间歇性跛行期间肌肉缺血的严重程度。

The severity of muscle ischemia during intermittent claudication.

作者信息

Egun Anselm, Farooq Vasim, Torella Francesco, Cowley Richard, Thorniley Maureen S, McCollum Charles N

机构信息

Academic Surgery Unit, South Manchester University Hospital, West Didsbury, United Kingdom.

出版信息

J Vasc Surg. 2002 Jul;36(1):89-93. doi: 10.1067/mva.2002.123678.

DOI:10.1067/mva.2002.123678

PMID:12096263

Abstract

PURPOSE

The degree of ischemia during intermittent claudication is difficult to quantify. We evaluated calf muscle ischemia during exercise in patients with claudication with near infrared spectroscopy.

METHODS

A Critikon Cerebral Redox Model 2001 (Johnson & Johnson Medical, Newport, Gwent, United Kingdom) was used to measure calf muscle deoxygenated hemoglobin (HHb), oxygenated hemoglobin (O(2)Hb), and total hemoglobin levels and oxygenation index (HbD; HbD = O(2)Hb - HHb) in 16 patients with claudication and in 14 control subjects before, during, and after walking on a treadmill for 1 minute (submaximal exercise). These measures were repeated after a second maximal exercise in patients with claudication and after 7 minutes walking in control subjects. Near-infrared spectroscopy readings during maximal exercise were then compared with a model of total ischemia induced with tourniquet in 16 young control subjects.

RESULTS

Total hemoglobin level changed little during exercise in both patients with claudication and control subjects. HHb levels rose, and O(2)Hb level and HbD falls were more pronounced in patients with claudication than in control subjects after submaximal and maximal exercise. During maximal exercise, HbD fell markedly by a median (interquartile range) of 210.5 micromol/cm (108.2 to 337.0 micromol/cm) in patients with claudication compared with 66.0 micromol/cm (44.0 to 101.0 micromol/cm) in elderly control subjects and 41.0 micromol/cm (36.0 to 65.0 micromol/cm) in young control subjects (P <.001). This fall also was greater than the HbD fall induced with tourniquet ischemia at 90.8 micromol/cm (57.6 to 126.2 micromol/cm; P =.006).

CONCLUSION

Hemoglobin desaturation in exercising calf muscle is profound in patients with claudication, considerably greater even than that induced with three minutes of tourniquet occlusion. Further studies are necessary to investigate the relationship between the inflammatory response and near-infrared spectroscopy during exercise in patients with claudication.

摘要

目的

间歇性跛行期间的缺血程度难以量化。我们使用近红外光谱法评估了跛行患者运动期间的小腿肌肉缺血情况。

方法

采用Critikon脑氧化还原模型2001（强生医疗公司，英国纽波特，格温特）测量16例跛行患者和14例对照者在跑步机上行走1分钟（次最大运动）之前、期间和之后的小腿肌肉脱氧血红蛋白（HHb）、氧合血红蛋白（O₂Hb）、总血红蛋白水平及氧合指数（HbD；HbD = O₂Hb - HHb）。在跛行患者进行第二次最大运动后以及对照者行走7分钟后重复这些测量。然后将最大运动期间的近红外光谱读数与16例年轻对照者使用止血带诱导的完全缺血模型进行比较。

结果

在跛行患者和对照者运动期间，总血红蛋白水平变化不大。次最大运动和最大运动后，跛行患者的HHb水平升高，O₂Hb水平和HbD下降比对照者更明显。在最大运动期间，跛行患者的HbD明显下降，中位数（四分位间距）为210.5微摩尔/厘米（108.2至337.0微摩尔/厘米），而老年对照者为66.0微摩尔/厘米（44.0至101.0微摩尔/厘米），年轻对照者为41.0微摩尔/厘米（36.0至65.0微摩尔/厘米）（P <.001）。这种下降也大于止血带缺血诱导的HbD下降，后者为90.8微摩尔/厘米（57.6至126.2微摩尔/厘米；P =.006）。