Method of treatment for trophic ulcers of venous etiology

FIELD: medicine.

SUBSTANCE: invention concerns medicine, laser medicine, and can be applied in treatment of trophic ulcers of venous etiology. Method involves processing of ulcer surface and skin around ulcer by air and gas flow with nitrogen oxide content 2000 ppm or more at 40°C, with 10 second exposition per 1 cm2. Further, 0.1% Radachlorine gel is applied as photo sensitiviser in amount of 0.2 g per 1 cm2 with 60 minutes exposition. Then laser emission of 0.665 mcm wavelength and light energy dosage of 150-200 J/cm2 is applied at 3-5 mm distance from wound surface. Afterwards intravenous blood irradiation is performed over cubital vein by laser emission of 0.632 mcm wavelength and radiation power of 5 mW with 15 minutes exposition. Treatment course comprises 10 daily procedures of air and gas flow processing and intravenous blood irradiation and 5-8 photodynamic therapy procedures performed over 2 day interval.

EFFECT: improved neurotrophic regulation of damaged tissues, antimicrobe effect, reduced frequency of purulent complications, improved blood flow properties, prevented resistance of ulcer microflora to antibiotics and drugs, prevented dysplasia, cicatrical changes and skin malignisation around trophic ulcer.

4 cl, 1 ex

 

The invention relates to medicine, namely, laser medicine, and can be used for the treatment of trophic ulcers of venous etiology.

There are surgical methods for the treatment of venous ulcers, such as excision, vacuuming, curettage (Yablokov Mrs x, Kiriyenko A.I., Bogachev VY Chronic venous insufficiency. - M - 1999.- 128 C.). However, the result of these serious effects is slow reparative processes.

There is a method of treatment of venous ulcers using a variety of wound coverings (bogdaniec, L.N., Kiriyenko A.I., E.A. Alekseev Local treatment of venous trophic ulcers. The magazine "Gedeon Richter" in the CIS. - 2000.- No. 2. - P.58-60). The application of this method is limited by the development of local allergic reactions. You should also bear in mind the high cost of wound dressing.

The prototype of the present invention is a method of treatment of trophic ulcers, namely, that on the trophic ulcer impose a sterile bandage from dialdehydes containing the photosensitizer "photosense", and after keeping the wipes within 24 hours additionally carry out the irradiation of wounds red light emitted from the solid-state laser yttrium aluminate with twice the frequency and wavelength of 670 nm (patent RF №2164426 from the 27.03.2001, State research center of laser medicine MSRP). The disadvantage of this method is the need for long exposure headbands with photosensibilisation on the wound surface.

The technical result of the invention is an antimicrobial effect, improved neurotrophic regulation of affected tissues, improvement of rheological properties of blood, prevention of resistance microflora ulcers to antibiotics and drugs, prevention of occurrence of dysplasia, scarring and zlokacestvennoe skin around the sores.

This technical result is achieved due to the fact that in the treatment of trophic ulcers, comprising applying to the wound a photosensitizer and laser irradiation, the first surface of the ulcers and the skin around the ulcer is treated with air-gas stream containing nitric oxide is not less than 2000 ppm at a temperature of 40°With an exposure time of 10 seconds to 1 cm2after that as a photosensitizer is applied 0.1% gel Radachlorin dose of 0.2 g per 1 cm2the exposure time 60 minutes, then carry out the action of the laser light wavelength 0,665 μm at a dose of light energy of 150-200 j/cm2at a distance of 3-5 mm to the wound surface, then spend intravenous irradiation of blood through the cubital vein laser light wavelength 0,632 microns at a radiation power of 5 mW exposure 15 minutes, and the course of treatment, the Oia is 10 daily procedures for handling air-gas stream and intravenous laser irradiation of blood, 5-8 treatments of photodynamic therapy with an interval of 2 days. As a source of air / gas flow using the apparatus "Plason", as the source of laser light for photodynamic therapy using the apparatus "LAHTA-MILON, and apparatus for intravenous irradiation of blood use the apparatus Mustang-ILIB.

