Schmid-Schönbein H
Arzneimittelforschung. 1981;31(11a):1999-2007.
At present, it is generally accepted that "microcirculatory disorders" are important, sometimes decisive complications of degenerative vascular diseases. In an attempt to sharpen the profile of these sometimes vaguely defined abnormalities, new definitions of "microcirculatory disorders" are proposed. After describing the normal circulation on the basis of the normal vascular integrity, the normal composition of blood and interstitial fluid, the normal rheological behavior of blood cells (in their natural habitat, the flowing blood) and the normal vascular tone, it becomes possible to define abnormalities. These abnormalities are not only quantitatively (as hypoperfusion) but also qualitatively different from the normal state of microcirculation. A microcirculatory disorder is therefore defined as a consequence of autonomous and autochthonous abnormalities of vascular wall, blood, and interstitial cells and fluids, which are basically independent of the macrocirculatory abnormalities but highly effective in complicating them. Proposals for therapeutic consequences of such concepts are given and criteria for the classification of drugs effective in the microcirculation are delineated. Lastly, in vitro and in vivo tests allowing to classify the success of the therapy are proposed. In the complex, chronic and multifacetted obliterative vascular diseases a pharmacological goal short of "clinical efficacy" is defined: a "useful therapeutic effect".
目前，人们普遍认为“微循环障碍”是退行性血管疾病重要的、有时甚至是决定性的并发症。为了更清晰地界定这些有时定义模糊的异常情况，本文提出了“微循环障碍”的新定义。在基于正常的血管完整性、血液和组织液的正常成分、血细胞（在其自然环境，即流动的血液中）的正常流变行为以及正常的血管张力描述了正常循环之后，就有可能定义异常情况。这些异常不仅在数量上（如灌注不足），而且在质量上也与微循环的正常状态不同。因此，微循环障碍被定义为血管壁、血液以及组织细胞和组织液自主和原发异常的结果，这些异常基本上独立于大循环异常，但在使大循环异常复杂化方面却非常有效。本文给出了基于这些概念的治疗建议，并阐述了用于微循环有效药物分类的标准。最后，提出了用于评估治疗效果的体外和体内试验方法。在复杂、慢性和多方面的闭塞性血管疾病中，定义了一个低于“临床疗效”的药理学目标：“有益的治疗效果”。
