RU2496536C1 - Method of treating intracranial small-volume haematomas - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely neural diseases, neurosurgery, traumatology. A neck surface is exposed to autoresonant red emission in a projection of carotid sinus at wave length 0.63-0.66 mcm, power 24-26 mWt for 7-10 minutes and to infrared emission at wave length 0.87-0.89 mcm, power 9-10 Wt for 10-15 minutes. That is followed by pharmacological neuroprotection by intranasal electrophoresis with neuroprotective preparation at current intensity 0.5-2.0 mA for 15-20 minutes. The treatment is started from the third post traumatic day. The first therapeutic day required the exposure to red laser light followed by a 15-20-minute pause and the intranasal electrophoresis in the morning with the exposure to red laser light in the evening. On the second therapeutic day, the exposure to red laser light is performed in the morning, and in the evening the same is followed by a 15-20-minute pause and the intranasal electrophoresis. The treatment is conducted within 14-20 days.

EFFECT: method enables reducing the length of traumatic intracranial haematoma resolution ensured by the synergetic effect of the red and infrared laser light and therapeutic preparations.

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Description

The invention relates to medicine, namely to nervous diseases, neurosurgery, traumatology, and can be used in the conservative treatment of traumatic intracranial hematomas with a volume of up to 45 cm ³ with a displacement of the median structures of no more than 4 mm.

In the structure of traumatic brain injury, hematomas comprise from 2.0 to 16.6%. Before the appearance of computed tomography, the treatment tactics regarding hematomas were unambiguous - the hematoma was removed at the earliest possible time after its detection, for example, by the method described in the SU certificate for invention No. 1498469.

There are also known methods of two-stage treatment of intracranial hematomas, which include surgical intervention for removal of the hematoma and the implementation in the postoperative period of repeated laser energy treatment of the affected area - the cavity of the removed hematoma through the laser fibers connected to it [RU patents for inventions No. 2100965, No. 2194549].

However, with the advent of computed tomography and magnetic resonance imaging, it became possible to determine the quantitative characteristics of the hematoma — the size, volume, timing of its formation, localization, appearance, and the degree of its effect on the brain. There was the possibility of dynamic monitoring of the evolution of intracranial pathology in general and hematomas in particular. There are works confirming the possibility of resorption of subdural and epidural hematomas, reports of their asymptomatic course. In connection with the foregoing, indications for conservative treatment of intracranial hematomas were significantly expanded [Grin A.A., Ioffe Yu.S., Krylov V.V. Traumatic intracranial shell hematomas of small volume (up to 50 cm ³ ) of supratentorial localization. UIlL: http: //www.neuro.neva.ru/RNOnline_22/Russian/Issues/Articles_l_2002/gri n.htm].

It is also known that, in the absence of indications for surgical treatment, conservative management of patients with intracranial hematomas is acceptable, including drug treatment with groups of drugs: dehydratants, antioxidants, antihypoxants, antipyretics, drugs that help regulate the aggregate composition of blood, vasoactive drugs, normalizers for the exchange of neurotransmitters and stimulators of reparators vitamin complexes; drugs that reduce the body’s immune reactivity, anticonvulsants [Practical Neurosurgery: A Guide for Physicians / Ed. B.V. Gaidar. - St. Petersburg: Hippocrates, 2002, p. 92, 96, 594].

The closest analogue to the claimed invention is a method of conservative treatment of intracranial hematomas [V.V. Krylov. Lectures on neurosurgery. M.: KMK scientific publications. 2007. S.93-94], including the implementation of infusion therapy with isoosmolar crystalloid in a volume of 50-60 ml / kg per day, in particular hypertonic NaCl solution (7.5%) in combination with dextrans to restore the volume of circulating blood by intravenous administration 4 -6 ml / kg for 5 minutes With insufficient effectiveness of infusion therapy, sympathomimetic agents are used, namely dopamine, adrenaline, norepinephrine, mesatone. The average doses at which it is possible to obtain the necessary hypertensive effect are 1 minute: dopamine - 12 ± 2.5 μg / kg, adrenaline - 0.15 ± 0.05 μg / kg, norepinephrine - 0.3 ± 0.1 μg / kg Mesatone, as a rule, is used together with dopamine at a dose of 0.2-0.5 μg / kg in 1 min. Along with infusion therapy, osmotic diuretics are also used with the mandatory control of the level of volemia, urine output and the content of sodium (osmolarity) and potassium in the blood plasma.