Treatment of trophic ulcers of venous etiology is as follows. The treatment is carried out sequentially. First ulcer surface is treated air-gas stream at a temperature of 40°C With nitrous oxide is not less than 2000 ppm (apparatus "Plason") exposure time 10 seconds on 1 cm2ulcer surface. Then, on the surface of the ulcers caused by the photosensitizer. As a last used by 0.1% gel Radachlorin for external use ("Radagel", 000 "RADA-PHARMA, Russia), which contains 1 mg/g of the active substance sodium salt of chlorin. Radagel applied on the entire ulcer surface with capture healthy tissue dose of 0.2 g per 1 cm2. After 60 minutes of exposure conducting photodynamic therapy laser light wavelength 0,665 μm at a dose of light energy of 150-200 j/cm2(apparatus "LAHTA-MILON"). The distance from the working end of the fiber to the wound surface 3-5 mm. After photodynamic treatment endovenous laser exposed the blood. The procedure is performed disposable quartz-polymer fibers in the cubital vein laser light of a wavelength of 0.63 µm, with output power of 5 mW (apparatus "Mustang-ILIB") and a duration of 15 minutes. Course NO therapy and intravenous laser irradiation of blood is 10 daily procedures. The number of sessions of photodynamic therapy for 5 to 8 with an interval of 2 days depending on the severity of inflammation and wound exudate.

The proposed method is illustrated by the following example.

Patient A. 52. Diagnosis: Chronic venous insufficiency complicated by trophic ulcers of both legs. Ill for 13 years. Treated inpatient and outpatient without any visible effect. In the lower third of both legs are trophic ulcers. On the right leg two ulcers dimensions of 5×6 cm and 3.5×5.5 cm, on the left leg one ulcer size 20×12 see Microbial infection of the ulcer surface 107microbial cells in 1 g of tissue. Patients received 8 sessions of photodynamic therapy with intervals of 2 days, NO therapy No. 10 daily. On the 4th day of treatment (2 sessions of photodynamic therapy and 4 session NO therapy) microbial colonization decreased to 105microbial cells in 1 g of tissue, which was accompanied by a significant decrease in discharge from the sores and swelling of the surrounding tissues. The patient notes that knowledge is sustained fashion decrease pain, normalized sleep. In parallel with the course of photodynamic treatment and NO-treatment patients received 10 sessions of intravenous irradiation of blood by laser with a wavelength of 632 nm. At the control examination after 2 months after starting treatment on the right leg there is one skin defect size 3×2 cm, on the left leg sizes 8×3, see the control examination after 6 months, no complaints. The skin of both legs without ulcers. Control examination after 12 months - no complaints, the skin of both legs without ulcers.

In this way treated 27 patients with a clinical picture of chronic venous insufficiency complicated by trophic ulcers. In all cases, was achieved this technical result.

The proposed method of treatment has a high antimicrobial activity, which reduces microbial contamination of the surface of ulcers, reducing the incidence of suppurative complications and do not require antibiotic treatment. Along with a significant decrease of pain syndrome, there are marked acceleration of the healing process. When this treatment is easily tolerated by patients and is performed on an outpatient basis.

1. Treatment of trophic ulcers of venous etiology, comprising applying to the wound a photosensitizer and laser irradiation, wherein the first surface of the ulcers and the skin around the ulcer is treated with air-gas stream containing nitric oxide is not less than 2000 ppm at a temperature of 40° exposure to 10 with 1 cm 2after that as a photosensitizer is applied 0.1%gel Radachlorin dose of 0.2 g per 1 cm2exposure 60 min, and then carry out the action of the laser light wavelength 0,665 μm at a dose of light energy of 150-200 j/cm2at a distance of 3-5 mm to the wound surface, then spend intravenous irradiation of blood through the cubital vein laser light wavelength 0,632 microns at a radiation power of 5 mW exposure 15 min, and the course of treatment is 10 daily procedures for handling air-gas stream and intravenous laser irradiation of blood, 5-8 treatments of photodynamic therapy with an interval of 2 days.

2. The method according to claim 1, characterized in that as the source of air / gas flow using the apparatus "Plason".

3. The method according to claim 1, wherein the source of laser light for photodynamic therapy using the apparatus "LAHTA-MILON".

4. The method according to claim 1, characterized in that in an apparatus for intravenous irradiation of blood using the apparatus "Mustang-ILIB".



 

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