内脏器官激光多谱勒血流灌注图象的显示

目的显示内脏器官血流灌注和分布的图象,探讨激光多谱勒血流成像技术在内脏微循环检测中的价值。方法应用激光多谱勒血流灌注成像仪(LDPI),对大鼠和家兔腹部脏器(肝、脾、肾、膀胱、胃、大小肠和肠系膜等)的血流灌注进行扫描和血流图显示。结果在体内脏器官显像清晰,肝、肾、脾、膀胱等微循环血流的整体分布较均匀;而胃、肠系膜、回盲肠等激光多谱勒血流图上大血流线状显示极其显著;大鼠与家兔两种动物之间相同脏器血流图上的差异并不明显。结论LDPI能将内脏器官的微循环状态以图象的形式显示,该新技术方法在检测内脏血流方面将有一定的应用价值。     

Sympathetic skin vasoconstriction--further evaluation using laser Doppler techniques.

The aim of this study was to quantify the reflex sympathetic vasoconstriction in skin at different depths. Twenty healthy subjects were studied. Finger skin blood flow was measured using laser Doppler perfusion imaging (LDPI) and laser Doppler perfusion monitoring (LDPM). In LDPM, a probe with fibres separated 0.25 mm (deep) and 0.14 mm (superficial) from the illuminating fibre was used. Local heating (40 degrees C) was achieved with a Peltier element, and reflex vasoconstriction induced by immersion of the contra-lateral hand and forearm for 3 min in water at 15 degrees C. The change in skin blood flow was measured and a vasoconstriction index (VAC: cooling/before cooling) calculated. VAC indices of LDPI, LDPM-0.25 and LDPM-0.14 were 0.60, 0.59 and 0.60, respectively. The two components of the LDPM perfusion value, blood cell velocity and concentration, were studied separately. Their contributions in LDPM-0.25 were roughly the same, whereas the velocity component dominated in LDPM-0.14, although their relative responses in the two channels were similar. We conclude that sympathetic skin vasoconstriction does not significantly differ in two compartments, as probed with fibres separated by 0.25 and 0.14 mm. Blood cell velocity is influenced in a proportional way, as is concentration.     

Effect of local cold provocation on systolic blood pressure and skin blood flow in the finger.

Demonstration of increased vascular cold reactivity in patients with Raynaud's syndrome is difficult. For medico-legal reasons, it is important to get objective measures of vasospasm in these patients. Evaluation of the degree of vasospasm also provides prognostic information which is useful for patient management. In this study, we compare two methods of arterial circulation measurement. The laser Doppler scanning is a new method, which uses the recently developed laser Doppler perfusion imaging (LDPI) instrument. The aim of the present study was to compare the effect on finger skin blood flow measured with LDPI with changes in finger systolic blood pressure during local cold provocation. The effect of such provocation, skin blood flow and systolic blood pressure, were studied in 15 healthy controls. Six patients with known traumatic vasospastic disease (TVD) were also tested with both methods. Finger skin blood flow was measured with LDPI on the distal phalanx of the index finger of the left hand, every minutes during 6 min of local heating at 40 degrees C followed by local cooling for 3 min at 15 degrees C and then for 3 min at 10 degrees C. Finger systolic blood pressure was measured with strain-gauge method before and after local cooling to 10 degrees C with a cuff perfused with water of desired temperature. The test was performed in the same finger within a week of the laser Doppler scanning. Local finger cooling to 15 degrees C and 10 degrees C caused a significant decrease in blood flow, most marked at 10 degrees C. There was, however, no correlation between the decrease in blood flow and blood pressure. In the TVD-patients decreases in skin blood flow were similar compared with the healthy controls. In contrast, the changes in systolic blood pressure, were outside normal range (systolic quotient <0.65) in five of the six patients (83%), and also in 11 of the 15 healthy controls (73%). In conclusion, there is no correlation between the decrease in finger skin blood flow and systolic blood pressure during local cold provocation. For diagnosis of traumatic vasospastic disease (TVD), local cold-induced changes in finger systolic blood pressure seems superior to changes in skin blood flow, but the ideal clinical method for demonstrating increased cold-induced vasospasm is, however, still lacking.     