However, the use of several drugs simultaneously in the closest and in the previous analogues of it, providing a combination of dehydration and infusion-transfusion therapy, can make the treatment process difficult to control, especially in conditions of intracranial hypertension, edema and cerebral ischemia, developing in the presence of intracranial hematomas, and increase the risk of complications associated with inadequate perfusion of the brain, a possible exacerbation of hypoxic disorders and progression m "secondary damage zone".

The task of the invention is to reduce the resorption of traumatic intracranial hematomas.

The essence of the claimed invention is characterized by the fact that in the method of treating intracranial hematomas of small volume from the third day after the injury, a complex treatment is carried out, including contact laser exposure to the front surface of the neck in the projection of the synocarotid zone in the autoresonance mode with red radiation with a wavelength of 0.63-0 , 66 microns, with a power of 24-26 mW for 7-10 minutes and infrared radiation with a wavelength of 0.87-0.89 microns, with a power of 9-10 W for 10-15 minutes and the implementation of pharmacological neuroprotection put m perform intranasal electrophoresis with neuroprotective drugs with a current strength of 0.5-2.0 mA for 15-20 minutes, and the treatment is carried out for 14-20 days, alternating every other day: execution on the first day - sequentially one after another with a break for 15-20 minutes of laser exposure to red radiation and intranasal electrophoresis in the morning, laser exposure to infrared radiation in the evening; on the second day in the morning - laser exposure to red radiation, in the evening - sequentially one after another with a break for 15-20 minutes of laser exposure to infrared radiation and intranasal electrophoresis.

The technical result of the claimed invention

The set of signs of the implementation of the proposed method, namely the type of physical impact, the sequence and frequency of the manipulations allows to achieve increased treatment outcome due to the synergistic effect of low-intensity red and infrared laser radiation and therapeutic drugs. Differentiated exposure to laser radiation with a different wavelength before pharmacological neuroprotection allows you to create the most optimal conditions for the delivery and inclusion in the metabolism of drugs, namely to improve the rheological properties of the blood, the functions of endotheliocytes, microcirculation, the plastic properties of the membranes of cellular elements and intracellular energy processes. The further use of pharmacological neuroprotection under conditions created by laser exposure to optimize the intravascular component of the microcirculation system can also increase the effectiveness of the drugs delivered to the damage zone and the surrounding brain tissue, making it possible to reduce doses and the number of types of drugs used in the treatment of drugs by creating a drug depot, which contributes to prolongation of their therapeutic effect during the day. Alternating laser irradiation with different wavelengths allows the therapeutic effect on various parts of a traumatic brain disease, namely, red radiation implements cellular and vascular effects, activates macrophages involved in the processes of resorption of damage zones; infrared radiation mainly affects the hemorheological properties of blood. Performing laser irradiation with infrared radiation in the evening allows you to most effectively influence the increasing coagulation potential of the blood, optimizing the microcirculation of the brain. Thus, the friendly use of physical and medicinal methods of exposure with certain parameters can reduce the damaging effect of the glutamate-calcium cascade on the “penumbra zone”, undoubtedly having a cytoneuroprotective and resorptive effect, thereby shortening the treatment time for patients with small volume intracranial hematomas.

Carrying out the administration of drugs by performing intranasal electrophoresis can reduce the dose of drugs used by minimizing the distance between the drug administration zone and the pathological focus, as well as eliminating the risk of complications associated with invasive methods of drug administration, for example, intravenously, as in analogues, namely the occurrence of additional painful reception and the possibility of damage to blood cells. The good ability of the nasal mucosa to be absorbed and the absence in this zone of enzymes that break down neuroprotective drugs provide rapid transport of the latter to the brain, which makes it possible to use small doses for 1 session of physiotherapy economically and effectively.

