In VivoIn Vivo Hemodynamic Measurement Hemodynamic Measurement

- - LightLight - Electric - Electric

王鐘賢王鐘賢長庚大學長庚大學

長壽醫學研究中心　復健科學研究所　物理治療學系長壽醫學研究中心　復健科學研究所　物理治療學系

Respiration Circulation Metabolism

ATP

O2

(+)

Heat

etc.

(-)

VE = f X Vt VE/VO2

Q = P/R

MBP = C.O X TPR

C.O. = HR X SV

SV= VO2/HR

R = 6L/r4

VO2, VCO2,

RQ, RER

MET

Aerobic,

Non-aerobic

Cutaneous Microcirculation

Sweat

Physical

Performance

Hemodynamic Hemodynamic Resistance and Flow in Networks of VesselsResistance and Flow in Networks of Vessels

Flow = pressure difference/ resistanceFlow = pressure difference/ resistance Q = Q = P/RP/R R = 8 LR = 8 L//rr44; Q = ; Q = P/8 LP/8 L//rr44

Laminar vs. Turbulence FlowLaminar vs. Turbulence Flow Laminar FlowLaminar Flow

Shear stress; Shear stress; ss = 4 = 4 QQ//rr33

== fluid viscosityfluid viscosity Turbulence FlowTurbulence Flow

Reynolds number (Reynolds number (RRee) >2000) >2000 RRee = 4 = 4 QQ//ddii

= fluid density; = fluid density; ddii = inside diameter = inside diameter

HemodynamicHemodynamic Determinants of Arterial PressureDeterminants of Arterial Pressure

Mean Arterial PressureMean Arterial Pressure PPAA = CO X TPR = CO X TPR

CO = HR X SVCO = HR X SV TPR = 8 LTPR = 8 L//rr44

Arterial Pulse PressureArterial Pulse Pressure PPpp = P = PSS-P-PDD

PPpp ~~ SV/C SV/CAA

Properties of VesselsProperties of Vessels

VenousVenous ComplianceCompliance

C = C = V/V/P P Deep venous throDeep venous thro

mbosismbosis

ValveValve venous Insufficientvenous Insufficient

ArteriesArteries StiffnessStiffness

ArteriosclerosisArteriosclerosis

ArteriolesArterioles Active hyperemiaActive hyperemia Reactive hyperemiaReactive hyperemia

Intermittent claudicaIntermittent claudicationtion

ArteriosclerosisArteriosclerosis

Intermittent ClaudicationIntermittent Claudication

Control of Arteriolar ZoneControl of Arteriolar Zone LocalLocal

MetabolicMetabolic ATP-senstive KATP-senstive K++ channel, adenosine, CO channel, adenosine, CO22, H, H++, O, O22

Flow responsesFlow responses Endothelial cellsEndothelial cells

EDRF, NO, EDHF, PGIEDRF, NO, EDHF, PGI22

EDCF, endothelin (ET)EDCF, endothelin (ET)

NeuralNeural sympathetic vasoconstrictor fiber sympathetic vasoconstrictor fiber 11

HormonalHormonal circulating catecholamines, vasopressin, anigotensin IIcirculating catecholamines, vasopressin, anigotensin II

Venous Valve InsufficientVenous Valve Insufficient

Deep Venous ThrombosisDeep Venous Thrombosis

MethodologyMethodology PlethysmographyPlethysmography

Air, WaterAir, Water Strain gaugeStrain gauge ImpedanceImpedance

Doppler flowometryDoppler flowometry LaserLaser UltrasoundUltrasound

Pulse wave analysisPulse wave analysis IR RheographyIR Rheography

SpectrophometrySpectrophometry Capillary ImagesCapillary Images

Strain Gauge PlethysmographyStrain Gauge Plethysmography

A change in the blood volume in an extremitA change in the blood volume in an extremity will lead to a change in its circumference y will lead to a change in its circumference

Elastic mercury tubesElastic mercury tubes the change of the electrical resistance of the the change of the electrical resistance of the

mercury corresponds with the change of the mercury corresponds with the change of the circumference of the extremity. circumference of the extremity.

35 cm calf 35 cm calf + a change of about 1-3 cm + a change of about 1-3 cm Water or air plethysmophy.Water or air plethysmophy.

Impedance Impedance PlethymographyPlethymography

The measurement of changes in the The measurement of changes in the electrical resistance (impedance) caused by electrical resistance (impedance) caused by blood volume changesblood volume changes

Very low amount of high frequency Very low amount of high frequency alternating current is passed through the alternating current is passed through the selected measuring segment.selected measuring segment.

Impedance changes is inverse proportional Impedance changes is inverse proportional to the relative changes in blood volume.to the relative changes in blood volume.

