Hersant Jeanne, Lecoq Simon, Ramondou Pierre, Papon Xavier, Feuilloy Mathieu, Abraham Pierre, Henni Samir
Vascular Medicine, University Hospital, Angers, France.
UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France.
Front Physiol. 2022 Feb 11;13:726315. doi: 10.3389/fphys.2022.726315. eCollection 2022.
Thoracic outlet syndrome (TOS) should be considered of arterial origin only if patients have clinical symptoms that are the result of documented symptomatic ischemia. Simultaneous recording of inflow impairment and forearm ischemia in patients with suspected TOS has never been reported to date. We hypothesized that ischemia would occur in cases of severely impaired inflow, resulting in a non-linear relationship between changes in pulse amplitude (PA) and the estimation of ischemia during provocative attitudinal upper limb positioning.
Prospective single center interventional study.
Fifty-five patients with suspected thoracic outlet syndrome.
We measured the minimal decrease from rest of transcutaneous oximetry pressure (DROPm) as an estimation of oxygen deficit and arterial pulse photo-plethysmography to measure pulse amplitude changes from rest (PA-change) on both arms during the candlestick phase of a "Ca + Pra" maneuver. "Ca + Pra" is a modified Roos test allowing the estimation of maximal PA-change during the "Pra" phase. We compared the DROPm values between deciles of PA-changes with ANOVA. We then analyzed the relationship between mean PA-change and mean DROPm of each decile with linear and second-degree polynomial (non-linear) models. Results are reported as median [25/75 centiles]. Statistical significance was < 0.05.
DROPm values ranged -11.5 [-22.9/-7.2] and - 12.3 [-23.3/-7.4] mmHg and PA-change ranged 36.4 [4.6/63.8]% and 38.4 [-2.0/62.1]% in the right and left forearms, respectively. The coefficient of determination between median DROPm and median PA-change was = 0.922 with a second-degree polynomial fitting, but only = 0.847 with a linear approach.
Oxygen availability was decreased in cases of severe but not moderate attitudinal inflow impairments. Undertaking simultaneous A-PPG and forearm oximetry during the "Ca + Pra" maneuver is an interesting approach for providing objective proof of ischemia in patients with symptoms of TOS suspected of arterial origin.
仅当患者出现有记录的症状性缺血所致的临床症状时，才应考虑胸廓出口综合征（TOS）源于动脉。迄今为止，尚未有关于在疑似TOS患者中同时记录血流灌注受损情况和前臂缺血情况的报道。我们推测，在血流严重受损的情况下会发生缺血，这会导致在诱发上肢特定姿势时脉搏幅度（PA）变化与缺血评估之间呈非线性关系。
前瞻性单中心干预性研究。
55例疑似胸廓出口综合征患者。
在“钙剂+握拳”动作的“握拳”阶段，我们测量经皮血氧饱和度压力从静息状态的最小下降值（DROPm），以此作为氧亏空的评估指标，并使用动脉脉搏光电容积描记法测量双臂从静息状态开始的脉搏幅度变化（PA变化）。“钙剂+握拳”是一种改良的鲁斯试验，可用于评估“握拳”阶段的最大PA变化。我们使用方差分析比较PA变化十分位数之间的DROPm值。然后，我们使用线性和二次多项式（非线性）模型分析每个十分位数的平均PA变化与平均DROPm之间的关系。结果以中位数[第25/75百分位数]报告。统计学显著性为<0.05。
右前臂和左前臂的DROPm值分别为-11.5 [-22.9/-7.2] mmHg和-12.3 [-23.3/-7.4] mmHg，PA变化分别为36.4 [4.6/63.8]%和38.4 [-2.0/62.1]%。二次多项式拟合时，中位数DROPm与中位数PA变化之间的决定系数为=0.922，但线性方法时仅为=0.847。
在严重但非中度的姿势性血流灌注受损情况下，氧供应会减少。在“钙剂+握拳”动作期间同时进行动脉脉搏光电容积描记法和前臂血氧饱和度测量，是为疑似源于动脉的TOS症状患者提供缺血客观证据的一种有趣方法。