胃缺血和再灌注时胃表面激光多谱勒血流图像的显示

目的：连续检测和显示胃脏缺血和再灌注图像，研究胃脏血液供应血管的分布及激光多谱勒血流成像新技术在内脏血循环检测中的价值。方法：对大鼠胃右动脉进行结扎和松解，用激光多谱勒血流灌注成像仪（LDPI）对该过程中的胃脏整体表面循环予以图像显示，分析结扎和松解时胃血流的改变。结果：（1）胃脏表面的血流灌注图像显像清晰，呈现出从胃小弯向胃大弯放射状血流分布的扇形特征；（2）胃右动脉结扎后，激光多谱勒血流图上胃表面血流灌注下降非常显著，一直持续到松解结扎；（3）松解结扎后，血流即刻骤升，前10min内血流灌注量可超过结扎前水平，随后逐渐平稳。结论：结扎胃右动脉可以形成胃脏缺血和再灌注模型，LDPI能将胃脏的血循环状态以图像的形式大范围显示。     

Polarized laser Doppler perfusion imaging--reduction of movement-induced artifacts

Laser Doppler perfusion imaging (LDPI) enables superficial tissue perfusion assessment, but is sensitive to tissue motion not related to blood cells. The aim was to investigate if a polarization technique could reduce movement-induced artifacts. A linearly polarized laser and a cross-polarized filter, placed in front of the detectors, were used to block specular reflection. Measurements were performed with, and without, the polarization filter, at a single site during horizontal and vertical movement of skin tissue (index finger, twelve subjects, n = 112) and of a flow model (n = 432), with varying surface structures. Measurements were repeated during different flow conditions and at increased skin specular reflection. Statistical analysis was performed using ANOVA models. The perfusion signal was lower (p < 0.001, skin and p < 0.05, flow model) using the polarization filter, due to movement artifact reduction. No significant influence from surface structure was found when using the polarization filter. Movement artifacts were lower (p < 0.05) in the vertical movement direction, however, depending on flow conditions for skin measurements. Increased skin specular reflection gave rise to large movement artifacts without the polarization filter. In conclusion, the polarized LDPI technique reduces movement artifacts and is particularly appropriate when assessing, e.g., ulcers and burns, where specular reflection is high.     

100例健康人不同部位体表血流量的测量

目的 :研究健康人不同部位的体表血流量。方法 :选择 2 0岁～60岁的健康自愿者 10 0例 ,用激光多普勒血流量图像仪 (LDPI)测量了 2 0个不同部位的体表血流量 ,比较了不同性别及不同年龄组间的差异。结果 :( 1)面部和手的血流量较高 ,下肢及躯体血流量较低。( 2 )面部与肢体左右侧体表血流量比较无明显差异。 ( 3 )男性的体表血流量除足背外其它部位均高于女性 ,尤以颜面部血流值的差异有显著意义 (P <0 .0 1)。 ( 4 )年龄 >40岁组血流量均高于年龄 <40岁组 ,除胸前及腰部外 ,其它部位的体表血流值均有显著的统计学差异(P <0 .0 1)。结论 :体表不同部位的血流量差异大 ,面部和手的血流量较躯体及下肢的高。左右侧对称部位体表血流值无明显差别 ,有男性血流量高于女性的趋势。在健康状态下 ,体表血流量不随年龄增长而减少     

Redistribution of skin blood flow during leg dependency in peripheral arterial occlusive disease.

