Menger M D, Barker J H, Messmer K
Institute for Surgical Research, University of Munich, Germany.
Plast Reconstr Surg. 1992 Jun;89(6):1104-14. doi: 10.1097/00006534-199206000-00017.
Monitoring of nutritive blood flow in muscle is of particular importance to reconstructive surgeons, since ischemia/reperfusion in striated muscle is known to result in postischemic microvascular perfusion failure. Laser Doppler flowmetry has recently been introduced as an easy-to-use, noninvasive technique for continuous monitoring of microvascular tissue perfusion. Despite its popularity, there exists a great deal of controversy as to what actually generates the laser Doppler signal recorded from a given tissue. Intravital microscopy is a technique for direct visualization of the nutritional circulation in tissue. By using intravital microscopy, direct measurements of blood perfusion in individual segments of the nutritional microcirculation can be made. In 22 Syrian golden hamsters we performed laser Doppler flowmetry and intravital microscopy measurements in muscle tissue prior to and during reperfusion after 4 hours of tourniquet ischemia using the dorsal skinfold chamber model. Intravital microscopy (n = 10) revealed a heterogeneous capillary perfusion during the early reperfusion phase with a decrease (p less than 0.01) in functional capillary density to 49.4 +/- 17.0 percent of control. No recovery was observed after 24 hours of reperfusion. Laser Doppler flowmetry (n = 12) showed a parallel reduction of capillary red blood cell flux during the early perfusion phase to 43.9 +/- 22.6 percent of control values (p less than 0.01), and no recovery was observed after 24 hours of reperfusion. However, the laser Doppler flowmetry technique was not able to detect the capillary perfusion inhomogeneities shown by intravital microscopy. Postischemic reperfusion in striated muscle is characterized by a decrease in functional capillary density and a heterogeneous capillary perfusion. Laser Doppler flowmetry is a useful tool for monitoring microvascular tissue perfusion, although in striated muscle of the hamster it must be considered that accurate nutritional "capillary" flow readings can be grossly overestimated if larger vessels, such as arterioles and collecting venules, are contained in the measuring field of the laser Doppler probe.
监测肌肉中的营养血流对重建外科医生尤为重要，因为已知横纹肌的缺血/再灌注会导致缺血后微血管灌注衰竭。激光多普勒血流仪最近作为一种易于使用的非侵入性技术被引入，用于连续监测微血管组织灌注。尽管它很受欢迎，但对于从给定组织记录的激光多普勒信号实际上是由什么产生的，存在大量争议。活体显微镜检查是一种直接观察组织中营养循环的技术。通过使用活体显微镜检查，可以对营养微循环的各个节段的血液灌注进行直接测量。在22只叙利亚金仓鼠中，我们使用背部皮褶腔模型，在止血带缺血4小时后的再灌注之前和期间，对肌肉组织进行了激光多普勒血流仪和活体显微镜测量。活体显微镜检查（n = 10）显示，在再灌注早期阶段毛细血管灌注不均匀，功能性毛细血管密度降低（p < 0.01）至对照的49.4±17.0%。再灌注24小时后未观察到恢复。激光多普勒血流仪（n = 12）显示，在灌注早期阶段毛细血管红细胞通量平行降低至对照值的43.9±22.6%（p < 0.01），再灌注24小时后未观察到恢复。然而，激光多普勒血流仪技术无法检测到活体显微镜检查显示的毛细血管灌注不均匀性。横纹肌缺血后再灌注的特征是功能性毛细血管密度降低和毛细血管灌注不均匀。激光多普勒血流仪是监测微血管组织灌注的有用工具，尽管在仓鼠的横纹肌中必须考虑到，如果激光多普勒探头的测量区域包含较大的血管，如小动脉和集合小静脉，准确的营养“毛细血管”血流读数可能会被严重高估。
