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Reclutamiento capilar y alivio del dolor en la dependencia de las piernas en pacientes con isquemia severa de las
D T Ubbink1, M J Jacobs, D W Slaaf
1Department of Surgery, Academic Hospital Maastricht, The Netherlands.
Circulation
|January 1, 1992
Resumen
Los pacientes con isquemia severa de las piernas pueden encontrar alivio del dolor cuando sus piernas cuelgan hacia abajo. Este estudio muestra reclutamiento capilar, no vasoconstricción perturbada, explica este fenómeno en isquemia avanzada de las extremidades inferiores.
Área de la Ciencia:
- Biología Vascular Biología Vascular
- Microcirculación Investigación Investigación de la microcirculación
- Estudios de la isquemia Estudios de la isquemia Estudios de la isquemia Estudios de la isquemia Estudios de la isquemia Estudios de la isquemia Estudios de la isquemia
Sus antecedentes:
- La isquemia severa de las extremidades inferiores puede, paradójicamente, causar alivio del dolor con dependencia de las piernas.
- La dependencia de las piernas típicamente induce vasoconstricción arteriolar.
- Investigar la microcirculación de la piel en la isquemia de las extremidades inferiores es crucial.
Objetivo del estudio:
- Para aclarar la paradoja del alivio del dolor en la isquemia severa de las extremidades inferiores durante la dependencia de las piernas.
- Para investigar el papel de la microcirculación de la piel en la isquemia de las extremidades inferiores.
- Para evaluar el mecanismo postural vasoconstrictivo a nivel nutricional.
Principales métodos:
- Se utilizó la video microscopía capilar del pliegue de las uñas.
- Se evaluó la densidad, el diámetro y la velocidad de los capilares perfundidos por glóbulos rojos.
- Comparación de posiciones supinas y sentadas en 75 pacientes con isquemia de las extremidades inferiores y 12 controles.
Principales resultados:
- La densidad capilar aumentó significativamente en la posición sentada, especialmente en isquemia grave (aumento de 4,5 veces).
- La perfusión capilar fue menor en posición sentada para isquemia leve, pero ligeramente mayor en isquemia severa.
- Alivio del dolor en isquemia severa correlacionado con mayor densidad capilar, no siempre mayor perfusión, en posición sentada.
Conclusiones:
- El mecanismo vasoconstrictor postural arteriolar se ve afectado en la isquemia severa de las extremidades inferiores.
- El reclutamiento capilar, la vasoconstricción arteriolar no perturbada, probablemente explica la preferencia por la dependencia de las piernas en la isquemia grave.
- Los hallazgos sugieren un mecanismo compensatorio en isquemia avanzada de las extremidades inferiores.
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