Tønnesen K H
Acta Anaesthesiol Scand Suppl. 1978;68:107-10. doi: 10.1111/j.1399-6576.1978.tb01403.x.
Transcutaneous oxygen tension at 44 degree C and maximal isotope clearance (90m Tc-pretechnetate + histramine) just proximal to the 1st toe and systolic toe blood pressure (strain gauge) were studied on a tilt table in patients with various degrees of obstructive arteriosclerotic disease. In legs with moderate obstruction, the oxygen tension reached zero at a toe systolic blood pressure of 5--10 mmHg (tilt toe up) and reached arterial oxygen tension at about 50 to 70 mmHg (tilt toe down). In legs withsevere arterial obstruction and ischaemic rest pain, oxygen tension rose from zero not before systolic toe blood pressure reached 20--50 mmHg. Significant isotope clearance was seen at pressures below the limits just mentioned for both types of patients. This phenomenon here seen of a perfusion without oxygen supply is explained by a gas leak (rendered significant because of the slow flow rate) from the arterioles into the tissue sink and counter current gas shunting. The hypoxia in spite of a positive perfusion pressure up to 50 mmHg explains our experience that ischemic ulcers in feet such low pressures never heal.
在倾斜台上对患有不同程度阻塞性动脉硬化疾病的患者进行了研究，测量了44摄氏度时的经皮氧分压、第一趾近端的最大同位素清除率（90m锝-高锝酸盐+组胺）以及趾收缩压（应变计）。在中度阻塞的腿部，当趾收缩压为5-10mmHg（趾向上倾斜）时，氧分压降至零，而当趾收缩压约为50至70mmHg（趾向下倾斜）时，氧分压达到动脉氧分压。在严重动脉阻塞且有静息性缺血性疼痛的腿部，直到趾收缩压达到20-50mmHg时，氧分压才从零开始上升。对于这两类患者，在低于上述限度的压力下均可见明显的同位素清除。此处所观察到的在无氧供应情况下的灌注现象，是由于小动脉向组织池的气体泄漏（由于流速缓慢而变得显著）以及逆流气体分流所致。尽管灌注压高达50mmHg仍存在缺氧现象，这解释了我们在临床上遇到的足部缺血性溃疡在如此低的压力下无法愈合的情况。