During the course of laser therapy, the carotid pool was chosen as the main point of application of laser light - the region of the synocarotid zone, which is due to the passage of large volumes of blood through it, as well as the presence of a common carotid gland in the bifurcation region, which belongs to the neuroendocrine glandular system. The impact on this system of laser radiation causes complex stimulation of the neuroendocrine system of the whole organism, normalizes rheology and microcirculation, stimulates metabolism, especially the oxygen regime, proliferation processes and at the same time reduces alteration and improves regeneration. In addition, laser light has a healing effect, integrally increases the effectiveness and quality of treatment.

The combination of all the signs of the proposed method of treatment, in particular, the use of just such a combination of physical effects of different types, with such quantitative parameters, at precisely this time of day, precisely according to the scheme described in this application, allows one to reduce the severity of neurological disorders and normalize what was lost in the process of trauma, the patient's vital activity as soon as possible, providing a reduction in the time spent on resorption of intracranial hematomas.

A method of treating intracranial hematomas of small volume is as follows.

Initially, a clinical examination of patients is carried out using standard methods, i.e. with a detailed collection of complaints and anamnesis, assessment of the clinical and neurological status, the use of additional examination methods, in particular neuroimaging.

After a clinical examination of patients and confirmation of the presence of a brain injury, namely intracranial hematomas with a volume of up to 45 cm ³ with a displacement of the median structures of not more than 4 mm according to computer and / or magnetic resonance imaging, from the third day after the injury, complex treatment is prescribed , including conducting laser contact on the front surface of the neck in the projection of the synocarotid zone and the implementation of pharmacological neuroprotection according to the following scheme.

In the first day of treatment. In the morning, the patient is laid on his back with a roller under his neck, providing a turn of his head in the direction opposite to the traumatic focus. After processing the skin in the region of the anterior surface of the neck, the projection of the synocarotid zone is determined by palpation - below the angle of the lower jaw, in front of the sternocleidomastoid muscle, at the level of the upper edge of the thyroid cartilage. Carry out contact laser irradiation with red radiation in autoresonance mode with a wavelength of 0.63-0.66 μm, a power of 24-26 mW for 7-10 minutes by bringing the emitter to a previously defined point corresponding to the projection of the synocarotid zone connected, for example, to semiconductor device "AZOR-2K-02", providing compression of soft tissues of the order of 3 mm 15-20 minutes after the end of the session, the patient undergoes intranasal electrophoresis with neuroprotective drugs with a current strength of 0.5-2.0 mA for 15-20 minutes. In most cases, instenon or actovegin is used as neuroprotective drugs or alternate their use every other day. To do this, gauze turundas, abundantly saturated with solutions of neuroprotective drugs, are loosely introduced into both nostrils using tweezers. Their free ends are laid on top of a small oilcloth on the upper lip, a conductive plate of 1.5 cm × 2-3 cm in size connected to the terminal of the device is placed on them. The lower edge of the oilcloth is bent onto a conductive plate to prevent it from touching the body, and everyone is fixed with several turns of the bandage. Depending on the location of the damage, there are two options for applying a second electrode with an area of 80-100 cm ² . The first option: the second electrode is placed on the back of the neck in the region of the upper cervical vertebrae, it is attached to the positive terminal of the device, and the first electrode is connected to the negative terminal of the device. The second option: the second electrode is located in the region of the lower cervical vertebrae, it is attached to the negative terminal of the device, and the first electrode to the positive terminal of the device. In the evening, lay the patient on his back with a roller under his neck, providing a turn of his head in the direction opposite to the traumatic focus. After processing the skin in the region of the anterior surface of the neck, the projection of the synocarotid zone is determined by palpation - the middle of the inner edge of the sternocleidomastoid muscle. Carry out contact laser irradiation with infrared radiation in autoresonance mode with a wavelength of 0.87-0.89 microns, a power of 9-10 W for 10-15 minutes by bringing the emitter to a previously defined point corresponding to the projection of the synocarotid zone connected, for example, to semiconductor device "AZOR-2K-02", providing compression of soft tissues of the order of 3 mm

