Transkutane Sauerstoffpartialdruckund Kohlendioxidpartialdruckmessung – Verfahrenstechnik- und Anwendungsgebiete

M. Stücker; U. Memmel; P. Altmeyer

doi:10.1055/s-0037-1617239

Phlebologie, Table of Contents

Phlebologie 2000; 29(04): 81-91
DOI: 10.1055/s-0037-1617239

Originalarbeit

Schattauer GmbH

Transkutane Sauerstoffpartialdruckund Kohlendioxidpartialdruckmessung – Verfahrenstechnik- und Anwendungsgebiete

Transcutaneous measurement of oxygen and carbon dioxide – process engineering and fields of applicationMesurage de la pression partielle transcutanée de l’oxygène et du carbon dioxide – Méthode et domaines d’applications

Authors

M. Stücker

¹Klinik für Dermatologie und Allergologie, Ruhr-Universität Bochum (Direktor: Prof. Dr. Peter Altmeyer)
U. Memmel

¹Klinik für Dermatologie und Allergologie, Ruhr-Universität Bochum (Direktor: Prof. Dr. Peter Altmeyer)
P. Altmeyer

¹Klinik für Dermatologie und Allergologie, Ruhr-Universität Bochum (Direktor: Prof. Dr. Peter Altmeyer)

Abstract

Zusammenfassung

Die transkutane Sauerstoffpartialdruckmessung ist ein nichtinvasives Verfahren zur Bestimmung des Sauerstoffpartialdrucks an der Hautoberfläche sowie des systemischen arteriellen Sauerstoffpartialdrucks. Ursprünglich wurde diese Technik zur Blutgasüberwachung in der Neonatologie entwickelt. Aktuelle Einsatzgebiete sind die Verlaufsbeurteilungen bei peripherer arterieller Verschlusskrankheit, bei chronischer Veneninsuffizienz und Diabetes mellitus sowie bei Kollagenosen und entzündlichen Hauterkrankungen. Die transkutane Kohlendioxidpartialdruckmessung ist eine nichtinvasive Methode zur Quantifizierung von systemischen Veränderungen des Säuren-Basen- Haushaltes und der Blutgase. Klinische Anwendungsgebiete ergeben sich neben der phlebologisch/ angiologischen Mikrozirkulationsdiagnostik in der Anästhesie und Intensivmedizin sowie der Atemphysiologie und Sportmedizin.

Summary

The transcutaneous measurement of oxygen is a noninvasive method to determine the partial pressure of oxygen of the skin surface and the systemic arterial partial pressure of oxygen. This technique initially was developed for blood gas analysis in the neonatology. Of current interest is the assessment of the peripherel arterial disease, the chronic venous insufficiency and the diabetes mellitus as well as collagenosis and inflammatory skin diseases. The transcutaneous measurement of carbon dioxide is a non-invasive method for the quantification of systemic changes of the acid-base metabolism and of blood gases. In clinical use we will apply this technique for diagnosis of the microcirculation in phlebology and angiology as well as in the respiratory physiology and sports medicine.

Résumé

Par moyen du mesurage de la pression partielle transcutanée de l’oxygène comme méthode non-invasive, on réusit à documenter la pression partielle de l’oxygène de la surface de la peau ainsi que la pression partielle artérielle systémique. D’abord cette technique était développée pour surveiller les gaz sanguins en Néonatologie. Maintenant les domaines d’applications s’étendent sur l’évolution des oblitérations artérielles, de l’insuffisance veineuse chronique et du diabète de plus sur les collagenoses et des maladies de la peau inflammatoires. Le mesurage de la pression partielle transcutanée du carbon dioxide est une méthode non-invasive pour quantifier les modifications des gaz sanguins. Les domaines d’applications cliniques s’étendent sur le diagnostique de la microcirculation phlebologique et angiogologique ainsi que sur l’anesthésie, la physiologie respiratoire et la médicine sportive.

Schlüsselwörter

Transkutaner Sauerstoffpartialdruck - transkutaner Kohlendioxidpartialdruck - Haut

Keywords

Transcutaneous partial pressure of oxygen - transcutaneous pressure of carbon dioxide - skin

Mots clés

Pression partielle transcutanée de l’oxygène - pression partielle transcutanée du carbon dioxide - peau

