脊髓电刺激治疗缺血性肢痛

Spinal cord stimulation for patients with ischemia pain of limbs

背景脊髓电刺激（spinal cord stimulation，SCS）在临床上已广泛用于治疗肢体缺血性疼痛，通过扩张外周血管、改善微循环、抑制痛觉传递等改善慢性缺血性静息痛、溃疡、坏疽等，但其扩张血管及镇痛的作用机制目前并不完全清楚。目的综述SCS治疗肢体缺血性疼痛的扩张血管及镇痛机制的研究进展及临床应用。内容阐述其诱导血管扩张及镇痛机制，包括通过交感神经系统调节机制、逆向激活感觉神经调节机制、抑制痛觉传递系统和激活镇痛物质的释放等，以及在临床应用中的适应证、疗效和并发症。趋向对不适合开放手术或血管介入手术的慢性肢体缺血疼痛患者，SCS治疗可作为一种合适的选择。

Background Spinal cord stimulation （SCS） has been apphed for the treatment of ischemia pain of limbs which can ameliorate chronical ischemia rest pain, ulcer and gangrene through dilation of the peripheral vessels, the improvement of microcirculation and inhibition of pain transduction. However, the precise mechanisms of SCS are still unclear now. Objective This article reviews the mechanisms of vasodilation and analgesia effects of SCS for the treatment of ischemia pain of limbs. Content Some possible mechanisms have been elucidated, including the sympathetic modification, the reverse activation of the sensory nerve, the modulation of descending system and the release of analgesic substance and the indications, curative effect, complications in clinical application. Trend Patients with chronic limb ischemia pain not amenable to open surgical or endovascular intervention have been identified as candidates for SCS therapy.