RU2441681C1 - Method of patient treatment in the acute period of a permanent craniocerebral trauma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions is referred to the area of medicine and can be used for patient treatment in the acute period of a permanent craniocerebral trauma. The method implies exposure of narrow-band photodiode irradiation with the wavelength 540±20 nm with a permanent contact exposure mode of both the orbs in a motionless manner for 5 minutes and to the collar zone in a labile manner for 10 minutes, the radiation intensity being 100%, radiation power 3.2 MW, the power density being 0.5 MW/cm². The total exposure duration is 20 min. A therapy cycle comprises 10 procedures. The method allows for.

EFFECT: restoration of the compromised compensation and regeneration mechanisms of the brain; improved microcirculation; normalized vascular tone, autonomic dysfunctions and glucose level in peripheral blood.

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Description

The invention relates to medicine, namely to neurosurgery, neurology, physiotherapy, rehabilitation, and can be used for rehabilitation treatment of patients in the acute period of severe traumatic brain injury.

There is a method of treating acute focal lesions of the brain by conducting electrical stimulation of the brain and the introduction of rheological preparations, characterized in that the projection zones of focal injuries after a traumatic brain injury from the very first days are exposed to direct current of 100-500 μA and lasting 30-40 minutes , within 10-15 days. Rheological preparations are administered during and within 5-10 days after exposure (RF Patent No. 2188674, publ. 09/10/2002). The disadvantages of the method are the limitation of its use in patients with cardiac arrhythmias, arterial hypertension with frequent vascular crises.

There is a method of treating brain lesions, in which they affect two types of radiation on 4 surfaces of the body per procedure (RF Patent No. 2222362, publ. January 27, 2004). Spend scanning low-intensity laser radiation (LLLT) with a frequency of 200 Hz, a power of 20 mW and a beam diameter of 3 mm from a helium-neon laser unit remotely up to 2 min on the field. EHF radiation with a power of 10 mW / cm ² act in a pulsed mode, alternating every other day with wavelengths of 5.6 mm and 7.1 mm, contact through a speaker with a size of 2 × 1 cm for up to 5 min in the field. In one procedure, two types of radiation are applied to the interscapular and lumbosacral regions and laser radiation to the popliteal regions. In another procedure, two types of radiation are applied to the palmar surfaces of the hands and the plantar surfaces of the feet. In severe brain damage, in addition to each procedure, two types of radiation are applied to the nose bridge region. The disadvantage of this method is that its use is possible only with the complete relief of signs of cerebral edema, which limits its use in the acute and acute period of severe traumatic brain injury.

Closest to the claimed is a method of treating patients in the acute period of severe traumatic brain injury by intravascular exposure to LILI (Germanovich V.V. Laser irradiation of blood in the acute period of severe craniocerebral injury. Author's abstract. Diss ... Candidate of Medical Sciences. St. Petersburg. - 1997. - P.18), adopted by us for the prototype. The essence of the method consists in intravascular laser irradiation of blood through a fiber with a diameter of 349 μm by a helium-neon laser with a wavelength of 0.63 μm and a power of 2-2.5 mW with an exposure of 60 minutes for 1-10 days of the acute period in patients with severe traumatic brain injury. The disadvantage of the prototype is that it does not ensure the restoration of impaired compensatory-regenerative mechanisms in the brain, reducing swelling and swelling of the brain in the acute period of traumatic brain injury. In addition, the method is invasive and can provoke complications such as infection, thrombosis, which makes it difficult to obtain stable positive dynamics in the neurological status and restoration of brain function in general.

The invention is aimed at creating a method for treating patients in the acute period of severe traumatic brain injury, which ensures the restoration of impaired compensatory-regenerative mechanisms in the brain, reducing the severity of processes of edema-swelling of the brain.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of treating patients in the acute period of severe traumatic brain injury, including exposure to light radiation, the peculiarity is that they are exposed to narrow-band LED radiation with a wavelength of 540 ± 20 nm, with continuous mode exposure, radiation intensity of 100%, radiation power of 3.2 mW, power density of 0.5 mW / cm ² in the orbit of both eyes contact motionless for 5 minutes and on the “collar” zone of the contact la 10 minutes, total duration of exposure is 20 minutes, the course of treatment is 10 procedures.

