【晨读】脊髓电刺激（四）
英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自ROCK AK , Truong H , Park YL, et al. Spinal Cord Stimulation[J]. Neurosurg Clin N Am, 2019, 30(2):169-194.本次学习由谢珺田副主任医师主讲。
Refractory Angina Pectoris
Table 4 summarizes studies related to SCS treatment of RAP. RAP is anginal pain commonly caused by coronary artery disease that does not respond to antianginal medications. Patients tend to experience episodes of heavy, pressure like chest pain. SCS has been proposed as a treatment of anginal pain when it becomes refractory to medical therapy. Initial concerns arose that SCS may mask the signs of myocardial ischemia, but early case series demonstrated antianginal effects without an increased risk for ischemia.
难治性心绞痛
表 4 总结了与SCS治疗RAP相关的研究结果。RAP是一种缺血性疼痛，通常由冠状动脉病变所致，扩血管药物治疗无效。患者可感到剧烈的压榨性胸痛。SCS已被推荐作为抗心绞痛药物治疗无效患者的一种可供选择的治疗方法。最初的顾虑是SCS可以掩盖心肌缺血的表现，但一系列病例报道系列均显示了抗心绞痛作用，而没有产生加重缺血的风险。
Notably, a small RCT (n 5 17) demonstrated improved performance on cardiac treadmill stress testing and reduced nitrate intake among those treated with SCS.34 Similar results were observed in other RCTs and case series that followed.35 In a larger scale RCT (n 5 100) by Mannheimer and colleagues,36 SCS was compared with coronary artery bypass surgery for the treatment of RAP. Patients who received coronary artery bypass surgery performed significantly better on exercise tolerance testing, but both groups experienced adequate symptom relief with no significant difference between the two cohorts.
值得注意的是，一个小样本随机对照试验（病例数只有17例）结果表明，在接受SCS治疗的患者中，心脏平板负荷试验的表现有所改善，硝酸甘油服用剂量减少。在其它随机对照试验和随后的病例报道中也观察到类似的结果。Mannheimer及其同事进行的规模较大的RCT（病例数为100）研究，比较了SCS与冠状动脉搭桥术治疗RAP的疗效。结果接受冠状动脉搭桥手术的患者在运动耐量测试中表现更好，但两组患者的症状都得到了充分缓解，两组患者缓解程度之间没有显著差异。
Table 5 summarizes studies related to SCS treatment of peripheral vascular disease and critical limb i chemia. The use of SCS for the treatment of critical limb ischemia has mixed evidence within the literature. Case series and case control studies report promising clinical outcomes with pain relief and the promotion of wound healing when SCS was added to the standard medical treatment.37–43 However, RCTs have had less robust results with only one out of three RCTs suggesting improved pain relief with SCS.
表 5 总结了SCS治疗周围血管疾病和严重肢体缺血疾病的相关研究。采用SCS治疗严重肢体缺血疾病的文献证据不一。病例报道和病例对照研究显示了有前景的临床结果，SCS加上常规药物治疗，可明显缓解疼痛，并能促进创面愈合。然而，随机对照试验的结果并不一致，三分之一的随机对照试验表明SCS能达到疼痛缓解标准。
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