Vyšetřovací metody mikrocirkulace kůže u syndromu diabetické nohy

Abstract

Introduction: Since the mid 1980s, a lot of attention has been dedicated to the importance of microcirculation; a part of arterial bed including arterioles, precapillary sphincters, capillaries, venules and arteriovenous shunts. It is a structure of decisive importance for an organism; in its domain an exchange of blood gases and metabolic products takes place and it contributes to thermoregulation. Mediation of vasomotor reaction and vasoarterial reflex maintaining a stable hydrostatic pressure is also an important function. Microcirculation is for its dimensions (capillary diameter approx. 5 x 10-5 mm2, blood flow velocity around 0.4 mm.s-1) relatively difficult to access for more detailed examination, yet its impairments are very severe and dominate in many metabolic disorders. Microcirculation impairment is crucial in diabetes mellitus, where arteriovenous shunts open at the expense of nutritive bed due to a loss of sympathetic tone in peripheral circulation in diabetic neuropathy (Netten, Houben). Blood flow is therefore seemingly sufficient, but the affected tissue undergoes ischemia (warm ischemia). To what extent hyperinsulinemia contributes to this effect is not yet clearly known, one of the possible explanations may be a stimulation of sympathetic activity. Not a few studies are dealing with...