下肢慢性静脉功能不全的血流动力学评价

Evaluation of the hemodynamics of chronic venous insufficiency in the lower extremities

目的 探讨下肢慢性静脉功能不全血流动力学改变与皮肤营养障碍的关系。方法 采用光电容积描记 (PPG)、空气容积描记 (PCR)和股静脉顺逆行造影术研究 83例慢性静脉功能不全和 12例对照组。结果 (1)Class1、2、3级其VRT均明显小于对照组 (P <0 0 5 ) ,Class2、3级其MVO和SVC均显著大于Class1级和对照组 (P <0 0 5 ) ;(2 )深静脉返流Kistner 3～ 4级与 1～2级比较 ,其VRT、SVC和MVO差异有显著性意义 (P <0 0 5 ) ;(3)逐步回归和相关分析显示深静脉返流程度 (P =0 0 0 4 4 )对临床分级作用较大 ,并且深静脉返流程度与SVC和MVO呈正相关 ,r值为 0 3987(P =0 0 177)和 0 4 2 5 3(P =0 0 1)。结论 深静脉返流越严重 ,血流动力学改变越明显 ,皮肤营养障碍越显著 ,结扎功能不全的交通支 ,治疗中度以上深静脉返流 (kistner3～ 4级 )是阻断异常血流动力学 。

Objective Exploring the relationship between hemodynamics change and skin nutrient disturbance of chronic venous insufficiency.Methods Using photoplethysmography, pressure cuff recording and venography,83 patients and 12 controls were studied.Results Venous refill time, segment venous capacitance and maximum venous outflow of class 2～3 and kistner 3～4 were compared with those of class 1, kistner 1～2 and controls with marked differences( P <0 05),The deep vein reflux was an effective index to clinical class greatly( P =0 004 4) and related to MVO and SVC positively, r =0 398 7( P =0 017 7) and r = 0 423 5 ( P =0 010 9).Conclusion The more severe the deep vein reflux ,the more marked clinical venous hemodynamics change. It may be a basis to handle the deep vein kistner 3～4 reflux and perforative vein insufficiency in the treatment of skin damage.