Ein neues, nicht-invasives, klinisch-diagnostisches Verfahren zur Ermittlung eines Sauerstoff-Status chronischer Unterschenkelgeschwüre mit peri-ulzeralen transkutanen Sauerstoffpartialdruck-Messungen: Ergebnisse der Anwendungen bei chronisch-venöser Insuffizienz (CVI)
| Autor: | Barnikol, Wolfgang K. R., Pötzschke, Harald |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
Mosaikwunde Gewebe-PO2 (gPO2) lcsh:Medicine physiologische Hypoxie synchronisierte tcPO2-Oszillationen mosaic wound decompensated hypoxia hyperoxic blood vessel constriction physiological hypoxia simultaneous peri-ulceral tcPO2 measurement chronisch-venöse Insuffizienz (CVI) Aged 80 and over oxidation potential integumentary system arterielle Okklusion kontrollierte Wundprophylaxe Leg Ulcer oxygen inhomogeneity (I-PO2) (simultaneously or sequentially determined) Sauerstoff-Kenngröße (K-PO2 ) chronic venous insufficiency (CVI) Middle Aged 610 Medical sciences Medicine synchronised tcPO2 oscillations weiße Haut-Atrophie ddc: 610 dekompensierte Hypoxie tissue PO2 (gPO2) Female chronische Wunden controlled wound rehabilitation Sauerstoff-pflichtige chronische Wunde arterial occlusion Adult Oxidationspotenzial Sauerstoff-Topographie peri-ulzeraler Sauerstoffpartialdruck Article Sauerstoff-Toxizität oxygen toxicity peri-ulceral oxygen partial pressure hypoxia grading Sauerstoff-Inhomogenität (I-PO2) (simultan oder sequenziell bestimmt) hyperoxische Gefäßkonstriktion Hämoglobin kontrollierte Wund-Rehabilitation Humans biologically available oxygen Ankle Brachial Index Electrodes Aged Monitoring Physiologic Hautpigmentierung lcsh:R white skin atrophy simultane peri-ulzerale tcPO2-Messung haemoglobin oxygen characteristic (K-PO2) Oxygen Hypoxie-Graduierung Venous Insufficiency Case-Control Studies chronic wounds Chronic Disease skin pigmentation controlled wound prophylaxis oxygen topography chronic wounds requiring oxygen biologisch verfügbarer Sauerstoff |
| Zdroj: | GMS German Medical Science; VOL: 10; DOC11 /20120614/ GMS German Medical Science GMS German Medical Science, Vol 10, p Doc11 (2012) |
| ISSN: | 1612-3174 |
| DOI: | 10.3205/000162 |
| Popis: | The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO2), using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1) the oxygen characteristic (K-PO2), and (2) the oxygen inhomogeneity (I-PO2) of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO2 measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO2 parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated) hypoxia with K-PO2 values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO2 values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance). The decompensated hypoxia can be (arbitrarily) divided into “simple” hypoxia (Grade I), intense hypoxia (Grade II) and extreme hypoxia (Grade III), with the possibility of intermediate grades (I/II and II/III). Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency) wounds. Sixteen of the 17 CVI wounds (i.e., 94%) were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO2) of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO2), with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healings, resulting in the so-called mosaic wounds. The hypoxia grades found in all of the chronic wounds was seen to be evenly distributed with values ranging from 0 to 40 mmHg, and therefore extremely inhomogeneous. In terms of oxygenation, chronic wounds are therefore inhomogeneous in two respects: (1) within the wound itself (intra-individual wound inhomogeneity) and (2) between different wounds (inter-individual wound inhomogeneity). Due to the extreme oxygen inhomogeneity, single measurements are not diagnostically useful. In healthy individuals the oxygen inhalation challenge (see above) results in synchronised tcPO2 oscillations occurring at minute rhythms, which are not seen in CVI wounds. These oscillations can be interpreted as a sign of a functioning arterial vasomotor system. The new procedure is suitable for the routine characterisation of chronic wounds in terms of their oxygen status, and correspondingly, their metabolically determining (and limiting) potential for healing and regeneration. The oxygen characteristic K-PO2 can furthermore be used as a warning of impending ulceration, since the oxygen provision worsens over time prior to the demise of the ulcerated tissue, thus making a controlled prophylaxis possible. GMS German Medical Science; 10:Doc11; ISSN 1612-3174 |
| Databáze: | OpenAIRE |
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