방사성 동위원소를 이용한 하지의 반응성 충혈에 대한 연구

Abstract

[한글]

사지의 혈관조영술에서 일시적으로 말초혈류를 증가시킴으로써 더 좋은 영상을 얻을 수 있는데 지혈대 폐색에 의한 반응성충혈법이 간단하고 안전한 방법으로 알려져 있다.

이에 저자는 말초혈관 폐쇄 질환이 없는 103명의 정상인을 대상으로 Tc-99m-labled red blood cells 혈관 조영술과 Tc-99m-methylene diphosphonate 골주사의 초기 혈류기에서 반응성 충혈상태에서의 하지의 혈류변화를 측정하여 지혈대원위부의 혈류 차단을 위한 안

전한 압력수준과 최대 반응성충혈을 유도하는 혈류차단시간을 정하고자 연군하여 다음과 같은 결론을 얻었다,

1. 지혈대에 의한 하지 혈류차단의 안전한 압력수준은 수축기 혈압보다 50 mmHg 이상이었다.

2. 3분에 비해 5분 혈류차단시에 반응성충혈이 증가하여 5분이내 에서는 혈류 차단 시간이 길어질수록 반응성충혈의 정도가 증가하였다.

3. Tc-99m-labeled RBC의 혈중 방사능 측정치가 3분에 비해 5분에서 감소함을 보여 5분까지도 혈중평형상태에 도달하지 않음을 알 수 있었다.

4. Tc-99m-MDP는 정맥주사후 3분에서 5분사이에 혈중 방사능 측정치의 30%가 혈중에서 혈관의 조직으로 제거됨을 알 수 있었다.

이상의 결과로 Tc-99m-labeled RBC 혈관조영술과 Tc-99m-MDP골주사의 혈류기는 반응성 충혈 상태에서의 하지의 혈류변화를 비침습적으로 측정할 수 있는 방법으로 생각된다. 정상인에서 지혈대폐색의 안전한 압력수준과 최대 반응성출혈을 유도하는 혈류 차단 시간을 정함으로써 조영제를 이용한 말초혈관조영술과 말초혈관폐쇄질환의 진단에 운용하게 이용할 수 있으며 Tc-99m-labeled RBC의 혈중평형상태에 도달하는 시간과 7c-99m-MDP의 혈

중제거율을 비침습적으로 측정할 수 있다고 사료된다.

Radionuclide Evaluation of Reactive Hyperemia in Lower extremities

Eun Ju Lee

Department of Medical Science The Graduate School, Yonsei University

(Directed by Prof. Chang Yun Park)

Reactive hyperemia fellowing arterial occlusion by tourniquet was the simplest

and safest method to increase the quality of peripheral arteriography. To assess

the peripheral blood flow during reactive hyperemia, first pass peripheral

radionuclide arteriography using Tc-99m-labeled RBC and dynamic please of bone scan

using Tc-99m-MDP were performed, those methods were noninvasive and clinically

useful.

We invesigated the optimal occlusion time and pressure level that could give a

stats of maximal reactive hyperemia in lower extremities and predicted the

usefullness of these for the scanty peripheral arteriography and the evaluation of

peripheral vascular disease.

We studied 103 normal subjects and the results were as fellows:

1. The least pressure level of tourniquet for arterial occlusion was 50 mmHg

above the systolic pressure.

2. Reactive hyperemia after 5 minutes occlusion was significantly greater than 3

minutest which may suggest that the degree of reactive hyperemia increased wish

time within 5 minutes.

3. The activity of Tc-99m-labeled RBC in vascular pool was lower at 5 minutes

than 3 minutes, suggesting that the equilibrium time expended beyond 5 minutes.

4. 30% of Tc-99m-MDP baa eliminated from vascular pool to extra-vascular space

between 3 minutes and 5 minutes.

These results suggest that peripheral radionuclide arteriography and dynamic

phase of bone scan are noninvasive methods for the assessment of peripheral blood

flow during reactive hyperemia. By determining the optimal occlusion time and

pleasure level for maximal reactive hyperemia in normal subjects , theae can be

used for contrast peripheral arteriography and the evaluation of peripheral

vascular disease. Additionally we can predict the equilibrium time of

Tc-99m-labeled RBC in vascular pool and quantitate the blood clearance of

Tc-99m-MDP, noninvasively.

[영문]

Reactive hyperemia fellowing arterial occlusion by tourniquet was the simplest and safest method to increase the quality of peripheral arteriography. To assess the peripheral blood flow during reactive hyperemia, first pass peripheral radionuclide arteriography using Tc-99m-labeled RBC and dynamic please of bone scan using Tc-99m-MDP were performed, those methods were noninvasive and clinically useful.

We invesigated the optimal occlusion time and pressure level that could give a stats of maximal reactive hyperemia in lower extremities and predicted the usefullness of these for the scanty peripheral arteriography and the evaluation of peripheral vascular disease.

We studied 103 normal subjects and the results were as fellows:

1. The least pressure level of tourniquet for arterial occlusion was 50 mmHg above the systolic pressure.

2. Reactive hyperemia after 5 minutes occlusion was significantly greater than 3 minutest which may suggest that the degree of reactive hyperemia increased wish time within 5 minutes.

3. The activity of Tc-99m-labeled RBC in vascular pool was lower at 5 minutes than 3 minutes, suggesting that the equilibrium time expended beyond 5 minutes.

4. 30% of Tc-99m-MDP baa eliminated from vascular pool to extra-vascular space between 3 minutes and 5 minutes.

These results suggest that peripheral radionuclide arteriography and dynamic phase of bone scan are noninvasive methods for the assessment of peripheral blood flow during reactive hyperemia. By determining the optimal occlusion time and

pleasure level for maximal reactive hyperemia in normal subjects , theae can be used for contrast peripheral arteriography and the evaluation of peripheral vascular disease. Additionally we can predict the equilibrium time of Tc-99m-labeled RBC in vascular pool and quantitate the blood clearance of Tc-99m-MDP, noninvasively.