Full Text

References

Literatur
1 Abendroth D, Schmand J, Landgraf R, Illner WD, Land W. Diabetic microangiopathy in type 1 (insulin-dependent) diabetic patients after successful pancreatic and kidney or solitary kidney transplantation. Diabetologica 1991; 34: S131-4.
2 Albrecht HP, Hiller D, Hornstein OP, Bühler-Singer S, Mück M, Gruschwitz M. Microcirculatory functions in systemic sclerosis: additional parameters for therapeutic concepts?. J Invest Dermatol 1993; 101: 211-5.
3 Altmeyer P, Hoffmann K. Stücker. Kutane Mikrozirkulation. Berlin, Heidelberg, New York: Springer Verlag; 1997
4 Ballard JL, Eke CC, Bunt TJ, Killeen JD. A prospective evaluation of transcutaneous oxygen measurements in the management of diabetic foot problems. J Vasc Surg 1995; 22: 485-92.
5 Baumbach P. Verständnis transkutaner pO₂- und pCO₂-Messungen. Radiometer A/S, Kopenhagen 1988
6 Baumberger JP, Goodfriend RB. Determination of arterial oxygen tension in man by equilibration through the intact skin. Fed Proc 1951; 10: 10.
7 Baumgärtl H, Ehrly AM, Saeger-Lorenz K, Lübbers DW. Initial results of intracutaneous measurement of pO₂ profiles. In: Clinical oxygen pressure measurement. Ehrly AM, Harss J, Huch R. (Hrsg). Berlin: Springer; 1984: 121-8.
8 Bongard O, Bounameaux H, Fagrell B. Effects of oxygen inhalation on skin microcirculation in patients with peripheral arterial occlusive disease. Circulation 1992; 86: 878-86.
9 Bongard O, Didier D, Bounameaux H. Effects of percutaneous transluminal angioplasty on skin microcirculation in patients with disabling peripheral arterial occlusive disease. Int J Microcirc: Clin Exp 1994; 14: 319-26.
10 Breuer HWM, Skyschally A, Alf DF, Schulz R, Heusch G. Transcutaneous p(co2)-monitoring for the evaluation of the anaerobic threshold –- comparison to lactate and ventilatory thresholds. International J Sports Medicine 1993; 14: 417-21.
11 Casillas JM, Michel C, Aurelle B, Becker F, Marcer I, Schultz S, Didier JP. Transcutaneous oxygen pressure: an effective measure for prothesis fitting on below-knee amputations. Am J Phys Med Rehabil 1993; 72: 29-32.
12 Creutzig A, Caspary L, Alexander K. Transcutaneous oxygen pressure at different dosages of intravenous prostaglandin E1 in patients with severe arterial occlusive disease: a doubleblind, placebo controlled study. In: Prostaglandin E1. New aspects on pharmacology, metabolism and clinical efficacy. Diehm C, Sinziger H, Rogatti W. (Hrsg). Berlin: Springer; 1991: 72-81.
13 Creutzig A, Caspary L, Alexander K. Zur Reproduzierbarkeit des transkutanen Sauerstoffdruckes bei fortlaufender Registrierung. VASA (Suppl.) 1992; 35: 32-3.
14 Creutzig A, Dau D, Caspary L, Alexander K. Transcutaneous oxygen pressure measured at two different electrode temperatures in healthy volunteers and patients with arterial occlusive disease. Int J Microcirc: Clin Exp 1987; 5: 373-80.
15 Didier D, Costes Y. Transcutaneous pO₂ (tcpO₂) monitoring during iliac and femoral percutaneous transluminal angioplasty (PTA). J Intervent Radiol 1992; 7: 7-20.
16 Diehm C, Kühn A, Strauss R, Hübsch-Müller C, Kübler W. Effects of regular physical training in a supervised class and additional intravenous Prostaglandin E1 and naftidrofuryl therapy in patients with intermittent claudication – a controlled study. Vasa 1989; 28 Suppl. 26-30.
17 Evans NTS, Naylor PFD. The systemic oxygen supply of human skin. Resp Physiol 1967; 3: 21-37.
18 Faergemann J, Aly R, Wilson DR, Maibach HI. Skin occlusion: effect on Pityrosporum orbiculare, Skin Pco2, pH, transepidermal water loss and water content. Arch Dermatol Res 1983; 275: 383-7.
19 Franzeck UK, Haselbach P, Speiser D, Bollinger A. Microangiopathy of cutaneuos blood and lymphatic capillaries in chronic venous insufficiency (CVI). Yale J Biol Med 1993; 66: 37-46.
20 Franzeck UK, Stengele B, Panradl U, Wahl P, Tillmanns H. Cutaneous reaktive hyperemia in short-term and long-term type I diabetes – Continuous monitoring by a combined laser Doppler and transcutaneous oxygen probe. VASA 1990; 19: 8-15.
