Fuhrman T M, McSweeney E
University of South Florida, College of Medicine, Tampa, Department of Anesthesiology, 33612, USA.
Acad Emerg Med. 1995 Mar;2(3):195-9. doi: 10.1111/j.1553-2712.1995.tb03196.x.
To compare four methods of evaluating collateral blood flow to the hand.
The hands of 74 volunteers on the faculty or staff of a university hospital were studied prospectively. Only subjects without known peripheral vascular disease were included. Four tests were used in random order to assess radial and ulnar artery flow. Results of the assessments using the modified Allen's test, pulse oximetry, plethysmography, and laser Doppler perfusion monitoring were compared.
No interrupted palmar arch was found. The modified Allen's test was normal in all cases. Pulse oximetry detected a 5% incidence of noticeably reduced blood flow in one artery compared with the other artery. This dominance of one artery was identified in 69% of the hands by plethysmography. The laser Doppler noted a dominant artery in 64% of the hands. Plethysmography and the laser Doppler disagreed in their findings in only 9% of the hands evaluated. Numerical values of blood flow, attainable only by the laser Doppler, were significantly lower upon occlusion of the radial vs the ulnar arteries (p < 0.05; paired t-test).
All of the tests provide information about the collateral circulation to the hand. Only the laser Doppler provides quantitative blood flow. Further studies involving subjects most at risk for post-cannulation ischemic injury are needed to guide the clinical application of these findings.
比较四种评估手部侧支血流的方法。
对某大学医院74名教职员工志愿者的手部进行前瞻性研究。仅纳入无已知外周血管疾病的受试者。采用四种测试方法，以随机顺序评估桡动脉和尺动脉血流。比较改良艾伦试验、脉搏血氧测定法、体积描记法和激光多普勒血流监测的评估结果。
未发现掌弓中断。所有病例中改良艾伦试验均正常。脉搏血氧测定法检测到一条动脉血流明显低于另一条动脉的发生率为5%。体积描记法在69%的手部中识别出一条动脉占优势。激光多普勒在64%的手部中检测到一条优势动脉。在仅9%的评估手部中，体积描记法和激光多普勒的结果不一致。仅激光多普勒可获得的血流数值在桡动脉闭塞时显著低于尺动脉闭塞时（p < 0.05；配对t检验）。
所有测试均提供有关手部侧支循环的信息。只有激光多普勒能提供定量血流。需要对插管后缺血性损伤风险最高的受试者进行进一步研究，以指导这些研究结果的临床应用。