A disturbed autoregulation of cutaneous blood flow in legs with peripheral arterial occlusive disease (PAOD) has previously been demonstrated for circumscribed skin areas. In the present study, posturally-induced changes of skin perfusion distribution along ischaemic limbs were investigated topographically in 35 PAOD patients by means of fluorescein perfusography. Among the 68 legs studied, 7 had patent arteries and 61 could be assigned to FONTAINE stages I to IV. Limbs with peripheral skin lesions (stage IV) were further differentiated according to either healing (stage IV+) or non-healing (stage IV-) on conservative treatment. Sitting-up always led to prolonged calf as well as foot fluorescein appearance times (AT) except for legs in stage III or IV- disease. In the latter two groups, decreased sitting as compared to supine AT foot-to-calf ratios indicated a relative shift of dye delivery from proximal towards distal skin regions during posture. In contrast, this measure of blood flow redistribution did not change in the other groups. The redirection of fluorescein influx was significantly correlated with the systolic arterial pressure ankle-to-arm ratios. In conclusion, besides small perfusion pressure increases or passive microvessel distension, a shift of the peripheral resistance ratios may contribute to the improved blood supply of ischaemic skin regions during leg dependency. An arteriolar vasoparalysis does not regularly exist in limbs with skin lesions not primarily originating from ischaemia (stage IV+).     

激光多普勒血流量图像仪在微循环基础与临床研究中的初步应用

利用激光多普勒效应非接触式扫描成像的原理，我们用激光多普勒血流量图像仪（ＬＤＩ）测量失血和再灌注期间大鼠小肠组织灌流量的变化；比较人体皮肤鲜红斑痣在激光治疗前后血流量的变化以及心脏直视手术中心脏在不同状态下心肌灌流量的改变。实验结果表明ＬＤＩ能够客观反映在不同的功能状态下组织血液灌流量的变比。提示：测量一区域组织表面血流量可反映组织微循环功能，在临床检查中具有重要意义；而作为自动化测量系统，激光多普勒血流量图像仪的性能优于激光多普勒血流量计。     

Effects of contusion and cryotherapy on microvascular perfusion in rat dorsal skeletal muscle

Dorsal microcirculatory chambers (DMCs) were surgically implanted in the backs of rats to expose, beneath a transparent coverslip, the skeletal muscle microvasculature under the skin; two studies were completed using this model. In one study, microvascular perfusion was monitored for 96 h with laser Doppler fluxmetry and laser Doppler perfusion imaging to measure microvascular perfusion before and after contusion of the skeletal muscle within the DMC. There were statistically significant differences in microvascular perfusion observed with laser Doppler fluxmetry (baseline vs. postcontusion at 48 h) and with the scanning laser Doppler perfusion imager (baseline vs. postcontusion at 96 h). The second study monitored changes in microvascular perfusion following 20 min of local ice application to the back side (fur and skin side) of the DMC. Ice application resulted in a statistically significant reduction in microvascular perfusion as demonstrated by both laser Doppler instruments. The use of the two laser Doppler instruments with this model of skeletal muscle microcirculation provides direct measurements of microvascular perfusion that can be used to monitor the effect of contusion and cryotherapy on skeletal muscle microcirculation.     

Measurement of digital blood flow using the laser Doppler,impedance and strain-gauge methods

Digital volume changes and blood flow have been measured with impedance and strain-gauge plethysmography as well as with laser Doppler flowmetry. A good agreement was found between the impedance and strain-gauge flow measurements with a correlation coefficient of 0·905. The laser Doppler method recorded minor changes in finger skin blood flow following changes in posture from 30 cm below heart level to 60 cm above heart level. This result can be explained as a consequence of the limited penetration depth of laser light into the skin or as a sign of autoregulation of skin blood flow. In these experiments the total blood flow to the finger underwent major changes.     

Posture primarily affects lung tissue distribution with minor effect on blood flow and ventilation

We used quantitative single photon emission computed tomography to estimate the proportion of the observed redistribution of blood flow and ventilation that is due to lung tissue shift with a change in posture. Seven healthy volunteers were studied awake, breathing spontaneously. Regional blood flow and ventilation were marked using radiotracers that remain fixed in the lung after administration. The radiotracers were administered in prone or supine at separate occasions, at both occasions followed by imaging in both postures. Images showed greater blood flow and ventilation to regions dependent at the time of imaging, regardless of posture at radiotracer administration. The results suggest that a shift in lung parenchyma has a major influence on the imaged distributions. We conclude that a change from the supine to the prone posture primarily causes a change in the vertical distribution of lung tissue. The effect on the vertical distribution of blood flow and ventilation within the lung parenchyma is much less.     

