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Wskaźnik kostka-ramię w leczeniu owrzodzeń goleni

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Wskaźnik kostka-ramię (ang. ankle-brachial index, ABI) to nieinwazyjna metoda diagnostyki przewlekłego niedokrwienia kończyn dolnych. Ze względu na dostępność i łatwość wykonania badanie to szeroko wykorzystuje się w diagnostyce i leczeniu owrzodzeń goleni.

Na czym polega badanie wskaźnika kostka-ramię?

Badanie wskaźnika kostka-ramię polega na analizie relacji między wartościami skurczowego ciśnienia tętniczego (SPB) mierzonymi na kończynach górnych i dolnych (iloraz wyższej wartości SBP na kostce do SBP na ramieniu po tej samej stronie ciała). Prawidłowa wartość wskaźnika mieści się w przedziale 0,9-1,3. Wartości poniżej normy mogą wskazywać na obecność niedokrwienia kończyn dolnych.

Do wykonania badania wykorzystywane są ultradźwięki o częstotliwości 5-10 MHz. Badanie trwa ok. 15-20 min. W czasie jego trwania pacjent przebywa w pozycji leżącej. Przed rozpoczęciem badania należy uwzględnić 10-minutowy okres adaptacyjny.

Zastosowanie wskaźnika kostka-ramię w leczeniu owrzodzeń

Według statystyk mieszane owrzodzenia tętniczo-żylne mogą stanowić nawet 20 proc. przypadków trudno gojących się ran w obrębie kończyn dolnych. Miażdżyca tętnic obwodowych może być przyczyną poważnych powikłań i utrudniać proces leczenia rany. W przypadku miażdżycy bezobjawowej współistniejącej z niewydolnością żylną istnieje duże ryzyko wdrożenia niewłaściwego leczenia przyczynowego. Kompresjoterapia stosowana w leczeniu owrzodzeń żylnych w przypadku współistniejącej miażdżycy może doprowadzić do nasilenia niedokrwienia i rozwoju martwicy. Z tego powodu w leczeniu owrzodzeń goleni bardzo istotną rolę odgrywa kompleksowa diagnostyka.

Wskaźnik kostka-ramię to nieinawazyjna, niskokosztowa i skuteczna metoda diagnozowania przewlekłego niedokrwienia kończyn dolnych (ang. peripheral artery disease, PAD). Badanie charakteryzuje się wysoką czułością (do 95 proc. u pacjentów ze stwierdzonymi zmianami w arteriografii). Badanie pozwala określić stopień zaawansowania niedokrwienia i progresji zmian oraz ryzyko rozwoju martwicy i owrzodzenia w obrębie kończyny. Jest także pomocne w prognozowaniu efektów leczenia.

Źródło:

J. Neubauer-Geryk, L. Bieniaszewski, „Wskaźnik kostka-ramię w ocenie pacjentów z ryzykiem miażdżycy”, „Choroby Serca i Naczyń” 2007, 4(1): 1-5.

J. Cwajda-Białasik, P. Mościcka i in., „Ocena wartości wskaźnika kostka-ramię u chorych z owrzodzeniem kończyny dolnej o etiologii naczyniowej”, „Pielęgniarstwo Chirurgiczne i Angiologiczne” 2016, 2, 84-91.

Przeczytaj także: Zdalna diagnostyka owrzodzeń żylnych – jak ją przeprowadzić?

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