Knobloch Karsten, Tomaszek Sandra, Lichtenberg Artur, Karck Matthias, Haverich Axel
Thoracic and Cardiovascular Surgery, Medical School Hannover, Hannover, Germany.
Ann Thorac Surg. 2006 May;81(5):1700-7. doi: 10.1016/j.athoracsur.2005.12.030.
The aim of this study was to assess palmar microcirculation in a long-term follow-up after radial artery harvesting for coronary revascularization.
One hundred fourteen patients (100 male; aged 61.7 +/- 6.7 years; preoperative New York Heart Association 2.3 +/- 0.6, ejection fraction 61.4% +/- 13.9%) were included after undergoing elective coronary revascularization using the radial artery of the nondominant forearm with a nonpathologic Allen's test. Superficial and deep tissue oxygen saturation (SO2), postcapillary venous filling pressure (rHb), capillary blood flow, and capillary blood flow velocity were determined at a mean 25 +/- 5 months after surgery using a combined laser Doppler spectrophotometry system.
At 2-mm tissue depth, there was a small, but significant, decrease of 3% of superficial SO2 at the thumb and the thenar eminence (D1: 75.3% +/- 8.9% versus 77.6% +/- 9.7%, p = 0.003; thenar: 71.5% +/- 10.5% versus 73.2% +/- 8.2%, p = 0.027). Deep palmar SO2 was changed significantly at 5 of 7 positions by 3%. Deep postcapillary venous filling pressure (8 mm) was significantly increased by 9% only at the fingertip of the fifth finger (112.4 +/- 49.7 versus 103.0 +/- 25.0, p = 0.033), while superficial capillary blood flow decreased by 13% at only 1 of 7 positions at the hypothenar eminence (242.0 +/- 153.6 versus 275.6 +/- 169.2, p = 0.009). Overall, only 2 of 56 positions exceeded a given threshold of 5% change of microcirculation. No clinical signs of malperfusion were found (postoperative New York Heart Association 1.1 +/- 0.4, p < 0.05), and no patient was impaired in daily palmar motor activity.
Long-term objective evaluation of superficial and deep palmar microcirculation confirms that radial artery harvesting for coronary revascularization does not compromise palmar microcirculation.
本研究的目的是评估在采用桡动脉进行冠状动脉血运重建术后的长期随访中手掌的微循环情况。
纳入114例患者（100例男性；年龄61.7±6.7岁；术前纽约心脏协会分级2.3±0.6级，射血分数61.4%±13.9%），这些患者均接受了非优势前臂桡动脉的择期冠状动脉血运重建术，且艾伦试验结果正常。在术后平均25±5个月时，使用联合激光多普勒分光光度测定系统测定浅部和深部组织氧饱和度（SO2）、毛细血管后静脉充盈压（rHb）、毛细血管血流及毛细血管血流速度。
在组织深度为2毫米处，拇指和大鱼际的浅部SO2有小幅但显著的降低，降低了3%（第一区：75.3%±8.9%对比77.6%±9.7%，p = 0.003；大鱼际：71.5%±10.5%对比73.2%±8.2%，p = 0.027）。手掌深部SO2在7个位置中的5个位置有显著变化，变化幅度为3%。深部毛细血管后静脉充盈压（8毫米）仅在小指指尖显著升高了9%（112.4±49.7对比103.0±25.0，p = 0.033），而浅部毛细血管血流仅在小鱼际的7个位置中的1个位置降低了13%（242.0±153.6对比275.6±169.2，p = 0.009）。总体而言，56个位置中只有2个位置超过了微循环变化5%的给定阈值。未发现灌注不良的临床体征（术后纽约心脏协会分级1.1±0.4级，p < 0.05），且没有患者的手掌日常运动活动受到损害。
对手掌浅部和深部微循环的长期客观评估证实，采用桡动脉进行冠状动脉血运重建不会损害手掌微循环。
