Jochmann W, Mostbeck A, Partsch H
Department of Dermatology, Wilhelminen Hospital, Vienna, Austria.
Vasa. 1993;22(4):306-15.
Laser-Doppler fluxmetry was performed in 42 patients with leg ulcers (18 venous, 8 arterial, 12 diabetic-arteriolar and 4 mixed arterio-venous) and in 9 healthy controls. Using a bipolar probe measurement was carried out at the ulcer border and on the dorsum of the foot in the supine and in the sitting position. Reactive hyperemia after three minute arterial occlusion was produced in both body-positions. In every ulcer-group resting and peak fluxes showed a statistically significant increase in the ulcer region as compared to normal skin of the lower leg in the control group, the quotient between peak and resting flux ("reactive hyperemia index" RHI) being significantly lower. The RHI values for four ulcer-patients with a dramatic deterioration worsening eight months later were close to one, while the unchanged and improved cases showed median values above 1,2. Sitting up was followed by a decrease of flux in all ulcer-groups as well as in the control group. On the dorsum of the foot there was an increase of the laser Doppler flux in patients with arterial occlusive disease, i.e. in the group with arterial and mixed ulcers. This study shows that the kind of microcirculatory flow damage is not different in various causes of ulcerations. The reduced reactive hyperemic response compared to the increased resting fluxes (amount of RHI-decrease) might be a useful predictor for healing or non-healing of the ulcer.
对42例腿部溃疡患者（18例静脉性溃疡、8例动脉性溃疡、12例糖尿病性小动脉溃疡和4例动静脉混合性溃疡）以及9名健康对照者进行了激光多普勒血流测定。使用双极探头，在仰卧位和坐位时于溃疡边缘及足背进行测量。在两种体位下均通过三分钟动脉闭塞诱导产生反应性充血。与对照组小腿正常皮肤相比，各溃疡组的静息血流和峰值血流在溃疡区域均有统计学意义的增加，峰值血流与静息血流的比值（“反应性充血指数”RHI）显著降低。8个月后病情急剧恶化的4例溃疡患者的RHI值接近1，而病情未改变和有所改善的患者的中位数高于1.2。所有溃疡组以及对照组在坐起后血流均减少。在患有动脉闭塞性疾病的患者中，即动脉性溃疡和混合性溃疡组中，足背的激光多普勒血流增加。本研究表明，不同病因的溃疡中微循环血流损伤类型并无差异。与静息血流增加相比反应性充血反应降低（RHI降低幅度）可能是溃疡愈合或不愈合的有用预测指标。
