Vascular pain disorders

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Due to lower extremity vascular disease classification of pain a lot, we will present the common lower extremity vascular disease pain do in

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Due to lower extremity vascular disease classification of pain a lot, we will present the common lower extremity vascular disease pain do include generous, to enable more patients to understand their illness and treatment as soon as possible:

Peripheral arterial disease (peripheralarterydisease, PAD), as a common disease, is the most common health problem. Although PAD is very common in clinical practice, few can be correctly diagnosed, the treatment is a few. In recent years, with the improvement of the awareness of the disease, improve the diagnostic rate, coupled with the continuous development of treatment methods, the situation is gradually changing.

The most common clinical manifestations of early PAD is due to lower extremity muscle pain, numbness, fatigue, intermittent claudication, of which approximately 25% of patients will progress to severe limb ischemia, often require amputation. According to reports, the United States has 12 million patients with peripheral arterial disease, mainly lower extremity arterial disease, about 20% of patients with symptomatic lower extremity arterial disease with diabetes. In patients with lower extremity arterial disease in about 1/3 with intermittent claudication, while more than about 50% of the patients had no symptoms or symptoms are not typical, so the actual incidence may be even higher. Cardiovascular and cerebrovascular disease in patients with PAD high incidence (40% ~ 60%PAD in patients with coronary artery disease, 25% ~ 50% with carotid artery disease) and the mortality rate is high (about 2.5 times the normal population), death is the main cause of stroke and myocardial infarction. Lack of awareness of PAD is an important cause of missed diagnosis, most doctors do not understand the history of PAD, and often ignore the physical examination of some of the subtle signs of the disease. It is estimated that only about 20% of PAD patients are diagnosed in the United states. Therefore, the basic level of doctors to accept the continuing medical education PAD imminent. Incorrect initial diagnosis of PAD directly affects the effectiveness of two prevention strategies.

Vasculitis called Buerger disease, is caused by a serious disease of vascular inflammation due to the small and medium-sized artery thrombosis occlusion. The cause of vasculitis is unknown. Statistics show that the incidence of vasculitis in cold regions is higher than that in warm areas, and the incidence rate of smokers is higher than that of non-smokers. Some people think that the immune genetic factors. The disease occurred in 20 to more than 40 years of age among young people, and the prevalence of male and female ratio was 29: 1. It mainly involves the anterior tibial, posterior tibial and dorsalis pedis arteries, which may be involved in the femoral artery. Due to thrombosis and occlusion of the lumen, blood supply, can cause thrombophlebitis, arteritis, intermittent claudication, tissue necrosis and even nutritional disorders and other damage, would seriously endanger human health.

Clinical manifestations of vasculitis:

Early symptom:

1, hemp, cold, pain

2, easy fatigue, leg swelling

3, pulse weakened, gradually disappear

Metaphase symptom:

1, the activities of calf pain

2, muscle twitching, especially at night

3, intermittent claudication

Advanced symptom:

1, persistent severe pain

2, the skin is dark red, dark brown, ulcer

3, feet, toes black, necrosis

Raynaud syndrome

Reynolds syndrome (Raynaudsyndrome) is the artery spasm disease, extremities spasm of arterioles caused by the syndrome or a series of hand foot skin color change. It can be divided into two categories: primary and secondary.

The primary cause of the disease (Raynauddisease), the occurrence of this disease is not associated with any systemic disease or the underlying cause of the disease.

Secondary also known as Raynaud's phenomenon (Raynaudphenomenon), which is caused by the basic disease of Raynaud's disease. The latter is more common and important, accounting for 2 / 3 of the disease. Raynaud's disease is rare.

The etiology of Raynaud's disease is not clear, and may be associated with neuroendocrine dysfunction, because some cases in each menstrual exacerbation. Patients often have family history, may also be related to genetic. Good hair in young women, male to female ratio of 1:10. Raynaud's phenomenon in many visible primary diseases, the most common connective tissue diseases, especially scleroderma. Systemic lupus erythematosus, rheumatoid arthritis, vasculitis, dermatomyositis may also occur. Other reasons are: occlusive atherosclerosis, cryoglobulinemia, neurovascular compression diseases such as thoracic outlet syndrome, such as hammer occupation disease such as disease of long-term use of vibration tools. In addition, also the application of certain drugs such as beta blockers and ergot caused. Raynaud's phenomenon is more common in women with connective tissue diseases than in women, while men are more likely to be associated with atherosclerosis in the elderly.

The pathological changes of Raynaud's syndrome can be divided into three stages: first, the first stage of spasm occurs in the first and second digits. The stagnant hypoxia period: artery spasm first subsided, capillary blood stasis, hypoxia, skin cyanosis. The congestion period: all spasm after the release of reactive hyperemia, skin flushing. And turn to normal skin color.

