Acute effects of periarterial sympathectomy on the cutaneous microcirculation.
Acute effects of periarterial sympathectomy on the cutaneous microcirculation.
复制标题
动脉周围交感神经切除术对皮肤微循环的急性影响。
DOI：
10.1002/jor.1100150313
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Smith,TL
中科院分区：
文献类型：
--
作者：
Pollock,DC;Li,Z;Rosencrance,E;Krome,J;Koman,LA;Smith,TL
外周交感神经切除术对血管闭塞性疾病患者的临床效果通常是显著的，包括缓解疼痛、改善生活质量和溃疡愈合。已知外周动脉周围交感神经切除术可增加皮肤温度并最大限度地增加外周血流的营养成分，但血管闭塞性疾病的病理生理学和该治疗的生理机制尚不清楚。在这项研究中，动脉周围交感神经切除术的急性效应直接观察兔耳模型的手指微循环（小动脉，动静脉闭塞，和微静脉）。动脉周围交感神经切除术对皮肤灌注和总流量的影响也用激光多普勒检查。灌注成像和数字温度测量。交感神经切除术后，耳中央动脉立即扩张（50-100%）;相对于交感神经切除术前的基线直径，小动脉、动静脉狭窄和小静脉在30分钟时分别扩张至165、156和0.223%，在60分钟时分别扩张至187、174和204%。交感神经切除术后，激光多普勒灌注成像值和耳温增加（8.9%，3°C），但家兔的核心温度没有变化。因此，急性动脉周围交感神经切除术可以（a）有效地降低远端微血管的血管张力和（B）通过微静脉和小动脉扩张增加总的微循环灌注-皮肤和温度调节。动脉周围交感神经切除术具有增加营养性血流量的临床潜力，从而改善与体温调节异常相关的缺血体征和症状。动静脉畸形的扩张，伴随着血管阻力的降低，可能是交感神经切除术后皮肤温度升高的原因。
The clinical effects of peripheral sympathectomy on patients with vaso‐occlusive disease are often dramatic and include relief of pain, improved quality of life, and healing of ulcers. Peripheral periarterial sympathectomy is known to increase skin temperature and to maximize the nutritional component of peripheral blood flow, but the pathophysiology of vaso‐occlusive disease and the physiologic mechanisms of this treatment are unknown. In this study, the acute effects of periarterial sympathectomy were directly observed in a rabbit ear model of digital microcirculation (arterioles, arteriovenous anastomoses, and venules). The effects of periarterial sympathectomy on cutaneous perfusion and total flow were also examined using laser Doppler. Perfusion imaging and digital temperature measurements. The central auricular artery became dilated (50–100%) immediately after sympathectomy; the arterioles, arteriovenous anastomoses, and venules dilated to 165,156, and.223%, respectively, at 30 minutes and to 187,174, and 204%, respectively, at 60 minutes, relative to their baseline diameters prior to sympathectomy. Laser Doppler perfusion imaging values and ear temperatures were noted to increase after sympathectomy (8.9%, 3°C), although the core temperature of the rabbit did not change. Thus, acute periarterial sympathectomy can (a) effectively reduce the vascular tone of the distal microvasculature and (b) increase total microcirculatory perfusion—cutaneous and thermoregulatory—by both venular and arteriolar dilation. Periarterial sympathectomy has the clinical potential to increase nutritional blood flow, thereby ameliorating the signs and symptoms of ischemia associated with thermoregulatory abnormalities. Dilation of the arteriovenous anastomoses, with a subsequent reduction in vascular resistance, may contribute to the increased cutaneous temperature noted after sympathectomy.