Non‐invasive monitoring of muscle blood perfusion by photoplethysmography: evaluation of a new application

Aim: To evaluate a specially developed photoplethysmographic (PPG) technique, using green and near‐infrared light sources, for simultaneous non‐invasive monitoring of skin and muscle perfusion. Methods: Evaluation was based on assessments of changes in blood perfusion to various provocations, such as post‐exercise hyperaemia and hyperaemia following the application of liniment. The deep penetrating feature of PPG was investigated by measurement of optical radiation inside the muscle. Simultaneous measurements using ultrasound Doppler and the new PPG application were performed to elucidate differences between the two methods. Specific problems related to the influence of skin temperature on blood flow were highlightened, as well. Results: Following static and dynamic contractions an immediate increase in muscle perfusion was shown, without increase in skin perfusion. Liniment application to the skin induced a rapid increase in skin perfusion, but not in muscle. Both similarities and differences in blood flow measured by Ultrasound Doppler and PPG were demonstrated. The radiant power measured inside the muscle, by use of an optical fibre, showed that the near‐infrared light penetrates down to the vascular depth inside the muscle. Conclusions: The results of this study indicate the potentiality of the method for non‐invasive measurement of local muscle perfusion, although some considerations still have to be accounted for, such as influence of temperature on blood perfusion.     

Comparison of laser speckle and laser Doppler perfusion imaging: Measurement in human skin and rabbit articular tissue

Laser Doppler perfusion imaging (LDI) is currently used in a variety of clinical applications, however, LDI instruments produce images of low resolution and have long scan times. A new optical perfusion imager using a laser speckle measurement technique and its use for in vivo blood flow measurements are described. Measurements of human skin and surgically exposed rabbit tissue made using this instrument were compared with a commercial laser Doppler perfusion imaging instrument. Results from blood flow measurements showed that the laser speckle imager measured an 11–67% decrease in blood flow under arterial occlusion. Under similar conditions, the laser Doppler imager measured blood flow decreases of 21–63%. In comparison with LDI, it was observed that the higher temporal resolution of the laser speckle imager was more sensitive to measuring the hyperaemic response immediately following occlusion. This in vivo study demonstrated some of the several advantages laser speckle imaging has over conventional LDI, making the new instrument more versatile in a clinical environment.     

Spectral signature and heterodyne efficiency for different wavelengths in laser Doppler flowmetry

Laser Doppler perfusion monitoring and imaging technologies generate time traces and two-dimensional flow maps of the microcirculation. With the goal of reaching different tissue depths, these technologies are equipped with lassers operating at different wavelengths λ. The fact that the average scattering angle, at a single scattering event, between a photon and a red blood cell increases with λ is compensated for by a 1/λ effect in the scattering vector, rendering the average frequency shift virtually independent of the choice of wavelength. Monte Carlo simulations showed that the corresponding spectral signature of the Doppler signals for λ=632.8nm and 780nm were close to identical. The theoretical predictions were verified by calculating the centre-of-gravity (COG) frequency of the laser Doppler power spectral density for the two wavelengths from forearm and finger skin, representing a low and high perfusion area, respectively (forearm COG=123 against 121Hz, finger COG=220 against 212 Hz). When the wavelength changes from 632.8nm to 780nm, the heterodyne efficiency of the detector and, thereby, the inherent system amplifcation increase. For tissues with identical microvascular flow conditions, the output signal therfore tends to increase in magnitude when shifting to longer wavelengths.     

