Jünger M, Hahn M, Klyscz T, Rassner G
Department of Dermatology, University Hospital, Tübingen.
Vasa. 1996;25(4):341-8.
Cutaneous blood flow regulation is disturbed in severe chronic venous insufficiency (CVI). The feedback system between the transmural pressure in the postcapillary venules and the precapillary resistance regulating arterioles has gone awry. The upregulated control system causes "luxus"-hyperperfusion. In this study laser Doppler fluxmetry was performed in 6 patients' florid venous ulcers (U) and later in the former ulcer area after healing (H) and in the inner ankle area of 12 healthy volunteers (C). Laser Doppler flux (LDF) changes were measured with the leg elevated and lowered as well as after arterial and during venous occlusion. The results proved a diminished (p < 0.01) flux increase with the leg elevated (U: LDF = -9%, H: LDF = 3.1%, C: LDF = 80%) and after arterial occlusion (U: LDF = 1.3%, H: LDF = 0%; C: 189.6%) in severe CVI both in florid ulcers and after healing. The ability to reduce flux when transmural pressures were increased remained. Leg lowering reduced flux by 46.4% in ulcers and by 36.8% after healing. This postural response to high transmural pressures, however, seemed weakened compared to controls, where LDF decreased by 65.8%. Our findings suggest that the postural feedback system remains disturbed and upregulated even after a venous ulcer has healed.
在严重慢性静脉功能不全（CVI）中，皮肤血流调节受到干扰。毛细血管后微静脉的跨壁压力与调节小动脉的毛细血管前阻力之间的反馈系统出现紊乱。上调的控制系统导致“过度”灌注。在本研究中，对6例患有活动性静脉溃疡（U）的患者进行激光多普勒血流测定，随后在溃疡愈合后的原溃疡区域（H）以及12名健康志愿者内踝区域（C）进行测定。在腿部抬高和降低时以及动脉闭塞后和静脉闭塞期间测量激光多普勒血流（LDF）变化。结果表明，在严重CVI中，无论是活动性溃疡还是愈合后，腿部抬高时（U：LDF = -9%，H：LDF = 3.1%，C：LDF = 80%）和动脉闭塞后（U：LDF = 1.3%，H：LDF = 0%；C：189.6%），血流增加均减少（p < 0.01）。当跨壁压力升高时降低血流的能力仍然存在。腿部降低使溃疡处血流减少46.4%，愈合后减少36.8%。然而，与对照组相比，这种对高跨壁压力的姿势反应似乎减弱，对照组LDF降低了65.8%。我们的研究结果表明，即使静脉溃疡愈合后，姿势反馈系统仍受到干扰且上调。
