Abu-Own A, Shami S K, Chittenden S J, Farrah J, Scurr J H, Smith P D
Department of Surgery, University College London Medical School, England.
J Vasc Surg. 1994 Jun;19(6):1074-83. doi: 10.1016/s0741-5214(94)70220-9.
The reasons for the efficacy of leg compression in the treatment of chronic venous insufficiency are not clear. We have used laser Doppler fluxmetry to assess the effect of external compression on the skin microcirculation.
Fifteen patients with lipodermatosclerosis caused by chronic venous insufficiency and 15 control subjects were studied in the supine and sitting positions. The laser Doppler probe, incorporated in a polyethylene chamber, was applied to the lower leg underneath a blood pressure cuff. Pressures were applied from 10 to 100 mm Hg in increments of 10 mm Hg. A computer data logging system recorded laser Doppler flux blood cell velocity, and concentration of moving blood cells.
In patients in the supine position, 20 mm Hg compression resulted in a median increase of 33% in laser Doppler flux, and a median increase of 79% in blood cell velocity, but higher pressures caused a progressive decrease in laser Doppler flux and blood cell velocity. With the patient in the sitting position, compression up to 60 mm Hg caused an increase in laser Doppler flux (median percentage increase at 20 mm Hg compression 84%) and blood cell velocity (median percentage increase at 20 mm Hg compression 22%). At 20 mm Hg compression, the concentration of moving blood cells decreased in the supine position (median percentage fall 27%) but did not change significantly in the dependent position. The effects of compression in control subjects were similar to those in patients, but to a lesser degree.
Our study suggests that compression treatment may achieve part of its effect by causing an increase in the microcirculatory flow velocity.
腿部加压治疗慢性静脉功能不全有效的原因尚不清楚。我们使用激光多普勒血流仪来评估外部加压对皮肤微循环的影响。
对15例由慢性静脉功能不全引起脂膜炎性硬化的患者和15名对照者进行仰卧位和坐位研究。将置于聚乙烯腔内的激光多普勒探头应用于小腿部的血压袖带下方。以10mmHg的增量从10至100mmHg施加压力。计算机数据记录系统记录激光多普勒血流、血细胞速度和流动血细胞浓度。
在仰卧位患者中，20mmHg的加压导致激光多普勒血流中位数增加33%，血细胞速度中位数增加79%，但更高的压力导致激光多普勒血流和血细胞速度逐渐降低。患者处于坐位时，高达60mmHg的加压导致激光多普勒血流增加（20mmHg加压时中位数增加百分比为84%）和血细胞速度增加（20mmHg加压时中位数增加百分比为22%）。在20mmHg加压时，流动血细胞浓度在仰卧位降低（中位数下降百分比为27%），但在垂位时无明显变化。对照者的加压效果与患者相似，但程度较轻。
我们的研究表明，加压治疗可能通过增加微循环流速来实现其部分效果。