The restoration of disturbed compensatory-regenerative mechanisms in the brain is achieved by the fact that the exposure to visible light of the green spectrum is carried out both by the transorbital technique, in which, under the specific influence of green light on the processes of excitability of the cerebral cortex and subcortical formations, modulation of psychoemotional processes in the body and reflexogenic action on the "collar" zone, which allows you to strengthen the response from organs and systems. With this effect, an improvement in microcirculation, normalization of vascular tone, autonomic dysfunctions and peripheral blood glucose levels are achieved.

The method is as follows.

In order to clarify the features of the clinical course of the acute period, a patient with severe traumatic brain injury is diagnosed with a clinical and neurosurgical complex. The condition for photochromotherapy (PCT) using narrow-band LED radiation with a wavelength of 540 ± 20 nm is the stability of the functions of life support organs. The presence of a tracheostomy, tube feeding and catheterization of the bladder is acceptable. For carrying out FHT use the apparatus "Spectrum LC-02." The radiation parameters of the green LED matrix type 1: radiation power 3.2 mW; power density 0.5 mW / cm ² ; wavelength 540 ± 20 nm.

Irradiation is carried out for a contact motionless region of the orbit of both eyes for 5 minutes, and a contact labile - “collar” zone - 10 minutes, the total exposure time of 20 minutes. Use a continuous exposure mode, the radiation intensity of 100%. The course of treatment consists of 10 procedures. If the patient worsens due to the development of meningoencephalitis, brain abscess, pneumonia, gastrointestinal bleeding, hemorrhagic pyelonephritis, the course of treatment is interrupted and resumed only with the stabilization of the functioning of the life support system. At the end of the course of treatment of 10 procedures, a comprehensive study is repeated, evaluating the effectiveness of the rehabilitation physiotherapeutic intervention.

The inventive method is developed in RNHI them. prof. A.L. Polenova and passed clinical trials in the treatment of 55 patients with severe traumatic brain injury on the basis of the neurosurgical department of the hospital of St. Martyr Elizabeth. Based on the results obtained and their analysis, conclusions can be drawn about the positive effect of photochromotherapy using narrow-band LED radiation with a wavelength of 540 ± 20 nm in the treatment of patients who have suffered severe head injury, which manifests itself in a more pronounced restoration of psycho-emotional status, motor dysfunctions , stabilization of impaired functions of the autonomic nervous system, a decrease in the level of glucose in peripheral blood.

We give examples - extracts from medical records.

Example 1

Patient Sh., B. 1976, medical history No. 17413, was admitted to the admission department on March 21, 2009, 8 hours after an injury with a diagnosis of Open craniocerebral injury. A severe brain contusion with the formation of an acute epidural hematoma in the frontotemporal-parietal region on the right. A linear fracture of the temporal bone scales with the transition to the base of the skull in the projection of the middle cranial fossa. The general condition of the patient upon admission is extremely difficult, the Glasgow coma score is 5-4 points, blood pressure (BP) is 160/100 mm Hg, pulse is 110 beats. per minute, vegetative Kerdo index = 10, respiration periodic in depth and frequency - 12 per minute, level of consciousness disturbance - coma 2, pupils D = S = 3 mm, no photoreactions, oculocephalic reflex was not caused, left-side hemiplegia, extensor movements in the extremities to a pain stimulus, a positive symptom of Babinsky on both sides, severe meningeal symptoms. CT scan of the brain (from 03/21/2009) - signs of acute epidural hematoma in the right frontotoparietal-temporal region. According to vital indications, the patient underwent decompressive osteoplastic trepanation of the skull in the right parietal-temporal region with the removal of acute epidural hematoma. In the postoperative period, the patient was hospitalized in the intensive care unit, where intensive care was started in full, despite which the patient's condition remained extremely serious. In the control SKT study, the signs of stage II hypertension-dislocation syndrome with prolapse of the brain substance into the trepanation defect are determined. In an emergency, a reoperation was carried out - reorganization of the foci of hemorrhagic contusion of the right temporoparietal lobe. In the postoperative period in somatic status - VIVL respiration, stable hemodynamics, in neurological status - exit to apallic syndrome, pronounced left-sided hemiplegia. Upon reaching the patient’s stabilization of the functions of the life support organs (on the 16th day of the patient’s stay in the hospital) according to the claimed method, a course of PCT was started using narrow-band LED radiation with a wavelength of 540 ± 20 nm. They acted contactly motionless on the orbit of both eyes for 5 minutes and contact labile on the area of the “collar” zone - 10 minutes, the total exposure time of 20 minutes, used a continuous exposure mode, radiation intensity of 100%, radiation power of 3.2 mW, power density 0 , 5 mW / cm ² , wavelength 540 ± 20 nm. 10 procedures were performed. After the course, the patient showed a positive dynamics of the pulse and blood pressure, which was reflected in the normalization of the indicators of the vegetative Kerdo index (up to 7), a decrease in the level of glucose and transaminases in the peripheral blood. Later, when the patient was in the intensive care unit of the neurosurgical department, 2 months after the first course, at the insistence of the patient's mother, a repeated course of FCT No. 10 was carried out. After 2.5 months, he was transferred to the general ward of the NHO, where he received vascular, nootropic, sedative, antibacterial, symptomatic therapy, exercise therapy courses. The patient is transferred to rehabilitation treatment at the PHI named after prof. A.L. Polenova. At the time of transfer, the patient is conscious, fixes his gaze, performs simple commands. Left-sided hemiparesis, pronounced intellectual-mnestic disorders, is preserved.

