Scheffler A, Bold M, Lienke U, Rieger H
Aggertalklinik, Clinic for Vascular Diseases, Engelskirchen, Germany.
Clin Physiol. 1991 Nov;11(6):501-12. doi: 10.1111/j.1475-097x.1991.tb00670.x.
From the pathophysiological point of view the regional distribution of blood flow is of special importance in ischaemic tissues. Within this study foot sole skin perfusion was investigated by means of fluorescein perfusography at rest and during reactive hyperaemia in patients with peripheral arterial occlusive disease confined to one limb (Fontaine stage II). Ambient temperatures were maintained around 21 degrees C. Mean fluorescein appearance times on the one side and their standard deviations (SD) and coefficients of variation (CV) on the other side were taken as measures of overall blood supply and homogeneity of flow, respectively. At rest no differences in these parameters could be detected between diseased legs and controls. After a 3-min supra-systolic circulatory arrest at the thigh, a significant reduction of fluorescein appearance times was observed for both groups but was statistically more pronounced in the controls. Furthermore, during reactive hyperaemia standard deviations as well as coefficients of variation decreased significantly only in normal limbs whereas they either remained constant (SD) or even increased (CV) in those with arterial obstructions. All effects associated with reactive hyperaemia showed statistically significant correlations with systolic ankle pressure indices. From these results it is concluded that haemodynamically effective arterial obstructions are followed by not only a restriction of overall hyperaemic blood supply but also a failure to homogenize microcirculatory perfusion in the case of increased flow requirements.
从病理生理学角度来看，血流的区域分布在缺血组织中具有特殊重要性。在本研究中，通过荧光素灌注造影术对仅一侧肢体患有外周动脉闭塞性疾病（Fontaine II期）的患者在静息状态和反应性充血期间的足底皮肤灌注情况进行了研究。环境温度维持在21摄氏度左右。一侧的平均荧光素出现时间及其标准差（SD）和变异系数（CV）分别被用作总体血液供应和血流均匀性的指标。静息时，患病侧下肢与对照组在这些参数上未检测到差异。在大腿进行3分钟的收缩期上的循环阻断后，两组的荧光素出现时间均显著缩短，但在对照组中在统计学上更为明显。此外，在反应性充血期间，仅正常肢体的标准差和变异系数显著降低，而在有动脉阻塞的肢体中，它们要么保持不变（SD），要么甚至增加（CV）。所有与反应性充血相关的效应在统计学上均与收缩期踝压指数显著相关。从这些结果可以得出结论，血流动力学上有效的动脉阻塞不仅会导致总体充血性血液供应受限，而且在流量需求增加的情况下，还会导致微循环灌注无法均匀化。
