuffs of the sounds (Korotkov's tones), synchronous with pulse, appearing in the squeezed arteries at the time of achievement in a cuff of level of the systolic ABP and disappearing with the compression pressure close to the diastolic ABP (see. the Blood pressure, methods and devices for measurement ). The research of the listened sounds conducted by M. V. Yanovsky and his pupils showed that in process of a decompression these sounds undergo dynamics, to-ruyu in some cases (but not in all) it is possible to characterize by five consecutive phases: I \the emergence of tones corresponding to the systolic ABP; II \change of tones by noise; III \change of noise by loud tones; IV \weakening of loudness of sounds; V \disappearance of sounds. True values of the diastolic ABP in most cases correspond to the level of compression pressure between IV and V phases of sounding, but in some cases (at special conditions of a tone of arteries — after sports loading, at fever etc.) Korotkov's tones are listened up to a full decompression of vessels (so-called infinite tone), and then the level of the diastolic ABP does not manage to be determined.
Simplicity, availability and accuracy of a method of Korotkov quite satisfactory for practical purposes provided his bystry world recognition and broad practical application that played an outstanding role in improvement of diagnosis at cardiovascular pathology; in a crust, time the method is the basic for measurement of the ABP in medical practice.
Sphygmomanometers — devices for indirect measurement of arterial pressure by compression of an artery variable pressure from the outside and overseeing by a pulsation distally the located artery. Devices for indirect measurement of the ABP by external compression of an artery and overseeing by its pulsation on pulse fluctuations of pressure in the most compression cuff are called arterial oscillographs.
Carry the devices allowing to create to the elementary and most widespread sphygmomanometers and to smoothly reduce pressure in the blood pressure cuff imposed around a segment of an extremity in which the ABP is measured. They intend for measurement of the ABP by an auskultativny method; Korotkov's tones are listened by means of a phonendoscope. These devices contain a compression cuff (a rubber bag in a textile cover), the pneumatic supercharger, the manometer for tonometry in a cuff and the gate for smooth deflation from a cuff in the atmosphere. There are two main modifications of measuring instruments of this sort — devices with mercury and membrane manometers. Sphygmomanometers of the first type are bulky, less convenient, but are more exact since they show pressure on real movement of a mercury column. Devices with diaphragm gages are easier to use, compact and equivalent mercury on accuracy, but need periodic check since owing to various reasons at operation can partially lose accuracy. In the USSR large batches manufacture both types of these devices — PMR (the device manometrical mercury with the maximum error of measurement of 3 mm of mercury., fig. 1) and the dishwasher (the device manometrical membrane with the maximum error of measurement of 4 mm of mercury., fig. 2). New generation of sphygmomanometers are the devices supplied with blocks of tool «listening» of tones of Korotkov, their identification and indication by light or sound pulses. Reception of a signal in them is carried out by the sensors of vibrations imposed over an artery in an elbow bend or in the lower third of a shoulder. For devices of this group the choice of signs for distinguishing of the «tones» corresponding and inappropriate auskultativny is basic. The domestic device of this type is the measuring instrument of arterial pressure of IAD-1 (fig. 3). Reception of vibrations in it is carried out by the sensor of tones of Korotkov DTK-1M with the piezoelectric sensitive element which is built in in a cuff. The electronic block working from the independent power supply strengthens the signals arriving from the sensor and creates the impulses managing sound and light indicators. A pneumatic part of the device — a compression cuff, the pneumatic supercharger, the manometer, etc. — is collected from the elements entering the dishwasher device.
Measurement of the ABP this device is performed the same as the ordinary sphygmomanometer. Korotkov's tones observe visually on a blinking of the light indicator and at the same time perceive as short sound impulses of one tone, synchronous light. Measurement by means of IAD-1 does not demand qualification of the operator that allows to apply it in house conditions for the purpose of self-checking of the ABP. The device is convenient for frequent measurements of the ABP, does not tire the operator with listening of tones of Korotkov; it also allows to measure the ABP in the conditions of noise that it is difficult to carry out at measurements by ordinary sphygmomanometers.
For further reduction of influence of a subjective factor by result of measurement of the ABP devices, in to-rykh an avtokhmatizirovana counting of level of pressure in a cuff, and also filling and its emptying are created. The devices of this type produced in the USSR in lots are pnevmatopressovazometr PPV-50 and pnevmatopressovazometr PPV-01. The first device has a compression cuff and the pneumatic supercharger, similar dishwashers, the sensor of tones of Korotkov (DTK-1M), similar to the IAD-1 device, the IAD-1 device possesses the same characteristics of the channel of strengthening and allocation of tones of Korotkov, as, but it is in addition supplied with the electronic manometer with a digital output and system of automatic distinguishing of systolic and diastolic levels of pressure by perception of the moment of emergence and disappearance of the vibrations equivalent to Korotkov's tones. The device has autonomous food, is compact, economic, more convenient in operation, than IAD-1 since it does not require attention of the operator for overseeing by indications of the manometer. It is suitable for use by paramedical staff, and also for self-checking of the ABP. Pnevmatopressovazometr of PPV-01 has the same functional nodes, as well as PPV-50, but, besides, contains the compressor and the electric air scheme for management of processes of filling of a compression cuff of air and the subsequent smooth pressure decrease in it. The device completely removes the exercise stress connected with manual forcing of air in a cuff from the operator and exempts from listening of tones of Korotkov. The device is useful to mass measurements of the ABP.
The ABP electronic measuring instruments of all three types (IAD-1, PPV-50, PPV-01) are made in many countries. It should be noted, however, that still there is no working standard regulating signs of automatic selection of tones of Korotkov. Therefore results of measurement of the ABP the automated devices have considerable dispersion that limits their use in responsible cases.
There are ABP measuring instruments based on the analysis of the pulse phenomena in the compressed artery not in sound, and in infrasonic frequency range. However the principles which are their cornerstone are less fully studied, than in Korotkov's method, and now cannot be considered as standard. The advantage of these devices is use in them physiologically steadier signs — changes of actually pulse process during compression of an artery, but not its high-frequency component (Korotkov's tones), emergence and disappearance to-rogo depends not only on the level of pressure in a vessel and a cuff, but also on many other factors, both physiological, and external.
Bibliography: Korotkov N. S. To a question 0 methods of a research of blood pressure, Izv. VMA, t. 11, No. 4, page 365, 1905; To about with and c to and y G. I. Sound method of a research of arterial pressure, M., 1959, bibliogr.; It is small yarenko Yu. E. Metod Korotkova at the present stage of development of cardiology, Cardiology, t. 16, Jsfg 9, page 142, 1976, bibliogr.; G e d-d e s L. A. The direct and indirect measurement of blood pressure, Chicago, 1970; George C. F., Lewis P. J. a. P e t-r i e A. Clinical experience with use of ultrasound sphygmomanometer, Brit. Heart J., v. 37, p. 804, 1975; M a 1 - 1 i o n J. M. e. a. Tension arterielle measure, Inform. Cardiol., t. 4, p. 235, 1980, bibliogr.; Riva-Rocci S. Un nuovo sfigmomanometro, Gaz. med. Torino, v. 47, p. 981, 1001, 1896.
V. P. Zhmurkin; E. K. Lukyanov (tekhn.).