Olszewski Waldemar L, Jain Pradeep, Ambujam Govinda, Zaleska Marzanna, Cakala Marta, Gradalski Tomasz
Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
Lymphat Res Biol. 2011;9(2):77-83. doi: 10.1089/lrb.2009.0025.
Physiotherapy of edema in cases with obstructed main lymphatics of lower limbs requires knowledge of how high external pressures should be applied manually or set in compression devices in order to generate tissue pressures high enough to move tissue fluid to nonswollen regions and to measure its flow rate.
We measured tissue fluid pressure and flow in subcutaneous tissue of lymphedematous limbs stages II to IV at rest and during pneumatic compression under various pressures and inflation timing. An 8-chamber sequential compression device inflated to pressures 50-120 mmHg, for 50 sec each chamber, with no distal deflation, was used. Pressures were measured using a wick-in-needle and electronic manometer. Fluid flow was calculated from continuously recorded changes in limb circumference using strain gauge plethysmography.
Before massage, in all stages of lymphedema, stagnant tissue fluid pressures in subcutaneous tissue ranged between -1 and +10 mmHg and did not differ from those measured in normal subjects. Pressures generated in tissue fluid by pneumatic compression reached 40-100 mmHg and were lower than those in inflated chambers. High pressure gradient through the skin was caused by its rigidity (fibrosis) and dissipation of applied compression force to proximal noncompressed limb regions. The calculated volumes of displaced tissue fluid ranged from 10 to 30 ml per compression cycle, to reach in some cases 100 ml in the groin region.
Tissue fluid pressures generated by a pneumatic device were found lower than in the compression chambers. The obtained results point to the necessity of applying high pressures and longer compression times to generate effective tissue fluid pressures and to provide enough time for moving the stagnant fluid.
对于下肢主要淋巴管阻塞所致水肿的物理治疗，需要了解手动施加或在加压装置中设置多高的外部压力，才能产生足够高的组织压力，将组织液转移至无肿胀区域并测量其流速。
我们测量了II至IV期淋巴水肿肢体皮下组织在静息状态以及不同压力和充气时间的气动加压过程中的组织液压力和流量。使用一个8腔序贯加压装置，每个腔室充气至50 - 120 mmHg，持续50秒，且无远端放气。压力通过针芯式压力计和电子压力计测量。使用应变片体积描记法根据连续记录的肢体周长变化计算液体流量。
按摩前，在所有淋巴水肿阶段，皮下组织中停滞的组织液压力在 - 1至 + 10 mmHg之间，与正常受试者测量值无差异。气动加压在组织液中产生的压力达到40 - 100 mmHg，低于充气腔室中的压力。皮肤的硬度（纤维化）以及施加的压缩力向近端未受压肢体区域的消散导致了通过皮肤的高压梯度。每个压缩周期计算出的组织液移位体积在10至30 ml之间，在某些情况下腹股沟区域可达100 ml。
发现气动装置产生的组织液压力低于加压腔室中的压力。所得结果表明有必要施加高压和更长的加压时间，以产生有效的组织液压力，并为移动停滞的液体提供足够时间。
