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Skala Fontaine’a – klasyfikacja przewlekłego niedokrwienia kończyn dolnych

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Ciężkie niedokrwienie kończyn dolnych może prowadzić do powstawania niegojących się owrzodzeń, zgorzeli, a także postępującej martwicy. Do oceny niedokrwienia kończyn służy klasyfikacja Fontaine’a, wyróżniająca cztery stopnie zaawansowania niedokrwienia.

Badanie przedmiotowe, a zwłaszcza badanie tętna na kończynach jest podstawą do rozpoznania niedokrwienia kończyn. Klinicysta podczas badań ocenia również nasilenie dolegliwości bólowych, a także chromanie przestankowe, czyli wystąpienie bólu w obrębie kończyny dolnej po przejściu pewnego dystansu. Pod uwagę, w diagnostyce niedokrwienia kończyn, brane są również inne choroby układu krążenia, choroby współistniejące, otyłość, nawyki pacjenta.

W ocenie stopnia niedokrwienia służy skala Fontaine’a, wprowadzona przez dr René Fontaine’a w 1954 roku. Klasyfikacji tej często towarzyszy wskaźnik ABI, który wyraża stosunek ciśnienia na tętnicy stopy do wyższego z ciśnień zmierzonych na obu tętnicach ramiennych (prawidłowa wartość wskaźnika wynosi 0,9-1,15). Skala Fontaine’a podzielona jest na IV stopnie.

Stopień I

Bezobjawowy. U większości pacjentów nie występują istotne dolegliwości kliniczne, natomiast może dochodzić do mrowienia czy drętwienia kończyn i parestezji. Obserwowana jest również zwiększona wrażliwość kończyn na zimno. Niekiedy obserwowane są siniaki nad naczyniami krwionośnymi, a także brak tętna. (ABI: 0,89-0,7)

Stopień II

Ten etap uwzględnia fakt, iż pacjenci zwykle po pokonaniu określonego dystansu odczuwają ból.

Stopień IIa – chromanie przestankowe o niewielkim nasileniu – dystans chromania powyżej 200 m. (ABI: 0,69-0,41);

Stopień IIb – umiarkowane bądź ciężkie chromanie  – dystans chromania poniżej 200 m.

Stopień III

Ten stopień charakteryzuje się występowaniem niedokrwiennych bóli spoczynkowych, a także deficytem ukrwienia, który jest najwyższy w dystalnych częściach kończyn. Ból spoczynkowy jest szczególnie dokuczliwy dla pacjentów w nocy. (ABI: 0,4-0,2).

Stopień IV

Ostatni stopień zaawansowania niedokrwienia kończyn objawia się występowaniem zmian martwiczych, owrzodzeń niedokrwiennych, zgorzeli i uszkodzeniem tkanek. Ponadto pacjenci odczuwają bardzo silne bóle spoczynkowe. (ABI: <0,2).

Klasyfikacja Rutherforda

W praktyce klinicznej w ocenie zaawansowania niedokrwienia kończyn stosowana jest również klasyfikacja według Rutherforda. Skala podzielona jest na 6 stopni, przy czym funkcjonuje również stopień zerowy oznaczający bezobjawowe niedokrwienie kończyn:

  1. Niewielkie chromanie
  2. Umiarkowane chromanie
  3. Ciężkie chromanie
  4. Niedokrwienny ból spoczynkowy
  5. Niewielkie uszkodzenie tkanek
  6. Duże uszkodzenie tkanek

Źródła:

„Algorytmy i wytyczne postępowania terapeutycznego w ranach trudno gojących się” w: „Forum Leczenia Ran”, 2020;1(3), str. 95-116

„Stanowisko polskich ekspertów dotyczące leczenia zachowawczego u pacjentów z chorobą tętnic kończyn dolnych” w: Via Medica, 2019 Vol. 25, No. 2, str. 77–114

 

Przeczytaj także: Jak różnicować owrzodzenia żylne, niedokrwienne i neuropatyczne?

Biblioteka Faktów

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Zakażeń”:

Zasady postępowania miejscowego i ogólnego w ranach/owrzodzeniach przewlekłych objętych procesem infekcji

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