tailieunhanh - The Foot in Diabetes - part 7

Trong bệnh tiểu đường, TcPO2 là thấp hơn so với bệnh nhân arteriopathic phù hợp, một TcPO2 dưới 40 mmHg có liên quan với thất bại của việc chữa lành vết thương, và tăng TcPO2 sau khi can thiệp dự đoán thành công của nong mạch tim và vết thương chữa bệnh chính xác hơn so với thay đổi trong ABPI9. Phân tích dạng sóng Doppler bệnh mạch máu ngoại vi, | Peripheral Vascular Disease and Vascular Reconstruction 221 chamber held in contact with the skin. The TcPo2 is measured using a probe to measure the Po2 in the solution. A low TcPo2 reflects the degree of tissue ischaemia and increases with successful intervention. In diabetes TcPo2 is lower than in the matched arteriopathic patients a TcPo2 of less than 40 mmHg is associated with failure of wound healing and increased TcPq2 after intervention predicts success of angioplasty and wound healing more accurately than changes in ABPP . Doppler Waveform Analysis In peripheral vascular disease the normal triphasic waveform detectable using Doppler waveform analysis is damped distal to haemodynamically significant lesions. In diabetes damping of the waveform may indicate PVD however diabetic neuropathy has been shown to be related to abnormalities of Doppler waveform in the dorsalis pedis artery in the absence of PVD10. Colour Duplex Sonography CDS Ultrasound of the peripheral vascular system has been greatly enhanced by duplex-Doppler imaging. Ultrasound imaging enhanced by colour flow representation and Doppler waveform analysis can be used to detect and characterize haemodynamically significant lesions in larger vessels with 90 accuracy and predicts final surgical intervention as accurately as does angiography. It has therefore been suggested that CDS may replace contrast angiography in the investigation of PVD11. Ultrasound resolution at present limits its use in assessing distal vessels for limb salvage procedures however no single modality can accurately identify foot vessels as suitable for a distal anastomosis. Contrast Angiography Non-invasive investigation using a combination of modalities can in most cases detect clinically significant ischaemia and will identify most lesions of the larger vessels that are amenable to intervention. At present however despite full non-invasive investigation it is impossible to exclude surgically correctable lesions because of .