遠在西元前2500年,埃及人已會利用冰塊放在創傷部位,以減輕傷口腫脹和疼痛。「Cryotherapy」起源於希臘字,最早出現在西元1880~1890s,Cryo是cold的意思,therapy是cure的意思。所以,Cryotherapy是降低局部或全身組織溫度以達到治療效果的方法。當時一位科學家成功地將O2和CO液化;西元1899懷特醫師首先將Cryotherapy應用在人體上,利用液化氣體治癒皮膚疣、痣及腫瘤前期階段的治療,從此進入一個新的醫療里程碑。
由於 "冷療"可促進血管收縮,減少組織血流量,降低細胞新陳代謝,增加細胞存活率,因此,可減少出血及發炎的情況。另外,Cryotherapy可以提升痛閾,減輕疼痛與痙孿,對緩解肌肉攣縮有一定的效果,使患者在日後的治療過程較舒適。
(Cryotherapy is the local or general use of low temperatures in medical therapy or the removal of heat from a body part. The term "cryotherapy" comes from the Greek cryo meaning cold and the word therapy meaning cure. It has been around since the 1880~1890s。Its goal is to decrease cellular metabolism, increase cellular survival, decrease inflammation, decrease pain and spasm, promote vasoconstriction)
Cryotherapy作用機轉過程可分作3個階段來實現,分別是熱傳導、破壞細胞、產生炎症反應(The mechanism of action in cryotherapy can be divided into 3 phases: (1) heat transfer, (2) cell injury, and (3) inflammation)。臨床上最常使用液態氮(liquid nitrogen, LN2)當作Cryogen為例,LN2的沸點(boiling point)是零下196℃(The most commonly used cryogen is liquid nitrogen, which has a boiling point of -196°C)。由於能量傳導的作用,LN2 與皮膚接觸,LN2會從皮膚吸收大量的熱能,LN2快速變成N2(g)( When using the spray cryotherapy technique, the liquid nitrogen is applied directly on the skin, and evaporation (boiling heat transfer) occurs in which the heat in the skin is quickly transferred to the liquid nitrogen. This process results in the liquid nitrogen evaporating almost immediately)者因為溫差階梯效應(The mechanism by which cryotherapy destroys the targeted cells is the quick transfer of heat from the skin to a heat sink. The rate of heat transfer is dependent on the temperature difference between the skin and the liquid nitrogen),距離皮膚接觸點較近的異常細胞,因急速降溫而使細胞內物質結晶化(Low temperature ensures maximum damage by concentrating electrolytes intracellularly)致細胞損傷、炎症、脫水,最後冷凍性壞死(Cryonecrosis)(Inflammation is the response to cell death and helps in local cell destruction);離皮膚接觸點較遠的正常細胞,受到影響較小;利用這種差異性,把皮膚中異常細胞殺死,而正常細胞傷害降到最低,經過一段時間修復後,自然回復至正常外觀。
可以根據不同部位或部位大小來決定冷療方法,如冰敷袋、冰棒按摩、冷浴、冷凍噴劑及控制型冷壓縮等,例如末端肢體,就可選用冷浴,把整個部位浸泡在內。冷療時間的掌握很重,時間過久可導致永久性低色素症與疤痕形成,如1~2小時,可能造成表皮周邊神經麻痺 (The time estimates given below must be adjusted depending on the skin temperature, local circulation, skin pigment, and method of delivery. Overfreezing can produce permanent hypopigmentation and scarring)
皮膚病治療比較有成效包括:
併發症可以分成幾類(Complications can be divided into): (1) acute (2) delayed (3) prolonged-temporary (4) permanent。
冷凍治療過程,會少許的刺痛感,大部份不需麻醉。治療後,會有程度不同的疼痛、紅斑、皮下水腫、皮下出血、色素沈著或色素脫失的現象,絕大多數都會完全消失,所以只要妥善地照顧傷口,預防感染,就可以得到最好的成果。治療的過程,往往需要2~3次以上,間隔約2~3週,所以需要耐心;半途而廢是治療失敗的最主要原因。 (One needs to be aware of the fact that lesions may need to be treated multiple times before resolution)
<100-1-72> 物理醫學上,下列何者不是冷療(cryotherapy)的生理作用?