脊髓电刺激治疗下肢外周动脉疾病的效果  

Efficacy of spinal cord stimulation in the treatment of lower extremity peripheral arterial disease

作　　者：史春雨 吴纯 房轩 高献忠[2] 华敏[2] 王然 曹缘 张萍霞 徐晨婕 Shi Chunyu;Wu Chun;Fang Xuan;Gao Xianzhong;Hua Min;Wang Ran;Cao Yuan;Zhang Pingxia;Xu Chenjie(Jiangsu Province Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]徐州医科大学江苏省麻醉学重点实验室,徐州221004 [2]南京医科大学附属南京医院(南京市第一医院)麻醉疼痛与围术期医学科(疼痛科),南京210006

出　　处：《中华医学杂志》2025年第14期1101-1106,共6页National Medical Journal of China

基　　金：南京市医学科技发展重点(ZKX18033);江苏省科技基金项目(BL2014012)。

摘　　要：目的观察脊髓电刺激(SCS)治疗下肢外周动脉疾病(PAD)的临床效果。方法回顾性分析2021年10月至2024年8月于南京医科大学附属南京医院诊断为下肢PAD患者的临床资料,根据是否行SCS植入手术分为SCS组和对照组,将两组进行倾向性评分匹配(PSM)。记录治疗前(T_(0))以及治疗后7d(T_(1))、1个月(T_(2))、3个月(T_(3))、6个月(T_(4))及1年(T_(5))的疼痛数字评定量表(NRS)评分、匹兹堡睡眠质量指数(PSQI)、血流灌注指数(PI)和皮肤血流量(SkBF)以及治疗后的不良反应和并发症。采用重复测量方差分析比较两组患者治疗前后不同时间点的疗效。结果共纳入46例下肢PAD患者,SCS组23例,男14例,女9例,年龄(63.3±7.6)岁;对照组23例,男13例,女10例,年龄(62.0±8.5)岁。SCS组和对照组的一般临床资料及治疗前NRS评分[(7.9±1.0)比(8.3±1.0)分]、PSQI[(16.4±1.3)比(16.9±1.2)分]、PI[(0.32±0.12)比(0.29±0.08)]和SkBF[(28.65±6.39)比(30.48±4.77)灌注单位]的差异均无统计学意义(均P>0.05)。重复测量方差分析显示不同随访时间点SCS组的NRS评分和PSQI均低于对照组(均P_(组间)<0.05),PI和SkBF均高于对照组(均P_(组间)<0.05);SCS组患者治疗后NRS评分和PSQI均低于T_(0)(均P_(时间)<0.05);PI和SkBF均高于T_(0)(均P_(时间)<0.05)。所有患者未发生SCS相关严重不良反应,无一例死亡。结论SCS治疗下肢PAD有效,可缓解疼痛、提高睡眠质量、改善下肢微循环。Objective To observe the clinical efficacy of spinal cord stimulation(SCS)in treating lower extremity peripheral arterial disease(PAD).Methods A retrospective analysis was conducted on the clinical data of patients diagnosed with lower extremity PAD at Nanjing Hospital of Nanjing Medical University from October 2021 to August 2024.Patients were divided into SCS group and control group based on whether they underwent SCS implantation surgery.Propensity score matching(PSM)was applied to match the two groups.The numeric rating scale(NRS)score,Pittsburgh sleep quality index(PSQI),perfusion index(PI),and skin blood flow(SkBF)were recorded at pre-treatment(T_(0)),7 days(T_(1)),1 month(T_(2)),3 months(T_(3)),6 months(T_(4)),and 1 year(T_(5))post-treatment,and adverse reactions and complications were also reviewed after treatment.Repeated measures analysis of variance(ANOVA)was used to compare the therapeutic effects between the two groups at different time points before and after treatment.Results A total of 46 patients were included,with 23 patients in the SCS group[14 males and 9 females,aged(63.3±7.6)years],and 23 patients in the control group[13 males and 10 females,aged(62.0±8.5)years].There were no statistically significant differences in general clinical characteristics,or in pre-treatment NRS score[(7.9±1.0)vs(8.3±1.0)scores],PSQI[16.4±1.3)vs(16.9±1.2)scores],PI[(0.32±0.12)vs(0.29±0.08)],and SkBF[(28.65±6.39)vs(30.48±4.77)perfusion units]between the SCS group and the control group(all P>0.05).Repeated measures ANOVA showed that at different follow-up time points,the NRS score and PSQI in the SCS group were lower than those in the control group(all P_(group)P<0.05),while the PI and SkBF were higher than those in the control group(all P_(group)P<0.05).Additionally,within the SCS group,post-treatment NRS score and PSQI were lower than those at T_(0)(all P_(time)<0.05),and the PI and SkBF were higher than those at T_(0)(all P_(time)<0.05).None of the patients experienced severe adverse reactions related to

关 键 词：脊髓 电刺激疗法 外周动脉疾病 慢性肢体威胁性缺血 神经调控 

分 类 号：R543.5[医药卫生—心血管疾病]