冠心病微循环改变的综合评价

Microcirculatory Changes Evaluated on Coronary Heart Disease

综合评价冠心病病人微循环改变状况并探讨可能的机制。方法应用显微镜、激光多普勒血流仪、经皮氧分压监测仪对36例冠心病病人甲襞微循环观测、皮肤微区血流量以及组织氧分压测定。结果⑴26例冠心病病人甲襞毛细血管数减少 ,交叉、畸形管襻增多 ,输入枝变细 ,输出枝和乳头下静脉丛扩张 ,血流速度慢伴红细胞聚集(P<0.05～0.001) ;LDF值、tcPO2 值无明显改变 ;⑵10例合并心力衰竭者除甲襞微循环异常改变外 ,LDF值、tcPO2 值也有显著改变(P<0.05～0.001) ;经过综合治疗后 ,甲襞微循环好转(P<0.05～0.01) ,LDF、tcPO2 显著提高(P<0.05)。⑶LDF、tcPO2 与输入枝口径呈直线正相关 ,与管襻数无相关关系 ,说明冠心病病人LDF、tcPO2 与甲襞微循环并不完全平行 ,还受其它因素影响。结论冠心病病人外周微循环存在结构的破坏与功能异常改变 ,体循环功能障碍是影响冠心病病人皮肤血流。

Objective Microcirculatory changes were evaluated on CHD. Methods Using capillaroscopy, transcutaneous oxygen tension(tcPO2)measurements and Laser Doppler Flux(LDF) on 26 patients with CHD,10 cases with heart failure,and 26 normal controls. Results ① In 26 cases of CHD,density of nailfold vasoloops, diameters of arterial limb of vasoloops,blood flow velocity decreased, intersection and deformity vasoloops, diameters of venous limb of vasoloops and the subpapillary venous plexa increased, while erythrocyte aggregated seriously as compared with those in control group(P<0.01～0.001),but there were no significant changes in LDF,tcPO2. ② In 10 cases of CHD with heart failure, except nailfold microcirculation disturbance, LDF, tcPO2 decreased obviously as compared with 26 cases of CHD(P<0.05). After treatment, the nailfold microcirculation nearly recovered to normal, while LDF, tcPO2 increased (P<0.05). ③ LDF, tcPO2 were correlated positively to diameters of arterial limb of vasoloops and were not siginificantly correlated with density of vasoloops.It showed that LDF,tcPO2 were not completely balanced with nailfold microcirculation on CHD and were influenced by many other factors. Conclusions there was a reduced microcirculation change in structure and function on CHD, LDF,tcPO2 diminished on CHD with heart failure,which bring about systemic circulation disturbance and heart failure.