脊髓电刺激治疗糖尿病周围血管病变的短期疗效

Short-term effect of spinal cord electrical stimulation on peripheral vascular disease in diabetes patients

背景糖尿病周围血管病及糖尿病足患者数量居高不下,脊髓电刺激作为可明确改善下肢循环的方法被专科医师所关注。如何简单有效地应用脊髓电刺激改善糖尿患者下肢循环,研究较少。目的观察微创短时程脊髓电刺激(spinal cord stimulation,SCS)对糖尿病周围血管病变患者的短期治疗效果。方法选取2021年1-12月我科糖尿病周围血管病患者,男12例,女8例,年龄51~87周岁,应用穿刺柱状电极放置于硬脊膜外腔持续电刺激脊髓治疗,对比患者治疗前后各时间点的视觉模拟评分(visual analogue scale,VAS),测温枪测试下肢5个点温度前后差异,红外热成像仪测试患者体表温度改变,对比手术前后患肢踝肱指数变化。结果20例电极置入后1 d、3 d、7 d的VAS评分(术前5.6±1.7,术后1 d、3 d、7 d分别为4.0±1.3、2.5±0.8、2.3±0.7)较治疗前显著降低(P<0.001);治疗后下肢各检测点温度较前显著上升,足背术前温度为(36.03±0.13)℃、术后7 d为(36.74±0.14)℃;足底术前温度(35.90±0.17)℃、术后7 d为(36.44±0.23)℃(P<0.001);治疗前与治疗后1周比较,健侧与患侧红外热成像显示体表温度显著提高。结论短时程SCS可改善糖尿病性周围血管病患者的疼痛,改善下肢循环,不良反应少,安全有效,可应用于糖尿病足和糖尿病周围血管病的治疗。

Background Diabetes peripheral vascular disease and diabetes foot patients,methods for improving diabetes peripheral vascular disease are gradually increasing.As a clear method to improve the circulation of lower limbs,spinal cord electrical stimulation has been concerned by specialists.How to simply and effectively use spinal cord electrical stimulation to improve the circulation of lower limbs in diabetic patients are still lacking of researches.Objective To observe the therapeutic effect of minimally invasive short course spinal cord stimulation(SCS)on diabetic patients with peripheral vascular disease.Methods From January to December in 2021,patients with diabetes peripheral vascular disease in our department were selected.Puncture cylindrical electrodes were placed in the epidural space to continuously stimulate the spinal cord for treatment.The visual analog scale(VAS)of patients at various time points before and after treatment were compared.The temperature gun was used to test the temperature differences at five points of lower limbs before and after treatment,and the infrared thermal imager was used to test the temperature change of patients'body surface,the changes of ankle brachial index of affected limb before and after operation were compared.Results Twelve males and 8 females were included with age ranging from 51 to 87 years.The VAS scores of 20 patients on the 1st,3rd and 7th day after electrode implantation(preoperative VAS was 5.6±1.7,and the VAS on the 1st,3rd and 7th day after operation were 4.0±1.3,2.5±0.8,2.3±0.7,respectively)were significantly lower than those before treatment(P<0.001);After treatment,the temperature at each detection point of the lower limb was significantly higher than that before treatment.The preoperative temperature of back of the foot was(36.03±0.13)℃,and it increased to(36.74±0.14)℃at 7 days after treatment;the plantar temperature was(35.90±0.17)℃before treatment,and it increased to(36.44±0.23)℃at 7 days after treatment(P<0.001).Compared with before treatment,the infrared thermography of the healthy side and the affected side showed a significant increase in body surface temperature at 1 week after treatment.Conclusion Short-term SCS can alleviate the pain of patients with diabetes peripheral vascular disease and improve the circulation of lower limbs,with less adverse reactions,safety and effectiveness,which can be effectively applied to the treatment of diabetes foot and diabetes peripheral vascular disease.