Thus, in a patient with severe traumatic brain damage, apallic syndrome, edema of the right hemisphere of the brain, a gradual recovery of consciousness and a significant reduction in neurological deficit occurred. Example 2

Patient P., born in 1977, medical history No. 13959, was admitted to the admission department 05.03.2009, 6 hours after the injury with a diagnosis of Closed head injury. A severe brain contusion with compression of the acute subdural hematoma of the left frontoparietal-temporal region. Subarachnoid hemorrhage. Upon admission, the general condition is serious, the Glasgow coma score is 10-12 points, blood pressure (BP) is 140/90 mm Hg, pulse is 86 beats. per minute, Kerdo autonomic index = -4, spontaneous breathing 18 per minute, level of consciousness loss - deep stunning, pupils D <S, contralateral anisocoria, photoreactions are reduced, corneal and pharyngeal reflexes are preserved, right-sided hemiparesis with increased tendon reflexes, a positive symptom of Babinsky on both sides, pronounced meningeal symptoms. On a CT scan of the brain dated 05/05/2009, an acute subdural hematoma was found in the left frontotemporal-temporal region. On March 5, 2009, an operation was performed on an emergency basis — decompressive osteoplastic trepanation of the skull in the left frontoparietal-temporal region, removal of the subdural hematoma. In the early postoperative period there was a regression of motor disorders, recovery of consciousness to a clear. A patient undergoing a basic conservative treatment, including antibacterial, vascular, sedative, and symptomatic therapy, was given a course of PCT on the 7th day after hospitalization according to the claimed method using narrow-band monochrome light radiation with a wavelength of 540 ± 20 nm, with a continuous exposure mode, radiation intensity 100%, radiation power 3.2 mW, power density 0.5 mW / cm ² . The PCT procedure was carried out contactlessly motionless to the orbit of both eyes for 5 minutes, and contact labilely - to the “collar” zone - 10 minutes, with a total exposure time of 20 minutes. The course of treatment was 10 procedures. On the control CT scan of the brain dated March 23, 2009, there was a condition after decompressive craniotomy. No evidence of subdural hematoma. In the biochemical analysis of blood at the time of discharge, normalization of glucose (4.3 g / l) compared with the level of glucose at admission (8.1 g / l) and transaminases (ACT level at admission and in dynamics, respectively, 200 units / l and 52 units \ l, the level of ALT at admission and in dynamics, respectively 87 units \ l and 42 units \ l). It is discharged on day 28 in satisfactory condition with the recommendations of observation by a neurologist, a second course of rehabilitation treatment after 3 months.

The use of narrow-band LED radiation with a wavelength of 540 ± 20 nm ensures the restoration of impaired compensatory-regenerative mechanisms in the brain by improving blood circulation in the microvasculature, normalizing glucose levels in the peripheral blood and reducing the severity of brain swelling and swelling. In addition, when using the method, the processes of excitation and inhibition in the central nervous system are stabilized.

Claims (1)

A method of treating patients in the acute period of severe traumatic brain injury, including exposure to light radiation, characterized in that they are exposed to narrow-band LED radiation with a wavelength of 540 ± 20 nm with a continuous exposure mode of 100% radiation intensity with a radiation power of 3.2 mW and a power density of 0, 5 mW / cm ² on the orbit of both eyes contact motionless for 5 minutes and on the "collar" zone contact labile 10 minutes with a total duration of exposure of 20 minutes, the course of treatment is 10 procedures.