Ogrin Rajna, Darzins Peteris, Khalil Zeinab
Endocrine Centre of Excellence, Heidelberg Repatriation Hospital, Melbourne, Australia.
Curr Aging Sci. 2009 Mar;2(1):72-80. doi: 10.2174/1874609810902010072.
Low frequency transcutaneous sensory nerve stimulation (LF-SNS) [International Patent PCT/AU2004/001079: "nerve function and tissue healing" (Khalil, Z.)] improves sensory nerve function and accelerates wound healing of older animals.
Double blind, placebo controlled randomised trial of LF-SNS for 5 minutes, twice daily for up to 12 weeks, on healing of chronic venous leg ulcers in older people. Four layer compression bandaging was the standard therapy. OUTCOME MEASURES (METHODS): Wound healing and the rate of epithelialisation (calculated from serial wound area estimation), microvascular blood flow (measured using LASER Doppler flowmetry), transcutaneous oxygen tension (measured using a transcutaneous oxygen monitor, TCM400 Radiometer). Sensory nerve activity (assessed via measuring electrical cutaneous perception threshold using the Neurometer((R))CPT and the flare response to 5% capsaicin (a selective activator of C fibres).
14 older people with chronic venous ulcers randomly allocated to active (mean age 74.8+/-2.3 years) and 15 to Sham nerve stimulation (mean age 76.5+/-2.6 years).
Microvascular blood flow improved in all participants. A high proportion of wounds healed ( approximately 60%). There were trends for better C-fibre function and faster healing rates in the Active group (1.1+/-0.3 cm(2)/wk) compared to the Sham group (0.6+/-0.2 cm(2)/wk) but failed to reach statistical significance due to the small sample size.
The improvement in microvascular blood flow in both groups was an unexpected finding that has not previously been described. Most likely this was due to the four layer compression bandaging provided to all participants. Improved microvascular blood flow may be a significant contributor to wound healing. The observed trends to increased healing rates and improvements in C-fibre function in the actively stimulated group compared to the sham group warrant further studies of LF-SNS as an adjunct therapy for chronic venous leg ulcers. An exploration of the possibility that LF-SNS induced-improvement in C-fibre function could protect against future ulceration is also warranted.
低频经皮感觉神经刺激（LF-SNS）[国际专利PCT/AU2004/001079：“神经功能与组织愈合”（哈利勒，Z.）]可改善老年动物的感觉神经功能并加速伤口愈合。
针对老年人慢性腿部静脉溃疡愈合情况，进行双盲、安慰剂对照的随机试验，对LF-SNS进行每日两次、每次5分钟、为期长达12周的治疗。四层加压包扎为标准治疗方法。
观察指标（方法）：伤口愈合情况及上皮形成速率（根据连续伤口面积估计计算）、微血管血流量（使用激光多普勒血流仪测量）、经皮氧分压（使用经皮氧监测仪TCM400 Radiometer测量）。感觉神经活动（通过使用Neurometer（R）CPT测量皮肤电感觉阈值以及对5%辣椒素（C纤维的选择性激活剂）的潮红反应进行评估）。
14名患有慢性静脉溃疡的老年人被随机分配至主动治疗组（平均年龄74.8±2.3岁），15名被分配至假神经刺激组（平均年龄76.5±2.6岁）。
所有参与者的微血管血流量均有所改善。高比例的伤口愈合（约60%）。与假刺激组（0.6±0.2平方厘米/周）相比，主动治疗组（1.1±0.3平方厘米/周）的C纤维功能有改善趋势且愈合速度更快，但由于样本量小，未达到统计学显著性。
两组微血管血流量的改善是一个此前未被描述的意外发现。这很可能是由于所有参与者均接受了四层加压包扎。微血管血流量的改善可能是伤口愈合的一个重要因素。与假刺激组相比，主动刺激组观察到的愈合速度加快趋势以及C纤维功能改善值得对LF-SNS作为慢性腿部静脉溃疡辅助治疗进行进一步研究。同时也有必要探讨LF-SNS诱导的C纤维功能改善是否能预防未来溃疡形成的可能性。
