RU2357772C1 - Method of treatment for trophic ulcers of venous etiology - Google Patents

Abstract

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

Description

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

There are surgical methods for treating trophic ulcers, such as excision, evacuation, curettage (Yablokov E.G., Kirienko A.I., Bogachev V.Yu. Chronic venous insufficiency. - M.- 1999.- 128 p.). However, the result of these gross effects is a slowdown in reparative processes.

There is a method of treating trophic ulcers using a variety of wound dressings (Bogdanets L.N., Kirienko A.I., Alekseeva E.A. Local treatment of venous trophic ulcers. Journal "Gedeon Richter" in the CIS. - 2000.- No. 2. - S.58-60). The use of this method is limited by the development of local allergic reactions. You also need to keep in mind the high cost of wound dressings.

The prototype of the present invention is a method of treating trophic ulcers, namely, that a sterile dialdehyde cellulose dressing containing a photosensitizer “Photosens” is applied to the trophic ulcer, and after holding the wipe for 24 hours, the wound is additionally irradiated with red light emitted from a solid state laser on yttrium aluminate with a double frequency and wavelength of 670 nm (Patent for the invention of the Russian Federation No. 2164426 dated 03/27/2001, State Scientific Center for Laser Medicine of the Ministry of Health of the Russian Federation). The disadvantage of this method is the need for a long exposure of the dressing with a photosensitizer on the wound surface.

The technical result of the invention is antimicrobial action, improving neurotrophic regulation of affected tissues, improving blood rheology, preventing ulcer microflora resistance to antibiotics and drugs, preventing dysplasia, scarring and skin malignancy around a trophic ulcer.

The specified technical result is achieved due to the fact that in the method of treating trophic ulcers, including applying a photosensitizer to the wound and irradiating with a laser, the ulcer surface and the skin around the ulcer are first treated with an air-gas stream with a nitric oxide content of at least 2000 ppm at a temperature of 40 ° C by exposure 10 seconds to 1 cm ^2, then as a photosensitizer applied Radachlorin 0.1% gel at a dose of 0.2 g per 1 cm ² exposure 60 min, then exposure is carried 0.665 micron wavelength laser light at a light dose ene ology 150-200 J / ^cm2 at a distance of 3-5 mm to the wound surface, after irradiation of blood carried through intravenous cubital vein laser light wavelength 0.632 microns with a radiation power of 5 mW, 15 minutes exposure, the treatment of 10 daily treatments processing by air-gas flow and intravenous laser irradiation of blood, 5-8 procedures of photodynamic therapy with an interval of 2 days. The Plazon apparatus is used as a source of air-gas flow, the LAHTA-MILON apparatus is used as a laser light source for photodynamic therapy, and the Mustang-VLOK apparatus is used as an apparatus for intravenous blood irradiation.

A method for the treatment of trophic ulcers of venous etiology is as follows. Treatment is carried out sequentially. First, the ulcer surface is treated with an air-gas stream at a temperature of 40 ° C with a nitric oxide content of at least 2000 ppm (Plazon apparatus) with an exposure of 10 seconds per 1 cm ^{2 of the} ulcer surface. Then a photosensitizer is applied to the surface of the ulcer. As the latter, 0.1% Radachlorin gel for external use is used (Radagel, 000 RADA-PHARMA, Russia), which contains 1 mg / g of the active substance of the chlorins sodium salt. Radagel is applied to the entire ulcer surface with the capture of healthy tissues in a dose of 0.2 g per 1 cm ² . After 60 minutes of exposure, photodynamic therapy is carried out with laser light with a wavelength of 0.665 microns at a dose of light energy of 150-200 J / cm ² (apparatus "LAHTA-MILON"). The distance from the working end of the fiber to the wound surface is 3-5 mm. After photodynamic therapy, intravenous laser irradiation of blood is performed. The procedure is performed with disposable quartz-polymer fibers into the cubital vein with a laser light of a wavelength of 0.63 microns, with a radiation power of 5 mW (apparatus "Mustang-VLOK") and a duration of 15 minutes. The course of NO-therapy and intravenous laser blood irradiation is 10 daily procedures. The number of sessions of photodynamic therapy from 5 to 8 with an interval of 2 days, depending on the severity of the inflammatory process and wound exudation.

The proposed method is illustrated by the following example.

Patient A., 52 years old. Diagnosis: Chronic venous insufficiency, complicated by trophic ulcers of both legs. Sick for 13 years. Treated stationary and outpatient without a pronounced effect. In the lower third of both legs there are trophic ulcers. On the right lower leg there are two ulcers 5 × 6 cm and 3.5 × 5.5 cm in size, on the left lower leg there is one ulcer 20 × 12 cm in size. Microbial contamination of the ulcer surface of 10 ⁷ microbial bodies in 1 g of tissue. The patient had 8 sessions of photodynamic therapy at intervals of 2 days, NO-therapy No. 10 daily. On the 4th day of treatment (2 sessions of photodynamic therapy and 4 sessions of NO-therapy), the microbial contamination decreased to 10 ⁵ microbial bodies in 1 g of tissue, which was accompanied by a significant decrease in the excreted from the ulcer and swelling of the surrounding tissues. The patient notes a significant reduction in pain, normalized sleep. In parallel with the course of treatment of photodynamic and NO-therapy, the patient underwent 10 sessions of intravenous blood irradiation with a laser with a wavelength of 632 nm. At the follow-up examination 2 months after the start of treatment, there was one skin defect 3 × 2 cm in size on the right lower leg and 8 × 3 cm on the left lower leg. There were no complaints at the follow-up examination after 6 months. The skin of both legs without ulcerative defects. Control examination after 12 months - no complaints, the skin of both legs without ulcerative defects.

This method was used to treat 27 patients with a clinical picture of chronic venous insufficiency complicated by trophic ulcer of the lower leg. In all cases, the specified technical result was achieved.

The proposed method of treatment has a high antimicrobial effect, which leads to a decrease in microbial contamination of the surface of the ulcer, a decrease in the frequency of purulent complications and does not require the use of antibiotics. Along with a significant reduction in pain, a marked acceleration of healing processes is observed. In this case, the treatment is easily tolerated by patients and is carried out on an outpatient basis.

Claims (4)

1. A method of treating venous etiology trophic ulcers, including applying a photosensitizer to a wound and laser irradiation, characterized in that the surface of the ulcer and the skin around the ulcer are first treated with an air-gas stream with a nitric oxide content of at least 2000 ppm at a temperature of 40 ° for 10 seconds with 1 cm ² , then a 0.1% Radachlorin gel is applied as a photosensitizer at a dose of 0.2 g per 1 cm ^{2 with an} exposure of 60 minutes, then the laser light is applied with a wavelength of 0.665 μm at a dose of light energy of 150-200 J / cm ² at rasstoyatsya and 3-5 mm to the wound surface, after which intravenous blood is irradiated through the cubital vein with a laser light of a wavelength of 0.632 μm with a radiation power of 5 mW with an exposure of 15 min, while the course of treatment is 10 daily treatments with air-gas flow and intravenous laser irradiation blood, 5-8 procedures of photodynamic therapy with an interval of 2 days. 2. The method according to claim 1, characterized in that the apparatus "Plason" is used as a source of air-gas flow. 3. The method according to claim 1, characterized in that as the laser light source for photodynamic therapy using the device "LAHTA-MILON". 4. The method according to claim 1, characterized in that the device "Mustang-VLOK" is used as an apparatus for intravenous irradiation of blood.