Jünger M, Frey-Schnewlin G, Bollinger A
Department of Internal Medicine, University Hospital, Zürich, Switzerland.
Int J Microcirc Clin Exp. 1989 Feb;8(1):3-24.
Transcapillary diffusion of Na-fluorescein injected by the intravenous route was measured by a videomicroscopy system in the skin of the dorsum of the forefoot in healthy controls (n = 21) and in patients with moderate (n = 35) and severe (n = 29) ischemia secondary to lower extremity arterial occlusive disease. Systolic ankle blood pressure and transcutaneous PO2 at the forefoot were significantly decreased in both groups of patients according to the severity of ischemic disease (p less than 0.001). The difference of the mean filling times between the first and last capillaries was used as a parameter for inhomogenous microvascular perfusion. It was significantly increased in moderate and severe ischemia (p less than 0.05). Transcapillary diffusion measured with a large window densitometer in a skin area of 2.8 mm2 was significantly enhanced in both groups of patients. The increase was more pronounced in the patients with severe ischemia (p less than 0.001) than in those with moderate ischemia (p less than 0.05). Among the patients with severe ischemia the diabetics exhibited significantly higher mean values of pericapillary fluorescence light intensity than the non-diabetics (p less than 0.001). At high magnification (550 times) distinct sites of increased transcapillary diffusion were detected in both groups of patients. They were most often localized at the apex of the capillary loops ("candle light phenomenon") and were more frequent in patients with severe than with moderate ischemia. In conclusion microvascular blood flow distribution is inhomogeneous and transcapillary diffusion increases at the level of single capillaries and skin areas in patients with moderate and especially severe foot ischemia.
通过视频显微镜系统，测量了健康对照组（n = 21）以及继发于下肢动脉闭塞性疾病的中度（n = 35）和重度（n = 29）缺血患者前足背部皮肤中经静脉注射的荧光素钠的跨毛细血管扩散情况。根据缺血疾病的严重程度，两组患者的前足收缩期踝部血压和经皮氧分压均显著降低（p < 0.001）。将第一个和最后一个毛细血管之间的平均充盈时间差异用作微血管灌注不均匀性的参数。在中度和重度缺血中，该参数显著增加（p < 0.05）。用大窗口密度计在2.8平方毫米的皮肤区域测量的跨毛细血管扩散在两组患者中均显著增强。重度缺血患者的增加比中度缺血患者更明显（重度缺血患者p < 0.001，中度缺血患者p < 0.05）。在重度缺血患者中，糖尿病患者的毛细血管周围荧光光强度平均值显著高于非糖尿病患者（p < 0.001）。在高倍放大（550倍）下，在两组患者中均检测到跨毛细血管扩散增加的明显部位。它们最常位于毛细血管袢的顶端（“烛光现象”），并且在重度缺血患者中比中度缺血患者更常见。总之，在中度尤其是重度足部缺血患者中，微血管血流分布不均匀，单个毛细血管和皮肤区域水平的跨毛细血管扩散增加。
