Koman L A, Ruch D S, Aldridge M, Smith B P, Holden M B, Fulcher M
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
J Hand Surg Am. 1998 Sep;23(5):773-82. doi: 10.1016/S0363-5023(98)80150-0.
Patients were evaluated before and after arterial reconstruction surgery (1) to define the physiology of the digital microcirculation in chronic subcritical ischemia, (2) to demonstrate the short-term effects of successful arterial reconstruction on microvascular flow, and (3) to document the effects of surgery on symptoms, function, and health-related quality of life. Arterial insufficiency was the result of a proximal reconstructible occlusive lesion, 1 or more distal unreconstructible occlusions, and secondary reactive vasospasm. Microvascular physiology was evaluated by monitoring digital temperatures, microvascular perfusion (laser Doppler fluxmetry) and perfusion patterns (laser Doppler perfusion patterns (laser Doppler perfusion imaging). Following successful vascular reconstruction, digital temperatures and microvascular perfusion improved significantly, approaching control levels. Although cold sensitivity was unchanged, symptoms decreased and upper extremity function and health-related quality of life improved after successful proximal reconstruction in patients with 2-level arterial occlusion.
对患者在动脉重建手术前后进行评估，目的如下：（1）明确慢性亚临界缺血状态下指端微循环的生理状况；（2）证明成功的动脉重建对微血管血流的短期影响；（3）记录手术对症状、功能及与健康相关的生活质量的影响。动脉供血不足是由近端可重建的闭塞性病变、1个或更多远端不可重建的闭塞以及继发性反应性血管痉挛所致。通过监测指端温度、微血管灌注（激光多普勒血流仪）及灌注模式（激光多普勒灌注模式（激光多普勒灌注成像））来评估微血管生理状况。血管重建成功后，指端温度和微血管灌注显著改善，接近对照水平。尽管冷敏感性未变，但在二级动脉闭塞患者中，成功进行近端重建后症状减轻，上肢功能及与健康相关的生活质量得到改善。