21 Franzeck UK, Talke P, Bernstein EF, Golbranson FL, Fronek A. Transcutaneous pO₂ measurements in health and peripheral arterial occlusive disease. Surgery 1982; 91: 156-63.
22 Franzeck UK, Talke P, Golbranson FL, Bernstein EF, Fronek A. Transcutaneous oxygen tension of the lower extremity as a guide to amputation level. In: Continuous transcutaneous blood gas monitoring. Huch A, Huch R. (Hrsg). New York, Basel: Marcel Dekker; 1983: 709-14.
23 Franzeck Uk. Transkutaner Sauerstoffpartialdruck (tcpO₂)-Messungen mit neuen Elektrodentypen. In: Methoden der klinischen Kapillarmikroskopie. Mahler F, Meßmer K, Hammersen F. (Hrsg.). Basel: Karger; 1986: 107-23.
24 Franzeck UK. Transkutaner Sauerstoffpartialdruck in der klinischen Mikrozirkulation: Grundlagen, Methoden, Neuentwicklungen von Kombinationssonden und Anwendung in der Angiologie. Bern: Huber; 1991
25 Gardner AW, Skinner JS, Cantwell BW, Smith LK, Diethrich EB. Relationship between foot transcutaneous oxygen tension and ankle systolic blood pressure at rest and following exercise. Angiology 1991; 42: 481-90.
26 Gothgen I, Jacobsen E. Transcutaneous oxygen tension measurement. I. Age variation and reproducibility. Acta Anaesth Scand 1978; 67 Suppl. 66-70.
27 Grossmann U, Lübbers DW. Analysis of epidermal oxygen supply by simulation of partial oxygen pressure fields under varying conditions. Crit Care Med 1981; 9: 734-5.
28 Hasibeder W, Haisjackl M, Sparr H, Klaunzer S, Hörman C, Salak N, Germann R, Stronegger WJ, Hackl JM. Factors influencing transcutaneous oxygen and carbon dioxide measurements in adult intensive care patients. Intensive Care Med 1991; 17: 272-5.
29 Huch R, Lübbers DW, Huch A. Continous pO₂ measurement on the skin of adults and newborns. In: Oxygen supply. Kessler M, Bruley DF, Clark CC, Lübbers DW, Silver IA, Strauss J. (Hrsg). München, Berlin, Wien: Urban und Schwarzenberg,; 1973: 270-2.
30 Huch R, Huch A, Lübbers DW. Transcutaneous pO₂ . New York: Thieme-Stratton; 1981
31 Kallis B, de Rigal J, Leonard F, Leveque JL, Riche O, Le Corre Y, de Lacharriere O. In vivo study of scleroderma by non-invasive techniques. Br J Dermatol 1990; 122: 785-91.
32 Kesten S, Chaoman KR, Rebuck AS. Response characteristics of a dual transcutaneous oxygen/ carbon dioxide monitoring system. Chest 1991; 99: 1211-5.
33 Lentner A, Younossi H, Planz S, Wienert V. Der Einfluss von hydrostatischem Druck, Umgebungstemperatur sowie Alter, Geschlecht und Rauchgewohnheiten auf die transkutane Sauerstoffpartialdruckmessung. VASA 1991; 32 Suppl. 243-46.
34 Liu Y, Steinacker J, Stauch M. Transcutaneous oxygen tension and Doppler ankle pressure during upper and lower body exercise in patients with peripheral arterial occlusive disease. Angiology 1995; 46: 689-98.
35 Lübbers DW. Cutaneous and transcutaneous pO₂ and pCO₂ and their measuring conditions. In: Continuous transcutaneous blood gas monitoring, Original Article Series-Birth Defects. The National Foundation March of Dimes. Huch A, Huch R, Lucey JF. (Hrsg.). New York: AR Liss; 1979. 15 13-31.
36 Mannarino E, Pasqualini L, Maragoni G, Sanchini R, Regni O, Inocente S. Chronic venous incompetence and transcutaneous oxygen pressure: a controlled study. VASA 1988; 17: 159-61.
37 Mayrowitz HN, Larsen PB. Periwound microcirculation of venous leg ulcers. Microvasc Res 1994; 48: 114-23.
38 Ott A. Langzeiteffekte des Zigarettenrauchens auf die Mikrozirkulation der Haut. Phlebologie 1993; 22: 128-30.
39 Prens EP, Joost TH, Steketee J. Quantification of patch test reactions by transcutaneous pO₂ measurement. Contact Dermatitis 1987; 16: 142-6.
40 Reiber GE, Roger EP. Risk factors for amputation in patients with diabetes. A case control study. Ann Intern Med 1992; 117: 97-105.
41 Reimers I, Schmeller W. Transkutane Sauerstoffpartialdruckmessung zur Verlaufskontrolle bei Patienten mit Erysipel. Hautarzt 1990; 41: 384-7.
