Mawson A R, Siddiqui F H, Biundo J J
Department of Ophthalmology, Louisiana State University Medical Center, New Orleans 70112.
Prev Med. 1993 May;22(3):433-50. doi: 10.1006/pmed.1993.1036.
Pressure ulcers are notoriously common in spinal-cord-injured patients, in patients with other neurological deficits, in malnourished and severely debilitated patients, and in the frail elderly. Prolonged localized external pressure, coupled with insensitivity to ischemia resulting from neurologic injury, has long been considered the major causal factor. Preventive efforts have focused on the relief of pressure via frequent repositioning and the use of pressure-relieving devices. However, consensus is growing that host factors also play a role in the development of pressure ulcers, the most important in spinal-cord-injured patients being the injury-induced loss of vasomotor control below the level of the lesion, resulting in hypoxemia. Accordingly, pressure ulcers may be prevented not only by reducing external pressure but also by increasing the patient's resistance to pressure, that is, by directly influencing tissue oxygenation. Review of the literature suggests that electrical stimulation increases cutaneous blood flow and promotes the healing of pressure ulcers. Moreover, high-voltage pulsed galvanic stimulation (75 V, 10 Hz) applied to the back at spinal level T6 in spinal-cord-injured persons lying supine on egg-crate mattresses can raise sacral transcutaneous oxygen tension levels into the normal ranges (A. R. Mawson, F. H. Siddiqui, B. J. Connolly, C. J. Sharp, W. R. Summer, and J. J. Biundo, Jr., Paraplegia in press). Randomized controlled trials are needed to determine the efficacy of high-voltage pulsed galvanic stimulation for preventing pressure ulcers in spinal-cord-injured persons and other groups at high risk.
压疮在脊髓损伤患者、患有其他神经功能缺损的患者、营养不良和严重虚弱的患者以及体弱的老年人中极为常见。长期局部外部压力，再加上因神经损伤导致的对缺血不敏感，长期以来一直被认为是主要致病因素。预防措施主要集中在通过频繁翻身和使用减压装置来缓解压力。然而，越来越多的共识认为，宿主因素在压疮的形成中也起作用，在脊髓损伤患者中最重要的是损伤导致损伤平面以下血管舒缩控制丧失，从而导致低氧血症。因此，预防压疮不仅可以通过减轻外部压力，还可以通过增强患者对压力的抵抗力，即直接影响组织氧合来实现。文献综述表明，电刺激可增加皮肤血流量并促进压疮愈合。此外，对仰卧在蛋托床垫上的脊髓损伤患者在T6脊髓水平的背部施加高压脉冲电流刺激（75V，10Hz），可使骶部经皮氧张力水平提高到正常范围（A.R.莫森、F.H.西迪基、B.J.康诺利、C.J.夏普、W.R.萨默和J.J.比温多， Jr.，《截瘫》即将发表）。需要进行随机对照试验来确定高压脉冲电流刺激对预防脊髓损伤患者和其他高危人群压疮的疗效。
