Noninvasive estimation of human tissue respiration with wavelet-analysis of oxygen saturation and blood flow oscillations in skin microvessels

Laser Doppler flowmetry, laser spectrophotometry of oxygen saturation, and the fluorescence determination of the NADH/FAD ratio were carried out in 30 subjects in the upper limb skin zones with and without arteriolovenular anastomoses (AVAs). It was demonstrated that the wavelet-analysis of oxygen saturation and blood flow oscillations in microvessels was an efficient approach to noninvasive estimation of the skin oxygen extraction (OE) and oxygen consumption (OC) rates. OE = (SaO₂ ? SvO₂)/SaO₂, where SaO₂ (%) and SvO₂ (%) are the oxygen saturations of arterial and venular blood, respectively. If the cardiac (A_c, perfusion units, p.u.) to respiratory rhythm amplitude (A_r, p.u.) ratio A_c/A_r ?? 1, SvO₂ = SO₂. If A_c/A_r > 1, SvO₂ = SO₂/(A_c/A_r). OC = M _nutr (SaO₂ ?? SvO₂) in p.u. · %O₂, where M _nutr is the nutritive blood flow value in p.u. M _nutr = M/SI, where SI is the shunting index of blood flow in microvessels. The perfusion, OE, and OC values were higher in the skin with AVAs than in the skin without AVAs. The perfusion and oxygen saturation values were more variable in the skin with AVAs. The oxygen diffusing from the tiniest arterioles and capillaries is the most important for tissue metabolism. The contribution of the total perfusion and the oxygen diffusion from arterioles to tissue metabolism increased under the tissue ischemia conditions.     

Evaluation of microcirculatory disturbances in patients with rheumatic diseases by the method of diffuse reflectance spectroscopy

Immunoinflammatory reactions affecting the state of the microvasculature play the key role in the genesis of rheumatic diseases. Therefore, it is important to develop new methods for the early detection of microcirculatory disorders. The purpose of this study was to assess the possibilities of diffuse reflectance spectroscopy used to identify microcirculatory disturbances in patients with rheumatic diseases by measuring skin blood supply and oxygenation rate and their relationship with the varying degrees of inflammatory activity. A total of 36 patients with rheumatic diseases and 31 healthy volunteers took part in the study. We analyzed the skin diffuse reflectance spectra recorded on the palmar side of the distal phalange of the right middle finger using a FLAME spectrometer. The erythema index and saturation rate were calculated to quantify the content of hemoglobin and oxygen saturation of tissues in both groups. The differences in the parameters under study between the groups were found to be statistically significant. The average value of erythema index was twofold higher in patients with rheumatic diseases with the second degree of inflammatory activity and about 2.5-fold higher in patients with the third degree of inflammatory activity, compared to the control group. This fact indicates impaired blood circulation with increased blood flow caused by inflammatory processes. Thus, diffuse reflectance spectroscopy can be used as an additional non-invasive diagnostic test for assessing the severity of microcirculatory disturbances and the activity of inflammation in rheumatic diseases.     

The influence of the sympathetic innervation on the skin microvascular tone and blood flow oscillations

The influence of the sympathetic innervation on the tone of resistive vessels and blood flow oscillations was studied using laser Doppler flowmetry and skin thermography in 18 healthy subjects (before and after reflex cold and heat tests and local thermal testing), 42 patients with denervation syndromes caused by median nerve damage, and 10 patients with an acute stage of aseptic inflammation after radius fracture. The blood flow oscillations in the range of neurogenic sympathetic influences (0.02–0.052 Hz) supported by low-frequency sympathetic rhythms are an essential component of neurovascular interrelations. The importance of these oscillations is determined by their contribution to an increase in tissue perfusion owing to a decrease in the peripheral resistance and also by the leveling of drastic changes in blood flow and stabilization of microhemodynamics upon pronounced changes in the stationary tone. The high-and low-frequency (tonic and oscillatory, respectively) sympathetic rhythmic activities are expressed in two ways: (1) a synchronous increase or decrease in their amplitudes and (2) frequency dominance. The reactivity of the vessel smooth muscles is an important factor in maintaining the blood flow oscillations. Denervation decreases the oscillation amplitude in the neurogenic range. Under the conditions of local “inflammatory sympatholysis,” reflex tonic effects, rather than oscillatory ones, of the sympathetic impulses are mainly suppressed. An isolated evaluation of the blood flow oscillations in the neurogenic sympathetic range cannot be a measure of sympathetic activity. In studies on its functional state and evaluation of the neurogenic tone (NT) of resistive vessels, it is necessary to take into account the parameters of both stationary and oscillatory components of the NT.     

Cardiac and respiratory oscillations of the blood flow in microvessels of the human skin

Laser Doppler flowmetry with wavelet analysis, spectrophotometry, computer-aided capillaroscopy, and thermometry were used to study cardiac and respiratory oscillations of the blood flow in the skin microvessels of 30 subjects. The amplitudes of the cardiac and respiratory rhythms (A_c and A_r, respectively) were found to be determined predominantly by the distribution of perfusion and pressure in larger vessels (arterioles and venules). The cardiorespiratory coupling is a regulatory factor in the microcirculatory system; at rest, the value of A_c/A_r reflects the capillary arteriovenous ratio. In the structure of the microcirculation index (MI) and A_c, the velocity-to-volume ratio depends on the perfusion of the corresponding skin region: at rest, the volume-related component is expressed only in the skin with arteriolovenular anastomoses, whereas, in the skin without these anastomoses, MI and A_c are predominantly correlated with the dynamic velocity-related component. A_c is inversely dependent on both stationary and oscillatory components of the microvascular tone. The nature of the respiratory wave depends not only on the respiratory modulation of the venous outflow, but also on the perfusion pressure in the microvessels and venular hematocrit. The correlation of A_r with the total blood flow in the skin microvessels and the individual contributions of velocity-and volume-related components to A_r were significant only in situations where the blood flow was above a certain threshold, below which the respiratory waves can penetrate into the microvessels but their correlation with the total perfusion is nonsignificant.     

Evaluation of the parameters of total,nutritive, and shunt blood flows in the skin microvasculature using laser Doppler flowmetry

Examination of 28 healthy subjects and 66 patients was performed using laser Doppler flowmetry (LDF) of the skin of fingers in the red and infrared ranges and wavelet analysis of microvascular blood flow oscillations. Formulas were suggested for the total (TF), nutritive (NF), and shunt (SF) local blood flows. TF = MI × A_c × A_n /(P_m × ), where MI is the microcirculation index in perfusion units (PU), A_n and A_c are the averaged maximum amplitudes of the neurogenic and cardiac rhythms (in PU), P_m is the mean arterial pressure (in mm Hg), and is the mean square deviation of the amplitude of blood flow oscillations (in PU). NF = TF/SP, where SP is the shunting parameter. SP = A_n/A_m, where A_m is the averaged maximum amplitude of the myogenic rhythm (in PU). SF = TF - NF. Significant positive relationships between the skin oxygenation and NF (red), temperature and TF (red), and blood flow measured by hydrogen clearance and TF (infrared) were revealed by comparison of the LDF parameters with polarographic and thermographic data. The advantages of the LDF parameters compared with the MI were shown, especially in skin denervation syndromes. The TF decreased in the case of complete anatomic rupture of the median nerve and increased in reflex sympathetic dystrophy, with both cases being accompanied by a deficit of the NF (red).Translated from Fiziologiya Cheloveka, Vol. 31, No. 1, 2005, pp. 114–119.Original Russian Text Copyright © 2005 by Krupatkin.