外周动脉闭塞性疾病患者上下身运动时的经皮氧分压和多普勒踝压

Transcutaneous oxygen tension and Doppler ankle pressure during upper and lower body exercise in patients with peripheral arterial occlusive disease.

作者信息

Liu Y, Steinacker J M, Stauch M

机构信息

Abt. Sport- und Leistungsmedizin, Universität Ulm, Germany.

出版信息

Angiology. 1995 Aug;46(8):689-98. doi: 10.1177/000331979504600807.

DOI:10.1177/000331979504600807

PMID:7639415

Abstract

The effects of upper and lower body exercise on blood supply to the lower extremities were investigated in patients with peripheral arterial occlusive disease (PAOD) by measurements of transcutaneous oxygen tension (tcPO2) and Doppler ankle pressure (DAP). Twenty patients with PAOD (PAOD group) and 10 subjects without PAOD (control group) performed treadmill test (TT), recumbent cycle ergometry (CE), and rowing ergometry (RE) with a fixed seat. The tcPO2 was registered on the calf and DAP was measured at the end of each step of CE and RE. The walking distance in TT of the control group was not limited (> 1000 m), whereas that of the PAOD group was 161 m in median. In the control group there was no significant difference of performance between CE (125 +/- 33 W) and RE (111 +/- 24 W), whereas in the PAOD group, performance was lower in CE (72 +/- 31 W) than in RE (102 +/- 28 W) (P < 0.01). DAP of controls increased during both CE (136 to 165 mmHg) and RE (170 to 213 mmHg), whereas the DAP of the PAOD group decreased during CE (from 85 to 44 mmHg) and remained relatively constant during RE (113 to 101 mmHg). In controls, tcPO2 did not distinctly change during TT (70 to 66 mmHg) and increased during CE (58 to 73 mmHg) and RE (69 to 82 mmHg), whereas in the PAOD group, tcPO2 decreased during TT (66 to 33 mmHg) and CE (50 to 22 mmHg) and remained almost unchanged in RE (64 to 60 mmHg). A hyperbolic relationship was found between tcPO2 and DAP. In conclusion, during upper body exercise, blood supply to the lower extremities in patients with PAOD was not affected, whereas lower body exercise led to exhaustion of the functional reserve of blood supply. Because of a hyperbolic relationship between tcPO2 and DAP, tcPO2 remained relatively constant if blood supply was sufficient, but in disturbed blood supply a small change of DAP was accompanied by a great change of tcPO2. Therefore, in critical ischemia the change of tcPO2 was more sensitive than that of DAP.

摘要

通过测量经皮氧分压（tcPO2）和多普勒踝压（DAP），研究了上下肢运动对周围动脉闭塞性疾病（PAOD）患者下肢血液供应的影响。20例PAOD患者（PAOD组）和10例无PAOD的受试者（对照组）进行了固定座位的跑步机测试（TT）、卧式自行车测力计测试（CE）和划船测力计测试（RE）。在小腿记录tcPO2，并在CE和RE的每一步结束时测量DAP。对照组TT的步行距离不受限（>1000米），而PAOD组的中位数为161米。在对照组中，CE（125±33瓦）和RE（111±24瓦）之间的表现无显著差异，而在PAOD组中，CE（72±31瓦）的表现低于RE（102±28瓦）（P<0.01）。对照组的DAP在CE（136至165毫米汞柱）和RE（170至213毫米汞柱）期间均升高，而PAOD组的DAP在CE期间下降（从85至44毫米汞柱），在RE期间保持相对稳定（113至101毫米汞柱）。在对照组中，tcPO2在TT期间无明显变化（70至66毫米汞柱），在CE期间升高（58至73毫米汞柱），在RE期间升高（69至82毫米汞柱），而在PAOD组中，tcPO2在TT期间下降（66至33毫米汞柱），在CE期间下降（50至22毫米汞柱），在RE期间几乎保持不变（64至60毫米汞柱）。发现tcPO2与DAP之间存在双曲线关系。总之，在上肢运动期间，PAOD患者下肢的血液供应不受影响，而下肢运动导致血液供应功能储备耗尽。由于tcPO2与DAP之间存在双曲线关系，如果血液供应充足，tcPO2保持相对稳定，但在血液供应紊乱时，DAP的微小变化会伴随着tcPO2的巨大变化。因此，在严重缺血时，tcPO2的变化比DAP更敏感。