Impedance Impedance PlethymographyPlethymography

Determine Resting and Hyperemic Determine Resting and Hyperemic Arterial InflowArterial Inflow

ApplicationApplication Testing of inflow at rest or of the arterial inflow durinTesting of inflow at rest or of the arterial inflow durin

g pharmaceutical or physical stimulationg pharmaceutical or physical stimulation Testing of hyperemic inflowTesting of hyperemic inflow

To diagnose arterial obliterative processesTo diagnose arterial obliterative processes To evaluate the haemodynamic quality of collateral circulatiTo evaluate the haemodynamic quality of collateral circulati

on on

LimitationLimitation A disturbed venous outflow (venous thrombosis)A disturbed venous outflow (venous thrombosis) MediasclerosisMediasclerosis Adipose (fat)Adipose (fat)

Reactive HyperemiaReactive Hyperemia

Venous Occlusion plethymographyVenous Occlusion plethymography

ApplicationApplication Diagnosis of deep venous thrombosisDiagnosis of deep venous thrombosis Testing the venous capacity and the venous Testing the venous capacity and the venous

compliance to quantify pathological changes of the compliance to quantify pathological changes of the veinsveins

Analysis of the circulation in the deep venous Analysis of the circulation in the deep venous system before vascular surgerysystem before vascular surgery

LimitationLimitation Disturbances of arterial inflowDisturbances of arterial inflow Adipose (fat)Adipose (fat)

Venous Function Venous Function

Venous capacityVenous capacity Venous outflowVenous outflow Venous toneVenous tone Flow resistanceFlow resistance

VenousVenous Reflux Test Reflux Test

ApplicationApplication Functional test of the venous valvesFunctional test of the venous valves Evaluation of the effectiveness of the muscle Evaluation of the effectiveness of the muscle

pumppump Early recognition of venous diseasesEarly recognition of venous diseases Evaluation of a possible success of Evaluation of a possible success of

operation on varicose veinsoperation on varicose veins

VenousVenous Reflux Test Reflux Test

Refilling timeRefilling time Refilling velocityRefilling velocity Volume displacementVolume displacement

Other Possible ApplicationsOther Possible Applications

Diagnosis of thoracic-outlet syndromeDiagnosis of thoracic-outlet syndrome Patient with scalenus anticus syndromePatient with scalenus anticus syndrome

Ankle-brachial index (ABI)Ankle-brachial index (ABI) PVDPVD

Pulse Wave AnalysisPulse Wave Analysis

IR RheographyIR Rheography

Determination of Determination of Artery Stiffness and Arteriole ReflectionArtery Stiffness and Arteriole Reflection

Artery StiffnessArtery Stiffness

Arteriole ReflectionArteriole Reflection

Pulse Wave AnalysisPulse Wave Analysis

Application of Application of Wound Healing, Wound Healing, Neuropathy, Neuropathy, and Endothelial Functionand Endothelial Function

This LDF is related to the average velocity and This LDF is related to the average velocity and number of red cells within the tissue volume.number of red cells within the tissue volume.

The Periscan PIM-II uses a 670nm laser whereThe Periscan PIM-II uses a 670nm laser whereas the Moor instruments use a 633nm laser anas the Moor instruments use a 633nm laser and a near-infrared 830 nm source for deeper ped a near-infrared 830 nm source for deeper penetration.netration.

InstrumentInstrument

Wound HealingWound Healing

Wound HealingWound Healing

Wound HealingWound Healing

Burn LevelsBurn Levels

Laser Doppler Imaging and InotophoresiLaser Doppler Imaging and Inotophoresiss

ACh

EDRF

SNP smooth cell

endothelial cell

Laser Doppler Imaging and InotophoresiLaser Doppler Imaging and Inotophoresiss

Aging, Exercise, MicrocirculationAging, Exercise, Microcirculation

Aging, Exercise, MicrocirculationAging, Exercise, Microcirculation

Aging, Exercise, MicrocirculationAging, Exercise, Microcirculation

In VitroIn Vitro Cell Isolation and Function Cell Isolation and Function

- - Centrifugation Centrifugation - Immunomagnetic Selection- Immunomagnetic Selection

- - FluorescenceFluorescence

王鐘賢王鐘賢長庚大學長庚大學

長壽醫學研究中心　復健科學研究所　物理治療學系長壽醫學研究中心　復健科學研究所　物理治療學系

HematopoiesisHematopoiesis

Blood CellsBlood Cells

Cluster of Differentiation (CD)

-Saline

-1.077 g/ml

-1.095 g/ml

-mononuclear cell

-granulocytes

-erythrocytes

Isolation of LeukocytesIsolation of Leukocytes

　　　　　　　　　　　　　 RCF=11.18(r)(rpm/1000)　 RCF ：離心力 r ：轉子 (Rotor) 半徑 rpm ：轉速

Immunomagnetic Selection TechniqueImmunomagnetic Selection Technique

Positive Negative

Cell MotionCell Motion

Adhesion Molecules

Adhesion molecules

1.Selectin 2.Mucin 3.Integrin 4.IgG-family CAM

Stokes’ LawStokes’ Law

FluorescenceFluorescence

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