Peripheral vascular examination:

Skin color test

Skin color is an indicator of peripheral vascular function. Acral skin capillary rich easy to observe the color change, especially refers to (toe) abdomen, hand (foot) is most easily observed with palm skin and nail bed capillaries. To observe the changes in skin color, should try to check in the appropriate temperature in the room, the room temperature should be controlled at 20 to 27 DEG C and make the best use of natural light, check should pay attention to control color limb symmetry part, in order to find the color difference.

(a) finger test

The examiner uses the finger to press the finger (toe) abdomen or nail bed, observe the capillary filling. Oppression of local pale, should be restored quickly after the release of pink, normal recovery time of 1 ~ 2 seconds. Such as local blood circulation disorder, then after relieving compression or local slow filling a pale or cyanosis. Pressure recovery time is more than 3 seconds, as artery abnormalities, pale turn rosy longer, indicating more severe limb ischemia. Experimental observation on acupressure nail color, attention should be paid to patients with micro flexor hyperextension, finger and nail color pale, easy to cause false positives, mistaken for limb blood disorder. Pressure test can also be whether limb tissue necrosis has difference in skin, cyanosis for finger test, under pressure as persistent pale white, suggesting that local severe hypoxia has been deactivated, organization.

(two) limb elevation test

The use of limb elevation or droop method, resulting in local limb blood pressure changes in the body, and then observe the changes in the skin. The method is to make the patient supine, the body naturally flat straight, observe the foot, toe (or palm finger) skin color. If one side limb or a toe (finger) or toe (finger), the emergence of local uniform pale or mottled cyanosis, suggesting that the presence of limb ischemia.

Limb elevation test: the lower limbs and check the table into 70 degrees, 60 seconds after the observation, the normal skin should be slightly pale pink. Ischemic limbs can be pale or white. The degree of pale limb ischemia was proportional to the severity of arterial occlusion, and the pale white range varied with the obstruction site, generally slightly below the plane of the obstructed artery. When the upper limb elevation test was done, the patient stood and held his hands for more than a few seconds, and then observed. By raising the body of the skin color changes, normal people in 10 seconds to restore the skin color. Limb ischemia can be delayed to 45 ~ 60 seconds or longer, and uneven skin color patches.

Drop test: when the body limbs sagging, normal skin color and no special changes or only mild flushing. Blood circulation disorders showed severe cyanosis, this is due to hypoxia, vascular congestion caused by limb. In patients with varicose veins and venous valve insufficiency, there was no significance for the drop test.

Two, skin temperature measurement

Individual differences in skin temperature is larger, so the individual not in absolute temperature to compare the different parts of the body, the skin temperature is different, the general body temperature than the limbs, toe at lower temperature; the temperature is higher than the hand foot temperature, finger (toe) temperature is higher than the temperature of the little finger (toe). The skin temperature is affected by temperature, mood, exercise, diet, smoking and other factors of hunger and satiety. The symmetry of the same individual parts of the skin temperature is the same, the temperature difference should not exceed 2 degrees Celsius, such as symmetrical parts of the skin temperature difference of more than 2 degrees Celsius or significantly lower, suggesting that local limb ischemia. Determination of limb skin temperature, at constant temperature (20 DEG to 27 DEG) room, rest 15 to 30 minutes, so that the body skin temperature achieved stability after measurement. Take the different parts of the different parts of the plane of symmetry. Decreased skin temperature is suggestive of limb ischemia, increased skin temperature is common in acute deep vein thrombosis and arteriovenous fistula.

Three, peripheral arterial pulse examination

Peripheral arterial pulsation is an important step in the detection of peripheral vascular disease. When considering arterial disease, the pulse of the main artery of the body should be checked regularly. When the artery stenosis, occlusion, arterial wall atherosclerosis, local or distal arterial pulse disappeared or weakened. High temperature, elevated body temperature, congenital arteriovenous fistula and so on can enhance the arterial pulse.

Attention should be paid to the examination of arterial pulse: the main artery must be checked. Bilateral symmetrical control. Depending on the location of the blood vessels, the use of different pressure touch check. The arterial pulse weakened or disappeared, the patient is very weak when the arteriopalmus examination should pay attention not to will own finger artery pulsation, mistaken artery pulse of the patient, with the patient on the opposite side of the same part of the arterial pulse or the patient's cardiac check identification. The important blood vessels such as the carotid artery pressure, should not be overweight and the inspection time is too long, so as not to cause cerebral ischemia. The palpation of the arterial pulse at the same time, still need to understand the elasticity and hardness of the artery, there is no distortion, nodules and tremor. Check the aneurysm beat, weight should be moderate, so as to avoid aneurysm rupture or aneurysm thrombosis.

 

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