Correlation of Lesion Configuration with Functional Significance
Correlation of Lesion Configuration with Functional Significance
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病变形态与功能意义的相关性
DOI：
10.1007/978-1-4684-6277-7_11
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发表时间：
1983
期刊：
影响因子：
3.8
通讯作者：
D. Giddens
中科院分区：
文献类型：
--
作者：
D. Sumner;D. Giddens
动脉炎病变显示出无限多样的形态。它们在狭窄程度和狭窄长度上各不相同;它们的孔口可能是突然的或逐渐变细的;它们与血流的界面可能是光滑的、粗糙的或溃疡的。它们的功能意义表现在两个方面：通过外周组织的血流的整体减少，以及通过使闭塞终末动脉的栓子脱落。当由此产生的流量赤字是严重的，组织变得缺氧，营养匮乏，缺乏宿主防御机制提供的保护。轻度狭窄甚至完全闭塞可以通过有效侧支网络的发展和微血管床的血管扩张得到很好的补偿。在这种情况下，阻塞可能是无症状的，或者只有当系统受到运动、创伤或感染的压力时才可能引起症状。另一方面，严重的、未代偿的阻塞，即使在休息或没有外来创伤的情况下，也会损害组织的活力--导致缺血性静息痛、不愈合的溃疡、未受抑制的感染引起的组织破坏和最终的坏疽。虽然能够抛出栓子的病变可能不会产生可辨别的生理变化，但它们可能具有高度的功能意义，特别是当涉及的血管供应敏感区域（如大脑）时。
Arteriosclerotic lesions display an infinite variety of configurations. They vary in degree of narrowing and length of stenosis; their orifices may be abrupt or tapering; and the interface that they present to the bloodstream may be smooth, rough, or ulcerated. Their functional significance is manifested in two ways: by a global reduction of flow to the peripheral tissues, and by shedding emboli that obliterate terminal arteries. When the resulting flow deficit is severe, the tissues become hypoxic, nutritionally deprived, and lack the protection afforded by host defense mechanisms. Mild degrees of narrowing and even total occlusions may be well compensated by the development of an efficient collateral network and by vasodilation of the micro-vascular bed. In such cases, the obstruction may be asymptomatic or may cause symptoms only when the system is stressed by exercise, trauma, or infection. Severe, uncompensated obstructions, on the other hand, compromise the viability of the tissues even at rest or in the absence of extraneous trauma--leading to ischemic rest pain, nonhealing ulcers, tissue destruction by unchecked infection, and eventual gangrene. Although lesions capable of throwing emboli may not produce discernable physiologic changes; they may be functionally highly significant, particularly when the vessel involved supplies a sensitive area, such as the brain.