Kloth L C, McCulloch J M
Program of Physical Therapy, Marquette University, Milwaukee, Wis, USA.
Adv Wound Care. 1996 Sep-Oct;9(5):42-5.
Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings, pressure-relieving devices, hyperbaric or topically applied oxygen, whirlpool/pulsed lavage, ultrasound, topical antibiotics, and cytokine growth factors. All except the last two interventions are physical treatments that create a wound-tissue environment conducive to healing. Unfortunately, many chronic wounds heal very slowly, do not heal, or worsen despite the best efforts of caregivers to promote tissue repair. An intervention commonly used to treat chronic wounds, especially by physical therapists, is electrical stimulation (ES). The rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body's endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source. The external current may serve to mimic the failed natural bioelectric currents so that wound healing can proceed. Certain chemotaxic factors found in wound substrates contribute to tissue repair processes by attracting cells into the wound environment. Neutrophil, macrophage, fibroblast, and epidermal cells involved in wound repair carry either a positive or negative charge. When these cells are needed to contribute to autolysis, granulation tissue formation, anti-inflammatory activities, or epidermal resurfacing, ES may facilitate galvanotaxic attraction of these cells into the wound tissue and thereby accelerate healing.
参与慢性伤口保守治疗的临床医生有多种治疗干预措施可供选择，包括清创/冲洗、敷料、减压装置、高压氧或局部应用氧气、漩涡浴/脉冲冲洗、超声波、局部抗生素以及细胞因子生长因子。除了最后两种干预措施外，其他都是物理治疗，可创造有利于愈合的伤口组织环境。不幸的是，尽管护理人员竭尽全力促进组织修复，但许多慢性伤口愈合非常缓慢、无法愈合或病情恶化。一种常用于治疗慢性伤口的干预措施，尤其是物理治疗师常用的，是电刺激（ES）。使用这种方法的理论依据是人体有一个内源性生物电系统，可促进骨折和软组织伤口的愈合。当人体的内源性生物电系统失效且无法促进伤口修复过程时，可从外部向伤口组织输送治疗水平的电流。外部电流可起到模拟失效的自然生物电流的作用，从而使伤口愈合得以继续。伤口基质中发现的某些趋化因子通过将细胞吸引到伤口环境中来促进组织修复过程。参与伤口修复的中性粒细胞、巨噬细胞、成纤维细胞和表皮细胞都带有正电荷或负电荷。当需要这些细胞参与自溶、肉芽组织形成、抗炎活动或表皮再上皮化时，电刺激可促进这些细胞向伤口组织的电趋性吸引，从而加速愈合。
