Bracale G C, Selvetella L, Mirabile F
Medical School of Naples, Department of Vascular Surgery, Italy.
Pacing Clin Electrophysiol. 1989 Apr;12(4 Pt 2):695-7. doi: 10.1111/j.1540-8159.1989.tb02717.x.
Spinal cord stimulation (SCS) by epidural electrodes is being used more often in the treatment of patients with severe intractable ischemic pain. The promising clinical results and the objective increase in lower extremity blood flow (plethysmography, thelethermography, etc.), suggests that spinal cord stimulation may have an important role in the management of advanced arterial disease when other forms of treatment have failed. The selection criteria for implantation of SCS are very important. Our indications in patients with peripheral vascular disease are: 1. Peripheral vascular disease with severe, intractable symptoms that are untreatable by medical or surgical therapy. 2. Inflammatory or diabetic arterial disease resistant to medical treatment and/or sympathectomy. 3. Persistent and severe ischemic pain and/or ulcers in patients with patent grafts. 4. Patients for lumbar sympathectomy who have a high myocardial risk. Contraindications to implantation of SCS are claudication intermittent, large necrotic lesions (gangrene) and patients who have undergone prolonged narcotic therapy.
硬膜外电极脊髓刺激（SCS）在治疗严重顽固性缺血性疼痛患者中应用越来越频繁。其令人鼓舞的临床结果以及下肢血流客观增加（通过体积描记法、皮温记录法等）表明，当其他治疗方法失败时，脊髓刺激在晚期动脉疾病的管理中可能发挥重要作用。SCS植入的选择标准非常重要。我们对外周血管疾病患者的适应证为：1. 患有严重、顽固性症状且药物或手术治疗无法治愈的外周血管疾病。2. 对药物治疗和/或交感神经切除术耐药的炎性或糖尿病性动脉疾病。3. 移植血管通畅的患者出现持续且严重的缺血性疼痛和/或溃疡。4. 心肌风险高的拟行腰交感神经切除术的患者。SCS植入的禁忌证为间歇性跛行、大面积坏死性病变（坏疽）以及接受过长时间麻醉治疗的患者。
