静脉病皮肤营养障碍时血流动力学和形态学的改变

采用无创性容积描记、静脉造影和光镜及电镜观察对４４例（５７条）下肢慢性静脉功能不全患者和１２例（２４条）正常人下肢的血流动力学和形态学进行对比研究。结果：皮肤营养障碍者其深静脉功能不全占６８％，其中伴交通支不全为４４％；营养障碍组（ｎ＝３７）与正常对照组（ｎ＝２４）和外观正常组（ｎ＝２０）比较，以及深静脉３～４级返流组（ｎ＝１５）与正常对照组（ｎ＝２４）和１～２级返流组（ｎ＝１５）比较，静脉回复时间（ＶＲＴ）、节段性静脉容积（ＳＶＣ）和静脉最大回流量（ＭＶＯ）均有显著性差异（Ｐ＜０．０５）；交通支异常者ＶＲＴ与正常人比较有高度显著性差异（Ｐ＜０．０１）。皮肤病理和超微结构研究结果表明，微血管内白细胞聚集是微血管病变的原因。提示：深静脉３～４级返流伴小腿交通支不全是皮肤营养障碍的主要原因；下肢ＶＲＴ明显缩短，ＳＶＣ显著增大是皮肤营养障碍的血流动力学特点；微血管内白细胞聚集是皮肤病变的病理基础。

A STUDY ON HEMODYNAMIC AND MORPHOLOGIC CHANGES OF DERMAL NUTRIENT DISTURBANCE IN VENOUS DISEASE

By using noninvasive venous plethysmography, venography and skin morphology, 44 patients (57 limbs) with chronic venous insufficiency (CVI) in lower extremity were studied , and compared with 12 normal subjects (24 limbs). The results showed that dermal nutrient disturbance caused by deep venous insufficiency accounted for 68%, and followed by perforating venous insufficiency was 44%. Furthermore compared venous refill time (VRT), segmented venous capacitancy (SVC) and maximum venous outflow (MVO) of dermal nutrient disturbance with those of exterior normal skin and normal subjects; and compared VRT, SVC, MVO of deep vein 3-4 stage reflux with those of 1-2 stage reflux and normal subjects,the differences were very significant ( P <0.05). Compared the VRT of perforating incompetence with that of competence ( P <0.01). Dermal pathology and ultramicrostructure showed that leucocytes trapping in capillary was a cause of microangiopathy. These results suggest that deep vein 3-4 stage reflux followed by calf perforating insufficiency was a main cause for dermal nutrient disturbance; lower extremity VRT reduced obviously and SVC increased significantly were hemodynamic character, leucocytes trapping in capillary was pathology basis of skin damage.