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Méthodologie et physiopathologie des mesures de pressions artérielles périphériques chez le sujet sain : aspects cliniques, méthodologiques et pédagogiques

Abstract : The measurement of ankle to brachial pressure index (ABPI) is a simple and non-invasive diagnostic tool for detecting arterial involvement of the lower limbs. If the methodology and interpretation of this index have been standardized, there remain some discrepancies about some aspects of its measurement. Thus, the present thesis reports the investigations of three of these aspects. First, the objective was to study the physiological relationship between ABPI and age among healthy and physically active subjects. The results show a positive relationship. This trend is consistent with structural modifications of arterial wall with ageing. Second, our aim was to investigate the use of automatic blood pressure measurement tools for the calculation of ABPI during the recovery of a maximal physical exercise. We found that the use of anoscillometric blood pressure device allowed to obtain a faster postexercise ABPI faster than a manual recording and also to reduce the standard error of the measurement. Finally, we discussed the learning strategies of this peripheral vascular measurement. Indeed, it appears that the measurement of arterial systolic blood pressure at the ankle (ASBPa) is largely under-taught compared to the humeral measurement. The purpose was to objectively assess, by a simulator, the effect of an additional practical and pedagogical intervention on the ability of novice students to perform ASBP a measurement. The results suggest that a one-hour practical learning allows to significantly reduce the measurement error but is not sufficient to harmonize all of the measurement parameters according to the measurement standards.
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Florian Congnard. Méthodologie et physiopathologie des mesures de pressions artérielles périphériques chez le sujet sain : aspects cliniques, méthodologiques et pédagogiques. Médecine humaine et pathologie. Université d'Angers, 2017. Français. ⟨NNT : 2017ANGE0049⟩. ⟨tel-01874255⟩

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