Neuromuscular electrical stimulation and an ottoman-type seat effectively improve popliteal venous flow in a sitting position

The aim of this study was to examine the effects of the sitting posture on the lower limb venous flow and to explore the beneficial effects of neuromuscular electrical stimulation (NMES) and an ottoman-type seat on the venous flow. Healthy adult volunteers without a history of lower limb surgery or thromboembolism were recruited, and the flow velocity, cross-sectional area, and flow volume of the popliteal vein were measured using Doppler ultrasound. A posture change from the prone position to the sitting position on the ottoman-type seat decreased the flow velocity and increased the cross-sectional area of the popliteal vein, and the flow volume was not altered over 120 min. The flow velocity was further decreased, and the cross-sectional area was further increased by subjects sitting on a regular driving seat when compared with the values obtained with an ottoman-type seat. The popliteal flow velocity in the NMES leg was significantly higher than in the non-NMES leg throughout the 120-min testing in the sitting position, but no difference in the cross-sectional area was found between the NMES and the non-NMES legs. Thus lower limb venous stasis elicited by the sitting posture was improved by the ottoman-type seat and NMES.     

Local Nervous Mechanism in Regulation of Blood Flow in Human Subcutaneous Tissue

The effect of local venous stasis upon blood flow in human subcutaneous adipose tissue on the distal part of the forearm was investigated in three healthy subjects and two chronically sympathectomized patients suffering from manual hyperhidrosis. The area under study was separated into two parts by means of a lead shield exerting a pressure of about 360 mmHg on the skin. The effect of venous stasis of about 40 mmHg on one side of the shield upon blood flow measured simultaneously on both sides of the shield by the local ¹³³Xenon washout technique was investigated. During venous stasis on one side of the shield, blood flow decreased about 40 per cent on both sides. The vasoconstrictor impulse could be transmitted over a distance of about 1–2 cm. The phenomenon was unaffected by nerve blockade induced 3 cm proximally, medially, and laterally to the area by infiltration the skin with lidocaine. Thus a vasoconstrictor impulse could be transmitted from the side of stasis to the non stasis side of the lead shield. The transmission was not affected by phentolamine but was blocked by lidocaine and chronic sympathetic denervation. The vasoconstrictor impulse elicited during venous stasis is therefore most likely transmitted by means of a local nervous mechanism involving sympathetic adrenergic vasoconstrictor fibres.     

The effect of high- and low-frequency transcutaneous electrical nerve stimulation upon cutaneous blood flow and skin temperature in healthy subjects.

The reported non-analgesic effects of transcutaneous electrical nerve stimulation (TENS) include alterations to the local circulation; however, research in this area has produced equivocal findings. In the present study, the effect of low- (4 Hz) and high-frequency (110 Hz) TENS on forearm skin blood perfusion was assessed using laser Doppler flowmetry. The effect on skin temperature was also assessed using a skin thermistor. Thirty healthy human volunteers were recruited and randomly assigned to a control or one of the two treatment groups. TENS was applied to the skin overlying the median nerve under double-blind conditions for 15 min. Blood flow and skin temperature readings were recorded pre-TENS, during TENS application and continued for 15 min post-TENS application. Analysis of results showed significant increases in blood perfusion during the treatment period in the low-frequency group when compared to the other two groups (P = 0.0106; ANOVA). No significant changes in skin temperature were observed. The results of this study demonstrate that low-frequency TENS produces a local increase in cutaneous blood flow.     

体外反搏对失血性休克犬大脑和皮肤微血管血流灌注的作用

应用激光多普勒测定微血管血流灌注技术，观察体外反搏提高灌注压力对失血性休克犬大脑皮层及皮肤微血管血流灌注的作用。结果显示，体外反搏可明显提高休克犬主动脉平均压力，增加休克犬大脑皮层及皮肤微血管血流灌注。在回输失血复苏后，对照组和反搏组主动脉平均压力恢复接近失血前水平，但反搏组微血管灌注的回升却明显高于对照组。结果提示体外反搏在犬失血性休克期预处理能改善其微循环障碍，有利于复苏期微血管的灌注