Levinsohn D G, Gordon L, Sessler D I
Department of Orthopaedic Surgery, UCSF School of Medicine 94143.
J Hand Surg Am. 1991 Nov;16(6):1056-62. doi: 10.1016/s0363-5023(10)80069-3.
This study sought to determine which of the four most commonly used objective monitoring modalities--pulse oximetry, laser Doppler flowmetry, skin surface temperature measurement, and skin surface fluorescence--is best able to detect early digital venous congestion. Digital venous congestion was induced in 12 hands by inflating a digital cuff to 5 mm Hg above the resting diastolic pressure. The cuff remained inflated for 1 hour while monitoring was done at 10-minute intervals. The baseline and experimental laser Doppler indices differed by at least 30% in each subject, and the laser Doppler index was always less than 40% during venous congestion. Skin surface fluorescence gave falsely normal results in three of eight hands, while pulse oximetry failed to detect venous congestion in any hand. The difference in temperature between the control and experimental fingers almost always exceeded the threshold of 2.5 degrees C. The results indicate that both laser Doppler flowmetry and skin surface temperature measurement are highly accurate methods of monitoring early digital venous congestion that are noninvasive and easy to use. Skin surface temperature measurement has further advantages in that thermometers are less expensive and easier to transport than laser Doppler devices. In contrast, skin surface fluorescence is invasive and cumbersome in addition to being less sensitive to experimentally induced early digital venous congestion than either laser Doppler flowmetry or skin surface temperature measurement. Pulse oximetry is unreliable in detecting early digital venous congestion.
本研究旨在确定四种最常用的客观监测方式——脉搏血氧饱和度测定法、激光多普勒血流仪、皮肤表面温度测量和皮肤表面荧光法——中哪一种最能检测出早期手指静脉淤血。通过将手指袖带充气至高于静息舒张压5毫米汞柱，在12只手上诱导出手指静脉淤血。袖带充气保持1小时，同时每隔10分钟进行一次监测。在每个受试者中，基线和实验性激光多普勒指数相差至少30%，并且在静脉淤血期间激光多普勒指数始终低于40%。皮肤表面荧光法在8只手中有3只给出了假正常结果，而脉搏血氧饱和度测定法在任何一只手中都未能检测出静脉淤血。对照手指和实验手指之间的温度差异几乎总是超过2.5摄氏度的阈值。结果表明，激光多普勒血流仪和皮肤表面温度测量都是监测早期手指静脉淤血的高度准确的方法，它们是非侵入性的且易于使用。皮肤表面温度测量还有进一步的优点，即温度计比激光多普勒设备更便宜且更易于运输。相比之下，皮肤表面荧光法除了对实验诱导的早期手指静脉淤血的敏感性低于激光多普勒血流仪或皮肤表面温度测量外，还具有侵入性且操作繁琐的特点。脉搏血氧饱和度测定法在检测早期手指静脉淤血方面不可靠。
