[激光多普勒血流仪与肢体动脉疾病。与经皮氧分压测量的相关性]

[Laser-Doppler flowmetry and arterial diseases of the limbs. Correlations with measurement of transcutaneous oxygen pressure].

作者信息

Schmidt C, Adechokan S, Mouhli J

机构信息

Unité d'Angiologie, Hôpital Central, CHU de Nancy.

出版信息

J Mal Vasc. 1996;21(5):294-8.

PMID:9026545

Abstract

The place of laser-Doppler flowmetry is not well established among the other techniques of evaluation of local microcirculatory blood flow. We conducted a study in 15 controls (mean age 49.5 yrs, 30 limbs) and 37 patients with peripheral arterial occlusive disease (PAOD) (mean age 59.1 yrs, 67 limbs, 50 mild ischemia and 17 severe ischemia) and assessed the local blood flow with laser-Doppler (Perimed PF3) and transcutaneous oximetry (Hellige Oxymonitor); both probes being heated at 44 degrees C. Transcutaneous oxygen tension (TcpO2 mmHg) and laser-Doppler fluxes (LDF in perfusion units PU) were measured at the foot dorsum in resting horizontal supine position and leg dependency (30 controls, 67 PAOD) and during post-ischemic reactive hyperemia (36 PAOD). The results (mean +/- sd) were compared within each group (controls, mild ischemia, severe ischemia) by means of a paired t-test, between the different groups by a variance analysis and correlations by a Spearman test. LDF decreased from supine position to leg dependency in the control group (24.1 +/- 22.2 PU horizontal vs 19.0 +/- 26.2 dependent, N = 30, p < .05) but not in the PAOD group (mild ischemia respectively 46.0 +/- 41 vs 42.9 +/- 35 PU, N = 50; severe ischemia 41.3 +/- 27 vs 48.6 +/- 42 PU, N = 17). LDF was significantly higher at rest: mild ischemia 46 +/- 41 (N = 50), severe ischemia 41.3 +/- 27 (N = 17) vs controls 24.1 +/- 22 PU (p < .005). LDF increased during hyperemia in controls (peak flux 42.4 +/- 28.9 PU, p < .00001) and in patients with mild ischemia (46.0 +/- 42 vs 32.5 +/- 39 PU at rest, N = 29, p < .005) but not in severe ischemia (29.4 +/- 18 vs 28.7 +/- 33 PU at rest, N = 7). TcpO2 at rest (65.9 +/- 14 mmHg in 30 controls) decreased significantly in mild ischemia (55.6 +/- 16 mmHg, N = 48) and severe ischemia (32.1 +/- 26 mmHg, N = 17, p < .005). On leg dependency, TcpO2 increased in mild ischemia (70.2 +/- 13 leg dependent vs 52.6 +/- 12 mmHg horizontal, N = 21, p < .001) and severe ischemia (respectively 35.6 +/- 24 and 26.1 +/- 15 mmHg, N = 10, p < .01). No correlations were found between LDF parameters and TcpO2 except in patients with severe ischemia (LDF horizontal and dependent with TcpO2 dependent).

摘要

在评估局部微循环血流的其他技术中，激光多普勒血流仪的地位尚未完全确立。我们对15名对照组患者（平均年龄49.5岁，30条肢体）和37名外周动脉闭塞性疾病（PAOD）患者（平均年龄59.1岁，67条肢体，50例轻度缺血和17例重度缺血）进行了一项研究，并用激光多普勒（Perimed PF3）和经皮血氧测定法（Hellige Oxymonitor）评估局部血流；两种探头均加热至44摄氏度。在静息水平仰卧位和腿部下垂位（30名对照组患者，67名PAOD患者）以及缺血后反应性充血期间（36名PAOD患者），测量足背的经皮氧分压（TcpO2 mmHg）和激光多普勒通量（LDF，以灌注单位PU表示）。通过配对t检验在每组（对照组、轻度缺血组、重度缺血组）内比较结果（平均值±标准差），通过方差分析在不同组之间比较结果，并通过Spearman检验分析相关性。在对照组中，LDF从仰卧位到腿部下垂位降低（水平位24.1±22.2 PU，下垂位19.0±26.2 PU，N = 30，p <.05），但在PAOD组中未降低（轻度缺血组分别为46.0±41和42.9±35 PU，N = 50；重度缺血组为41.3±27和48.6±42 PU，N = 17）。静息时LDF显著更高：轻度缺血组为46±41（N = 50），重度缺血组为41.3±27（N = 17），而对照组为24.1±22 PU（p <.005）。对照组和轻度缺血患者在充血期间LDF增加（峰值通量分别为42.4±28.9 PU，p <.00001和46.0±42与静息时32.5±39 PU，N = 29，p <.005），但重度缺血患者未增加（静息时29.4±18与28.7±33 PU，N = 7）。静息时的TcpO2（30名对照组患者为65.9±14 mmHg）在轻度缺血组（55.6±16 mmHg，N = 48）和重度缺血组（32.1±26 mmHg，N = 17，p <.005）中显著降低。在腿部下垂位时，轻度缺血组（腿部下垂位70.2±13与水平位52.6±12 mmHg，N = 21，p <.001）和重度缺血组（分别为35.6±24和26.1±15 mmHg，N = 10，p <.01）的TcpO2增加。除了重度缺血患者（LDF水平位和下垂位与TcpO2下垂位）外，未发现LDF参数与TcpO2之间存在相关性。