42 Roszinski S, Koser T, Wilhelm KP, Schmeller W. Untersuchungen der Oxygenierung von Dermis und Subkutis bei Dermatoliposklerose. VASA 1993; 22: 297-305.
43 Russell RIR, Helms PJ. Comparative accuracy of pulse oximetry and transcutaneous oxygen in assessing arterial saturation in pediatric intensive care. Critical Care Med 1990; 18: 725-7.
44 Scheffler P, de la Hamette D, Leipnitz G. Placebokontrollierte Studie über die Wirkung von i.v. PGE1 auf Makro- und Mikrozirkulation bei Patienten mit AVK Stadium III/IV. VASA 1991; 33 Suppl. 343-4.
45 Schmidt JA, Bracht C, Leyhe A, von Wiechert P. Transcutaneous measurement of oxygen and carbon dioxide tension (TcpO₂ and TcpCO₂) during treadmill exercise in patients with arterial occlusive disease (AOD) - stages I and II. Angiology 1990; 41: 547-52.
46 Schmidt JA, Leyhe A, von Wichert P. Transkutaner Sauerstoffdruck unter Belastung bei Patienten mit arterieller Verschluflkrankheit der Beine im Stadium I und IIa. Inn Med 1989; 16: 41-5.
47 Spence VA, Swanson Beck J. Transcutaneous measurement of pO₂ and pCO₂ in the dermis at the site of the tuberculin reaction in healthy human subjects. J Pathol 1988; 155: 289-93.
48 Silverstein GL, Steen VD, Medsger TA, Falanga V. Cutaneous hypoxia in patients with systemic sclerosis (scleroderma). Arch Dermatol 1988; 124: 1379-82.
49 Stücker M, Altmeyer P, Struk A, Hoffmann K, Schulze L, Lübbers DW. The epidermal oxygen uptake from the atmosphere is in balance with the capillary oxygen supply. J Invest Dermatol 2000; 114: 533-40.
50 Stücker M, Falkenberg M, Reuther T, Altmeyer P, Lübbers DW. Lokal oxygen content in the skin is increased in chronic venous incompetence. Microvasc Res 2000; 59: 99-106.
51 Stücker M, Quinna S, Memmel U, Röchling A, Traupe M, Hoffmann K, Köster O, Altmeyer P. Macroangiopathy of the upper extremities in progressive systemic sclerosis. Eur J Med Res. (im Druck).
52 Stücker M, Schöbe MC, Hoffman K, Schultz-Ehrenburg U. Microvascular changes found in macroscopically unchanged skin in patients with chronic venous insufficiency. Proceedings of the European Congress of the International Union of Phlebology Budapest 1993. Essex: Multiscience 1993, Essex, 4-7.
53 Stücker M, Schöbe MC, Hoffman K, Schultz-Ehrenburg U. Cutaneous microcirculation in skin lesions associated with chronic venous insufficiency. Dermatol Surg 1995; 21: 877-922.
54 Stücker M, Schulze L, Pott G, Hartmann P, Lübbers DW, Röchling A, Altmeyer P. FLIM of luminescent oxygen sensors: clinical applications and resuts. Sens Actuators B 1998; 51: 171-5.
55 Takiwaki H. Transcutaneous pO₂ and pCO₂ measurement in dermatology. Acta Derm Venereol 1994; 185 Suppl. 21-5.
56 Tooke JE, Lins PE, Östergren J. Skin microvascular autoregulatory responses in Type I-Diabetes: The influence of duration and control. Int J Microcirc: Clin Exp 1985; 4: 249-56.
57 Tremper KK, Shoemaker WC. Transcutaneous oxygen monitoring of critically ill adults, with and without low flow shock. Crit Care Med 1981; 9: 706-9.
58 Uccioli L, Monticone G, Russo F, Mormile F, Durola L, Mennuni G, Bergamo F, Menzinger G. Autonomic neuropathy and transcutaneous oxymetry in diabetic lower extremities. Diabetologica 1994; 37: 1051-5.
59 Valentini G, Leonardo G, Moles DA, Apaia MR, Maselli R, Tirri G, Del Guercio R. Transcutaneous oxygen pressure in systemic sclerosis: evaluation at different sensor temperatures and relationship to skin perfusion. Arch Dermatol Res 1991; 283: 285-8.
60 Widmer LK. Peripheral venous disorders: prevalence and socio-medical importance. Observations in 4529 apparently healthy persons. Basle Study III. Bern: Huber; 1978
61 Wienert V. Ist der Einsatz der transkutanen Sauerstoffpartialdruckmessung in der Angiologie sinnvoll?. Phlebologie 1992; 21: 271-3.
62 Wollersheim H, Thien TH. Transcutaneous pO₂ measurements in Raynaud’s phenomenon. Value and limitations. Int J Microcirc: Clin Exp 1988; 7: 357-66.