使用计算机辅助静脉充血体积描记法评估创伤后I型复杂性区域疼痛综合征的外周微循环。

Assessment of the peripheral microcirculation using computer-assisted venous congestion plethysmography in post-traumatic complex regional pain syndrome type I.

作者信息

Schürmann M, Zaspel J, Gradl G, Wipfel A, Christ F

机构信息

Department of Surgery, Ludwig Maximilians University of Munich, Germany.

出版信息

J Vasc Res. 2001 Sep-Oct;38(5):453-61. doi: 10.1159/000051078.

DOI:10.1159/000051078

PMID:11561147

Abstract

In complex regional pain syndrome type I (CRPS-I), edema of the affected limb is a common finding. Therefore, the changes in macro- and microcirculatory parameters were investigated to elucidate the underlying pathophysiology. Twenty-four patients with post-traumatic CRPS-I and 25 gender- and age-matched healthy subjects were examined by means of an advanced computer-assisted venous congestion strain-gauge plethysmograph. The recording of the volume response of the forearm to a stepwise inflation of an occlusion cuff placed at the upper arm enabled the calculation of the arterial blood flow into the arm (Q(a)), the vascular compliance (C), the peripheral venous pressure (P(v)), the isovolumetric venous pressure (P(vi); = hydrostatic pressure needed to achieve net fluid filtration) and the capillary filtration capacity (CFC)--an index of microvascular permeability. The study revealed no difference in any of the parameters between the right and left hand of healthy subjects. In CRPS-I patients, however Q(a), P(v), P(vi) and CFC were significantly (p < 0.01/0.001) elevated in the affected arm (Q(a) 11.2 +/- 7.0 ml x min(-1) x 100 ml(-1), P(v) 20.2 +/- 8.1 mm Hg, P(vi) 24.7 +/- 4.2 mm Hg, CFC 0.0058 +/- 0.0015 ml x min(-1) x 100 ml(-1) x mm Hg(-1)) compared to the unaffected arm (Q(a) 4.2 +/- 2.4 ml x min(-1) x 100 ml(-1), P(v) 10.0 +/- 5.1 mm Hg, P(vi) 13.2 +/- 3.7 mm Hg, CFC 0.0038 +/- 0.0005 ml x min(-1) x 100 ml(-1) x mm Hg(-1)) and the values obtained in healthy controls (Q(a) 5.1 +/- 1.3 ml x min(-1) x 100 ml(-1), P(v) 10.4 +/- 4.3 mm Hg, P(vi) 15.7 +/- 3.3 mm Hg, CFC 0.0048 +/- 0.0012 ml x min(-1) x 100 ml(-1) x mm Hg(-1)). Whereas the values in the unaffected arm of CRPS-I patients revealed no difference in Q(a), P(v) and P(vi) but a lower CFC (p < 0.01) compared to those from healthy controls. These results suggest profound changes in both macro- and microvascular perfusion in the affected arm of CRPS-I patients. The high CFC contributes to the edema formation, and combined with the elevated P(vi), they are in agreement with the hypothesis of an inflammatory origin of CRPS.

摘要

在I型复杂性区域疼痛综合征（CRPS-I）中，患肢水肿是常见表现。因此，研究了宏观和微观循环参数的变化，以阐明潜在的病理生理学机制。通过先进的计算机辅助静脉充血应变片体积描记仪，对24例创伤后CRPS-I患者和25例性别与年龄匹配的健康受试者进行了检查。记录前臂对置于上臂的袖带逐步充气的体积反应，从而能够计算进入手臂的动脉血流量（Q(a)）、血管顺应性（C）、外周静脉压（P(v)）、等容静脉压（P(vi)；即实现净液体滤过所需的静水压力）和毛细血管滤过能力（CFC）——微血管通透性指标。研究发现，健康受试者左右手的任何参数均无差异。然而，在CRPS-I患者中，与未受影响的手臂（Q(a) 4.2±2.4 ml·min⁻¹·100 ml⁻¹，P(v) 10.0±5.1 mmHg，P(vi) 13.2±3.7 mmHg，CFC 0.0038±0.0005 ml·min⁻¹·100 ml⁻¹·mmHg⁻¹）以及健康对照者（Q(a) 5.1±1.3 ml·min⁻¹·100 ml⁻¹，P(v) 10.4±4.3 mmHg，P(vi) 15.7±3.3 mmHg，CFC 0.0048±0.0012 ml·min⁻¹·100 ml⁻¹·mmHg⁻¹）相比，受影响手臂的Q(a)、P(v)、P(vi)和CFC显著升高（p<0.01/0.001）（Q(a) 11.2±7.0 ml·min⁻¹·100 ml⁻¹，P(v) 20.2±8.1 mmHg，P(vi) 24.7±4.2 mmHg，CFC 0.0058±0.0015 ml·min⁻¹·100 ml⁻¹·mmHg⁻¹）。而CRPS-I患者未受影响手臂的值在Q(a)、P(v)和P(vi)方面与健康对照者无差异，但CFC较低（p<0.01）。这些结果表明，CRPS-I患者受影响手臂的宏观和微观血管灌注均发生了深刻变化。高CFC导致水肿形成，并且与升高的P(vi)相结合，它们与CRPS炎症起源的假说相符。