Emmanuel A V, Kamm M A, Beard R W
Physiology Unit, St Mark's and Northwick Park Hospitals, Watford Road, Harrow, Middlesex HA1 3UJ, U.K.
Clin Sci (Lond). 2000 Feb;98(2):201-7.
Pelvic venous congestion is a common cause of chronic pelvic pain in women of reproductive age. Although this condition represents a functional disturbance of the pelvic circulation which is related to the menstrual cycle, its aetiology remains unknown. Indirect techniques demonstrate that the vasoconstrictive reflex response of the microcirculation of the foot to a rise in venous pressure is attenuated throughout the menstrual cycle. We wished to develop a simple and non-invasive direct measure of pelvic blood flow to aid diagnosis of this condition. Laser doppler blood flux measurements of the skin of the big toe and of the vaginal and rectal mucosa in the follicular and luteal phases of the menstrual cycle in 12 healthy asymptomatic premenopausal women (mean age 30 years) with regular cycles and in four healthy asymptomatic postmenopausal women (mean age 59 years) were carried out both in the supine position and in response to 40 degrees head-up tilt. The coefficient of variation of resting vaginal flux was lower for measurements in postmenopausal women (0.04) and in premenopausal women in the follicular phase (0. 07) compared with those in the luteal phase (0.16). At rest, vaginal blood flow was higher than rectal and skin flux in both premenopausal and postmenopausal women. In the follicular phase a decrease in flow was observed in response to head-up tilt in the skin (-32.0%), vagina (-34.3%) and rectum (-9.4%). In the luteal phase this reflex was attenuated at these three sites (-8.6%, +6.7% and +7.4% respectively). There were no significant reflex changes in postmenopausal women. Thus laser doppler fluximetry is a reproducible method for comparing the flux of blood in the microcirculation of the skin and of the vaginal and rectal mucosa. The skin is the least sensitive site for testing vascular reactivity in response to cyclical changes. The vaginal and rectal microcirculations are the most sensitive sites for testing visceral cyclical reactivity, and have the advantage of direct anatomical relevance. The follicular phase of the menstrual cycle is associated with greatest vascular reactivity and is the most appropriate phase during which to test for abnormal vascular responses.
盆腔静脉淤血是育龄期女性慢性盆腔疼痛的常见原因。尽管这种情况代表了与月经周期相关的盆腔循环功能紊乱，但其病因仍不清楚。间接技术表明，在整个月经周期中，足部微循环对静脉压升高的血管收缩反射反应减弱。我们希望开发一种简单且无创的直接测量盆腔血流的方法，以辅助诊断这种疾病。对12名月经周期规律、健康无症状的绝经前女性（平均年龄30岁）和4名健康无症状的绝经后女性（平均年龄59岁），在月经周期的卵泡期和黄体期，于仰卧位以及在头高位倾斜40度时，对其拇趾皮肤、阴道和直肠黏膜进行激光多普勒血流测量。绝经后女性（0.04）以及卵泡期绝经前女性（0.07）静息阴道血流的变异系数低于黄体期（0.16）。静息时，绝经前和绝经后女性的阴道血流量均高于直肠和皮肤血流量。在卵泡期，头高位倾斜时皮肤（-32.0%）、阴道（-34.3%）和直肠（-9.4%）的血流量均出现下降。在黄体期，这三个部位的这种反射减弱（分别为-8.6%、+6.7%和+7.4%）。绝经后女性无明显的反射变化。因此，激光多普勒血流仪是一种可重复的方法，用于比较皮肤、阴道和直肠黏膜微循环中的血流情况。皮肤是测试对周期性变化的血管反应性最不敏感的部位。阴道和直肠微循环是测试内脏周期性反应性最敏感的部位，并且具有直接的解剖学相关性优势。月经周期的卵泡期与最大的血管反应性相关，是测试异常血管反应的最合适阶段。
