REFLEX SYMPATHETIC DYSTROPHY - EVOLUTION OF MICROCIRCULATORY DISTURBANCES IN TIME

被引:102
作者
KURVERS, HAJM
JACOBS, MJHM
BEUK, RJ
VANDENWILDENBERG, FAJM
KITSLAAR, PJEHM
SLAAF, DW
RENEMAN, RS
机构
[1] UNIV LIMBURG HOSP, DEPT SURG, 6202 AZ MAASTRICHT, NETHERLANDS
[2] ACAD MED CTR, AMSTERDAM, NETHERLANDS
[3] CARDIOVASC RES INST MAASTRICHT, DEPT BIOPHYS, 6202 AZ MAASTRICHT, NETHERLANDS
[4] CARDIOVASC RES INST MAASTRICHT, DEPT PHYSIOL, 6202 AZ MAASTRICHT, NETHERLANDS
关键词
LASER DOPPLER FLOWMETRY; TRANSCUTANEOUS OXIMETRY; CAPILLARY MICROSCOPY; SYMPATHETIC DENERVATION; HYPERSENSITIVITY; REFLEX SYMPATHETIC DYSTROPHY;
D O I
10.1016/0304-3959(94)00133-Y
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Reflex sympathetic dystrophy (RSD) is a pain syndrome that is characterised by autonomic, motor and sensory disturbances. The syndrome has often been associated with sympathetic dysfunction. Therefore, we investigated whether there are disturbances in the sympathetic function of skin microcirculation in the various clinical stages of RSD. Laser Doppler flowmetry (LDF) was used to obtain information about total (mainly thermoregulatory) skin blood flow (TSBF), since blood flow in arteriovenous anastomoses and subpapillary plexus, which are richly innervated by sympathetic nerve endings, contributes predominantly to the flow signal as obtained by LDF. Capillary microscopy was used to appraise whether the trophic changes, as observed in RSD, result from an impaired nutritive skin blood flow (NSBF). Transcutaneous oximetry (TCPO2) was employed as a measure of the oxygenation of superficial skin layers. Skin temperature (ST) was also determined. Patients were divided into 3 clinical stages: stage I in case of a chronic warmth sensation, stage II in case of an intermittent warmth and cold sensation, and stage III in case of a chronic cold sensation. As compared to controls: (1) TSBF was increased (P < 0.05) at stage I and decreased at stages II (P < 0.05) and III (P < 0.001), (2) NSBF was decreased at stages II (P < 0.05) and III (P < 0.001), (3) TCPO2 was not impaired at any stage, (4) ST was increased (P < 0.01) at stage I and decreased (P < 0.05) at stage III. The present study is the first to report an increase of TSBF at stage I of RSD, which may be caused by a decrease in efferent sympathetic nerve impulses. At stages II and III both TSBF and NSBF were decreased which may reflect increased sensitivity of skin microvessels to (circulating) catecholamines.
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页码:333 / 340
页数:8
相关论文
共 39 条
[1]   REFLEX SYMPATHETIC DYSTROPHY SYNDROME - CONSENSUS REPORT OF AN AD HOC COMMITTEE OF THE AMERICAN-ASSOCIATION-FOR-HAND-SURGERY ON THE DEFINITION OF REFLEX SYMPATHETIC DYSTROPHY SYNDROME [J].
AMADIO, PC ;
MACKINNON, SE ;
MERRITT, WH ;
BRODY, GS ;
TERZIS, JK .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1991, 87 (02) :371-375
[2]   INCREASED VENOUS ALPHA-ADRENOCEPTOR RESPONSIVENESS IN PATIENTS WITH REFLEX SYMPATHETIC DYSTROPHY [J].
ARNOLD, JMO ;
TEASELL, RW ;
MACLEOD, AP ;
BROWN, JE ;
CARRUTHERS, SG .
ANNALS OF INTERNAL MEDICINE, 1993, 118 (08) :619-621
[3]   ABNORMALITIES OF CUTANEOUS BLOOD-FLOW REGULATION IN PATIENTS WITH REFLEX SYMPATHETIC DYSTROPHY AS MEASURED BY LASER DOPPLER FLUXMETRY [J].
BEJ, MD ;
SCHWARTZMAN, RJ .
ARCHIVES OF NEUROLOGY, 1991, 48 (09) :912-915
[4]   NORADRENERGIC AND NEUROPEPTIDE-Y MECHANISMS IN GUANETHIDINE-SYMPATHECTOMIZED RATS [J].
BENARROCH, EE ;
SCHMELZER, JD ;
WARD, KK ;
NELSON, DK ;
LOW, PA .
AMERICAN JOURNAL OF PHYSIOLOGY, 1990, 259 (02) :R371-R375
[5]  
BEVAN RD, 1979, BLOOD VESSELS, V16, P109
[6]   CHANGES OF REFLEXES IN VASOCONSTRICTOR NEURONS SUPPLYING THE CAT HINDLIMB FOLLOWING CHRONIC NERVE LESIONS - A MODEL FOR STUDYING MECHANISMS OF REFLEX SYMPATHETIC DYSTROPHY [J].
BLUMBERG, H ;
JANIG, W .
JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM, 1983, 7 (3-4) :399-411
[7]  
BLUMBERG H, 1991, NERVENARZT, V62, P205
[8]   CAUSALGIA AND OTHER REFLEX SYMPATHETIC DYSTROPHIES [J].
BONICA, JJ .
POSTGRADUATE MEDICINE, 1973, 53 (06) :143-148
[9]  
BONICA JJ, 1979, ADV PAIN RES THER, P141
[10]  
BONNETT J, 1953, THESIS AMSTERDAM