Chen Min-Ling, Lin Bor-Shyh, Su Cheng-Wei, Lin Yen-Bin, Chen Mei-Yen, Shen Jen-Hsiang, Chang Chang-Cheng
Department of Plastic Surgery, Chiayi Chang Gung Memorial Hospital, Wound Care Center, Chiayi County 613, Taiwan.
Institute of Imaging and Biomedical Photonics, College of Photonics, National Chiao Tung University, Tainan, Taiwan.
Lasers Surg Med. 2017 Sep;49(7):652-657. doi: 10.1002/lsm.22667. Epub 2017 Jun 5.
The majority of patients with diabetes foot ulcer have peripheral arterial disease. The technique of near infrared spectroscopy (NIRS) used to monitor the dorsal foot blood circulation condition is by measuring the absorption differences between oxy-hemoglobin and deoxy-hemoglobin.
STUDY DESIGNS/MATERIALS AND METHODS: Patients with diabetic foot ulcer (DFU) treated in our wound care center were divided into two sub-groups based on the Duplex ultrasound or angiography. Patients with peripheral arterial disease (PAD) and non-peripheral arterial disease were divided into group A1 and A2, respectively. We applied wireless NIRS on patients' dorsal foot to assess the peripheral circulation by continuously detect the signal penetrating the tissue while patients were asked to do Buerger's exercise. The same procedure was also repeated on 15 healthy participants as control group B.
From January to August 2015, 30 patients with DFU (Group A) were enrolled in the study, 9 patients in Group A1 and 21 patients in Group A2. Tissue concentration of oxygenated hemoglobin (HbO2) in each group varied in a similar trend among five stages of Buerger's exercise. HbO2 concentration increases at post-exercise stages in all groups (P = 0.006 in Group A1, P = 0.223 in Group A2, P = 0.03 in Group B), however, there were significant difference in both pre- and post-exercise stages (P = 0.001 and P = 0.01, respectively) between Group A and B. Moreover, significant differences (P = 0.0009) of HbO2 were also found between Group A1 and A2 in pre-exercise status, but no significant difference (P = 0.294) was found in post-exercise status. Similar results were also found in total hemoglobin (Hb) concentration analyses.
Buerger's exercise could increase peripheral HbO2 and total Hb circulation in patients with diabetes foot ulcer. The NIRS could continuously and quantitatively monitor real-time peripheral circulation in postural changes and is novel to rehabilitation program. A larger scale study to prove the accuracy of NIRS system in detecting peripheral circulation could be worthwhile. Lasers Surg. Med. 49:652-657, 2017. © 2017 Wiley Periodicals, Inc.
大多数糖尿病足溃疡患者患有外周动脉疾病。用于监测足背血液循环状况的近红外光谱（NIRS）技术是通过测量氧合血红蛋白和脱氧血红蛋白之间的吸收差异来实现的。
研究设计/材料与方法：在我们伤口护理中心接受治疗的糖尿病足溃疡（DFU）患者，根据双功超声或血管造影分为两个亚组。患有外周动脉疾病（PAD）和非外周动脉疾病的患者分别分为A1组和A2组。我们将无线NIRS应用于患者的足背，通过在患者进行勃格运动时连续检测穿透组织的信号来评估外周循环。同样的程序也在15名健康参与者身上重复进行，作为对照组B。
2015年1月至8月，30例DFU患者（A组）纳入研究，A1组9例，A2组21例。在勃格运动的五个阶段中，每组的氧合血红蛋白（HbO2）组织浓度变化趋势相似。所有组在运动后阶段HbO2浓度均升高（A1组P = 0.006，A2组P = 0.223，B组P = 0.03），然而，A组和B组在运动前和运动后阶段均存在显著差异（分别为P = 0.001和P = 0.01）。此外，在运动前状态下，A1组和A2组之间的HbO2也存在显著差异（P = 0.0009），但在运动后状态下未发现显著差异（P = 0.294）。在总血红蛋白（Hb）浓度分析中也发现了类似结果。
勃格运动可增加糖尿病足溃疡患者外周HbO2和总Hb循环。NIRS可以连续、定量地实时监测姿势变化时的外周循环，这在康复计划中是新颖的。进行一项更大规模的研究以证明NIRS系统检测外周循环的准确性可能是值得的。《激光外科与医学》49:652 - 657，2017。© 2017威利期刊公司
