Fagrell B
Karolinska Institute, Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden.
Int J Microcirc Clin Exp. 1995;15 Suppl 1:34-40. doi: 10.1159/000179093.
Many methods are available today for clinical evaluation of the blood supply to an extremity or part of an extremity, some of which are excellent for determining the presence and severity of arterial and venous disorders. These methods, however, do not give any information on the microvascular status of the diseased areas. This is particularly true for the skin circulation, which has a rather complex vascular network with nutritional and thermoregulatory vessels, arteriovenous shunts, etc. The most useful method for clinical evaluation of the skin capillary circulation is vital capillary microscopy. The skin capillaries in an area with a reduced microcirculation change in structure, and it is possible to evaluate the viability of the skin by microscopic studies of these capillary changes. Both morphology and blood flow can be investigated. By using different intravital fluorescent dyes, e.g. sodium fluorescein and indocyanine green, the microvascular dynamics, flow distribution and microvascular permeability can also be studied. The total skin microcirculation can be evaluated by Laser Doppler fluxmetry, which measures primarily the blood flow in the thermoregulatory vascular bed, i.e. the subpapillary arterial and venous plexa. It is easy to use in clinical practice, but interpretation of the results can sometimes be difficult. Measuring transcutaneous oxygen tension has for many years been used in clinical routine to evaluate the viability of skin in patients with vascular disorders. It has recently been shown that inhalation of oxygen may induce vasoconstriction in healthy subjects and in patients with moderate arterial insufficiency, but an increase of the skin microcirculation in areas of severe ischaemia. By using different combinations of the above mentioned microcirculatory techniques, valuable information can be gained regarding pathophysiological phenomena of the microcirculation in many diseases, e.g. vascular disorders, collagenosis. Raynaud's phenomenon, diabetes and hypertension. Using techniques for both macro- and microcirculation is also of great importance for evaluating the effect of therapeutic procedures in several of these disorders.
如今有许多方法可用于临床评估肢体或肢体某一部分的血液供应情况，其中一些方法在确定动脉和静脉疾病的存在及严重程度方面非常出色。然而，这些方法无法提供有关患病区域微血管状态的任何信息。对于皮肤循环而言尤其如此，皮肤具有相当复杂的血管网络，包括营养血管、体温调节血管、动静脉分流等。临床评估皮肤毛细血管循环最有用的方法是活体毛细血管显微镜检查。微循环减少区域的皮肤毛细血管结构会发生变化，通过对这些毛细血管变化进行显微镜研究，可以评估皮肤的活力。形态和血流均可进行研究。通过使用不同的活体荧光染料，例如荧光素钠和吲哚菁绿，还可以研究微血管动力学、血流分布和微血管通透性。激光多普勒血流仪可用于评估皮肤整体微循环，它主要测量体温调节血管床（即乳头下动静脉丛）中的血流。该方法在临床实践中易于使用，但结果的解读有时可能会有困难。多年来，测量经皮氧分压一直用于临床常规评估血管疾病患者皮肤的活力。最近有研究表明，吸氧可能会使健康受试者和中度动脉供血不足患者的血管收缩，但会使严重缺血区域的皮肤微循环增加。通过将上述微循环技术进行不同组合，可以获得有关许多疾病（例如血管疾病、胶原病、雷诺现象、糖尿病和高血压）中微循环病理生理现象的有价值信息。对于评估这些疾病中几种疾病的治疗程序效果而言，同时使用宏观和微观循环技术也非常重要。
