脳卒中片麻痺患者の皮膚温分布とCRTに関する臨床的研究

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Skin temperature is easily influenced by the environmental and the individual factors, and on the other hand, the skin plays a major role in the regulation of body temperature. And the great variavility of skin temperature is due to the complexity of the cutaneous thermoregulatory mechanism. This apparently indicates a restricted value of skin thermometry as a sensitive and reliable index of peripheral cutaneous circulation.For the successful study of peripheral circulation, therefore, there is a great need for the development of systematic method including the measurements of several vascular parameters.The abnormal skin temperature in the hemiplegic limb often observed in postapoplectic patients is considered to be one of the impeding factors in the rehabilitation program.In the present paper, therefore, the distribution and the deviation of skin temperature on the body surface and the mechanism of the cusaneous thermoregulation by means of cold-rewarming test (CRT) in hemiplegics were investigated. These results were summarized as follows.First, (1) a common tendency was seen in both healthy and hemiplegic subjects, regarding the distribution and the thermal gradient of skin temperature from the frank or the proximal part of the limb to the periphery, and the inter-individual variations of skin temperature, (2) the statistically normal range of skin temperature was to wide to identify the abnormality of measured values, (3) however, hemiplegic subjects showed an apparent abnormality in the difference of skin temperature between hemiplegic and healthy limb. the value of difference ranged from maximal decrease of 8.8°C to maximal increase of 4.5°C in hemiplegic side.Secondary, (1) the responses to CRT were classified into following three types, (a) CRT (+): higher temperature in hemiplegic side, (b) CRT (0): no difference between both sides, (c) CRT (-): lower temperature in hemiplegic side, (2) a type of response to CRT was not always constant in individual case, but it was variable with the course of disease, (3) an abnormal response to CRT could arise from a defect at any level of the areas from the cerebral cortex to the brain stem, (4) the response to CRT was unrelated to edema, sensory disturbance and spasticity respectively, (5) clinical observations showed the existence of called "warm edema" and "cold edema" in hemiplegic side, and these changes were speculated to be partially due to the venous stasis and the delay in the return of the venous tone, (6) a type of CRT response was significantly related to motor dysfunction evaluated by Brunnstrom's recovery stage, but it was unrelated with activities of daily living.In the present study, the clinical characteristics of the skin temperature in hemiplegic patients were suggested. A classification of CRT responses proposed by the author was practically usefull for the additional explanation of the difference of skin temperature between the hemiplegic and the normal side.Furthermore, such analysis was available to precisely understand the changes of abnormal skin temperature and in part the central thermoregulatory controls of peripheral circulation in hemiplegic subjects.
一般社団法人日本温泉気候物理医学会の論文

著者

佐直信彦
東北大学医学部温泉医学研究施設

脳卒中片麻痺患者の皮膚温分布とCRTに関する臨床的研究

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