Kram H B, Appel P L, Shoemaker W C
Department of Surgery, King-Drew Medical Center, Los Angeles, California 90059.
Am J Surg. 1988 Apr;155(4):551-8. doi: 10.1016/s0002-9610(88)80409-4.
The present study examined prospectively the prognostic value of preoperative clinical findings, angiography, and conventional vascular hemodynamic and transcutaneous oximetry measurements in a consecutive series of patients undergoing lower extremity vascular reconstruction. A total of 25 variables were independently evaluated in each limb. Follow-up at least 6 months after operation was carried out in all patients. The postocclusive transcutaneous oxygen recovery time was found to be the most accurate predictor of short-term femoropopliteal bypass graft success. Preoperative foot transcutaneous oxygen recovery time values were significantly worse in patients whose femoropopliteal bypass grafts failed than in those in whom the outcome was successful (p less than 0.03). Transcutaneous oxygen recovery time values were also valuable in patients who underwent aortofemoral bypass; patients with isolated aortoiliac disease had significantly better foot transcutaneous oxygen recovery time values than those with combined aortoiliac and femoropopliteal disease (p less than 0.05). Foot transcutaneous oxygen recovery time values were also found to correlate well with the severity of symptoms (p less than 0.01), as did ankle-brachial Doppler pressure indices. Although the other variables analyzed provided useful diagnostic information, none were as accurate as the postocclusive transcutaneous oxygen recovery time in predicting the outcome of peripheral vascular reconstruction. As a means of more accurately classifying patients with peripheral vascular disease, we recommend the complimentary use of clinical findings, angiography, and hemodynamic and transcutaneous oximetry measurements. Because transcutaneous oxygen tension reflects the balance between local oxygen supply and demand, it may help to better define risk factors preoperatively in physiologic terms.
本研究前瞻性地探讨了术前临床检查结果、血管造影以及传统血管血流动力学和经皮血氧饱和度测量在一系列连续接受下肢血管重建手术患者中的预后价值。对每个肢体独立评估了总共25个变量。所有患者均在术后至少随访6个月。发现闭塞后经皮氧恢复时间是股腘动脉旁路移植短期成功最准确的预测指标。股腘动脉旁路移植失败患者的术前足部经皮氧恢复时间值明显比手术成功患者差（p<0.03）。经皮氧恢复时间值在接受主股动脉旁路移植的患者中也很有价值；单纯主动脉髂动脉疾病患者的足部经皮氧恢复时间值明显优于合并主动脉髂动脉和股腘动脉疾病的患者（p<0.05）。还发现足部经皮氧恢复时间值与症状严重程度密切相关（p<0.01），踝臂多普勒压力指数也是如此。尽管所分析的其他变量提供了有用的诊断信息，但在预测外周血管重建的结果方面，没有一个像闭塞后经皮氧恢复时间那样准确。作为更准确地对周围血管疾病患者进行分类的一种方法，我们建议综合使用临床检查结果、血管造影以及血流动力学和经皮血氧饱和度测量。由于经皮氧张力反映了局部氧供需之间的平衡，它可能有助于从生理学角度更好地术前确定危险因素。
