Kazmers A, Koski M E, Groehn H, Oust G, Meeker C, Bickford-Laub T, Abson K, Bass N
Vascular Surgery Laboratory, Harper Hospital, Detroit, Michigan, 48201, USA.
Am Surg. 1996 Apr;62(4):315-9.
Palpation of pedal pulses was compared to noninvasive testing in 100 patients referred to a vascular laboratory. Subjects were 65 +/- 13 (mean +/- s.d.) years old. The right dorsalis pedis (DP) artery served as the reference artery for comparison of Doppler studies with physical examination of the pulses. Absolute Doppler pressures in the right DP were 129 +/- 50 mm Hg. The right ankle:brachial index (ABI) was 0.86 +/- 0.32. There were significant differences in ABI in those with (0.68 +/- 0.28) vs without (0.95 +/- 0.31) claudication in either extremity (p < 0.001). Rest pain was also associated with lower ABI (P < 0.04). Diabetics, hypertensives, claudicants and those with ischemic rest pain were less likely to have palpable pulses (P < 0.035). With right DP pressure >/= 118 mm Hg, 63 per cent of subjects had a palpable DP pulse, whereas 68 per cent with ABI > 0.82 had a palpable right DP. Of those (n = 35) with a right DP pressure < 118 mm Hg, only 6 per cent (n = 2) had a palpable pulse, whereas 5 per cent (2/40) with ABI </= 0.82 had palpable DP pulses. Based on these findings, it was predicted that a pulse would likely not be palpable in the left DP with a pressure < 118 mm Hg or with AB </= 0.82. The prediction based on systolic ankle pressures was correct, with 66 per cent sensitivity and 91 per cent specificity. The predication that a left DP pulse would not be palpable with AB </= 0.82 was more accurate (78% sensitive, 97% specific). Presence of a palpable DP pulse suggests the presence of a Doppler pressure >/= 188 mm Hg and ABI > 0.82. The range of ankle pressures with palpable right DP pulses was 64-220 mm Hg, whereas the range with nonpalpable DP was 42-300 mm Hg. Given the frequent disparity of pulse exam and ankle pressures, noninvasive Doppler testing may be necessary for many patients to accurately assess the vascular status of the leg.
对100名转诊至血管实验室的患者进行了足背脉搏触诊与非侵入性检测的比较。受试者年龄为65±13（均值±标准差）岁。右侧足背动脉（DP）作为参考动脉，用于将多普勒研究结果与脉搏体格检查结果进行比较。右侧DP的绝对多普勒压力为129±50mmHg。右侧踝肱指数（ABI）为0.86±0.32。双下肢有间歇性跛行（0.68±0.28）与无间歇性跛行（0.95±0.31）的患者ABI存在显著差异（p<0.001）。静息痛也与较低的ABI相关（P<0.04）。糖尿病患者、高血压患者、间歇性跛行患者以及有缺血性静息痛的患者触及脉搏的可能性较小（P<0.035）。当右侧DP压力≥118mmHg时，63%的受试者可触及DP脉搏，而ABI>0.82的受试者中68%可触及右侧DP脉搏。在右侧DP压力<118mmHg的35名受试者中，只有6%（n = 2）可触及脉搏，而ABI≤0.82的受试者中5%（2/40）可触及DP脉搏。基于这些发现，预计左侧DP压力<118mmHg或ABI≤0.82时可能触不到脉搏。基于收缩期踝压的预测是正确的，敏感性为66%，特异性为91%。关于ABI≤0.82时左侧DP脉搏触不到的预测更准确（敏感性78%，特异性97%）。可触及DP脉搏提示存在多普勒压力≥188mmHg且ABI>0.82。可触及右侧DP脉搏时的踝压范围为64 - 220mmHg，而不可触及DP脉搏时的范围为42 - 300mmHg。鉴于脉搏检查和踝压经常存在差异，对于许多患者来说，非侵入性多普勒检测可能是准确评估腿部血管状况所必需的。
