Goldman Robert, Brewley Barbara, Zhou Linqiu, Golden Michael
Department of Rehabilitation Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Adv Skin Wound Care. 2003 Mar-Apr;16(2):79-89. doi: 10.1097/00129334-200303000-00009.
To determine if high-voltage pulsed current (HVPC) augments ischemic wound healing and increases periwound perfusion.
A 5-year, retrospective, observational study was conducted on successive patients with ischemic wounds who were poor candidates for revascularization.
HVPC was applied directly to wounds at greater than 100 volts, 100 pulses per second, 1 hour per day. In addition to HVPC, patients received standard care for ischemic wounds at the study facility. Ischemic wounds for which HVPC was not clinically indicated or not available received standard care alone.
Wound area measured by planimetry, wound appearance observed by digital imaging techniques, and microcirculation monitored by transcutaneous oxygen (TcPo(2)) levels.
The group that received HVPC plus standard care showed smaller wound areas from weeks 20 though 52 after the start of treatment compared with the group that received standard care alone (P <.05; Mann-Whitney test). One year after the start of treatment, 90% of HVPC-treated wounds were healed, compared with 29% of the wounds that received only standard care (P <.05; Fisher exact test). For the HVPC group, maximum periwound TcPo(2) improved during electrotherapy (6 +/- 8 mm Hg [standard deviation; SD] at baseline improved to 26 +/- 20 SD, during HVPC, P <.05; Wilcoxon signed rank test).
The results of this retrospective trial demonstrate that HVPC plus standard care improved the healing rate of high-risk ischemic wounds. A direct relationship was shown between improved healing rates and increased periwound perfusion. A prospective randomized controlled trial is needed to further support these observational, preliminary findings.
确定高压脉冲电流（HVPC）是否能促进缺血性伤口愈合并增加伤口周围灌注。
对一系列血管重建术效果不佳的缺血性伤口患者进行了一项为期5年的回顾性观察研究。
将HVPC以大于100伏、每秒100次脉冲、每天1小时的强度直接施加于伤口。除HVPC外，患者在研究机构接受缺血性伤口的标准护理。未被临床指征使用HVPC或无法使用HVPC的缺血性伤口仅接受标准护理。
通过平面测量法测量伤口面积，采用数字成像技术观察伤口外观，通过经皮氧分压（TcPo₂）水平监测微循环。
与仅接受标准护理的组相比，接受HVPC加标准护理的组在治疗开始后第20周至52周时伤口面积更小（P<.05；Mann-Whitney检验）。治疗开始一年后，接受HVPC治疗的伤口90%愈合，而仅接受标准护理的伤口愈合率为29%（P<.05；Fisher精确检验）。对于HVPC组，在电疗期间伤口周围最大TcPo₂有所改善（基线时为6±8毫米汞柱[标准差；SD]，在HVPC期间提高到26±20 SD，P<.05；Wilcoxon符号秩检验）。
这项回顾性试验的结果表明，HVPC加标准护理提高了高危缺血性伤口的愈合率。愈合率的提高与伤口周围灌注增加之间存在直接关系。需要进行一项前瞻性随机对照试验来进一步支持这些观察性的初步发现。
