Ray S A, Buckenham T M, Belli A M, Taylor R S, Dormandy J A
Department of Vascular Surgery and Interventional Radiology, St. George's Hospital Medical School, London, U.K.
Eur J Vasc Endovasc Surg. 1997 Jan;13(1):54-9. doi: 10.1016/s1078-5884(97)80051-2.
To investigate the predictive value of laser Doppler fluxmetry and transcutaneous oximetry in 41 patients undergoing technically successful revascularisation for severe leg ischaemia.
Toe and ankle systolic arterial pressures, transcutaneous oxygen tension (tcpO2), and stressed laser Doppler fluxmetry at the foot (time to peak laser Doppler flux following 2 min arterial occlusion, tp LDF, and the response of LDF to raising the leg 40 cm, the elevated:supine LDF ratio) were measured before revascularisation. Six months later these measurements were compared in those patients who were clinically improved, and those who still had symptoms of severe ischaemia or had lost their limb.
Vascular Laboratory, St. George's Hospital, London SW17, U.K.
Six months following revascularisation 30 (73%) of the 41 patients had partial or complete symptomatic relief. Six (15%) had undergone major amputation and five (12%) still had symptoms of severe ischaemia. Before intervention toe and ankle systolic pressures were similar in the 30 who were improved and the 11 who had lost, or were still at risk of losing, their leg. Pre-revascularisation tcpO2 was significantly lower (18.3 mm Hg vs 33.5 mm Hg; p < 0.05) and tp LDF significantly longer (140 s vs 92 s; P < 0.05) in the 11 patients who were not clinically improved at 6 months. Whilst pre-revascularisation toe and ankle pressures below 30 mm Hg and 50 mm Hg respectively identified only 55% of those patients who were not improved 6 months later, a tp LDF in excess of 100 s identified 82% (p < 0.05) and was noted in five of the six amputees.
Microcirculatory assessments performed in patients with limb-threatening ischaemia are likely to be more deranged in those patients who suffer clinical failure or amputation despite an apparently successful revascularisation procedure.
研究激光多普勒血流测定法和经皮血氧测定法对41例因严重下肢缺血而接受技术上成功的血管重建术患者的预测价值。
在血管重建术前测量趾部和踝部的收缩期动脉压、经皮氧分压（tcpO2）以及足部的应激激光多普勒血流测定值（动脉闭塞2分钟后激光多普勒血流峰值出现的时间，tp LDF，以及将腿部抬高40厘米时LDF的反应，即抬高：仰卧LDF比值）。六个月后，对临床症状改善的患者以及仍有严重缺血症状或已截肢的患者进行这些测量值的比较。
英国伦敦SW17圣乔治医院血管实验室
血管重建术后六个月，41例患者中有30例（73%）部分或完全缓解了症状。6例（15%）接受了大截肢手术，5例（12%）仍有严重缺血症状。在症状改善的30例患者和腿部已丧失或仍有丧失风险的11例患者中，干预前趾部和踝部收缩压相似。在六个月时临床症状未改善的11例患者中，血管重建术前tcpO2显著更低（18.3毫米汞柱对33.5毫米汞柱；p<0.05），tp LDF显著更长（140秒对92秒；P<0.05）。虽然血管重建术前趾部和踝部压力分别低于30毫米汞柱和50毫米汞柱仅能识别出6个月后症状未改善患者中的55%，但tp LDF超过100秒能识别出82%（p<0.05），且6例截肢患者中有5例出现这种情况。
在肢体威胁性缺血患者中进行的微循环评估，在那些尽管血管重建手术表面上成功但仍出现临床失败或截肢的患者中可能更紊乱。