On the second day of treatment, contact laser exposure and intranasal electrophoresis with the above parameters are carried out in a similar manner. However, in the morning only laser exposure to red radiation is performed for 7-10 minutes, and in the evening, successively, one after another, with a break of 15-20 minutes, laser exposure to infrared radiation for 10-15 minutes and intranasal electrophoresis for 10-15 minutes are performed.

Subsequently, for 14-20 days, alternating every other day, continue complex treatment according to the scheme described above.

Example 1

Patient M., 59 years old, was admitted to the neurosurgery clinic with a diagnosis of Closed skull injury with moderate brain contusion. Intracranial hematoma of the fronto-parietal localization on the left.

In the clinical and neurological status were noted: paresis of convergence on the right, paresis of the facial nerve on the right in the central type, right-sided hemiparesis up to 4 points, coordinating disorders.

When magnetic resonance imaging was visualized intracranial hematoma 4.8 × 3.4 × 2.7 cm in size, which corresponded to 44 cm ³ , not accompanied by a dislocation of the middle structures of the brain.

Based on the data obtained, it was decided to conduct complex treatment from the third day after receiving the injury according to the method described in this application for 14 days with the technical parameters:

- laser exposure to red radiation in autoresonance mode with a wavelength of 0.65 microns, a power of 25 mW for 10 minutes;

- laser exposure to infrared radiation in autoresonance mode with a wavelength of 0.89 microns, a power of 10 W for 15 minutes;

- intranasal electrophoresis with a current of 2.0 mA for 20 minutes with a solution of instenon.

After 3 weeks from the start of complex treatment, a clinical follow-up examination noted: regression of cerebral symptoms and hemiparesis, improved attention, normalization of sleep and wakefulness. During the control MRI tomography, the following was recorded: a decrease in the volume of the intracranial hematoma to 2.5 × 2.8 × 2.3 cm - 16 cm ³ , the disappearance of the zone of perifocal edema, and restoration of the ventricular pattern.

After 6 months from the end of the course of complex treatment, it was noted: the patient's condition is satisfactory, leads an active lifestyle, headaches do not bother.

Example 2

Patient K., 43 years old, was admitted to the neurosurgery clinic with a diagnosis of Closed skull injury with moderate brain contusion. Intracranial hematoma of the parietal-temporal localization on the right.

In the clinical and neurological status were noted: paresis of the facial nerve on the left in the central type, left-sided pyramidal symptoms in the form of increased reflexes from the extremities, coordinating disorders.

Magnetic resonance imaging visualized intracranial hematoma with dimensions of 2.8 × 3.2 × 3.4 cm, which corresponded to 30 cm ³ , not accompanied by a dislocation of the median structures of the brain.

Based on the obtained data, it was decided to conduct complex treatment from the third day after receiving the injury according to the method described in this application for 20 days with the technical parameters:

- laser exposure to red radiation in autoresonance mode with a wavelength of 0.63 microns, a power of 24 mW for 7 minutes;

- laser irradiation with infrared radiation in autoresonance mode with a wavelength of 0.87 μm, a power of 9 W for 10 minutes;

- intranasal electrophoresis with a current strength of 0.5 mA for 15 minutes with solutions of instenon and actovegin, alternating their use every other day.

After 3 weeks from the start of complex treatment, a clinical follow-up examination noted: regression of cerebral and focal symptoms, mnestic disorders, improved attention, normalization of sleep and wakefulness. During the control MRI scan, the following was recorded: a decrease in the volume of the intracranial hematoma to 1.8x2.5x1.6 cm - 7 cm ³ , the disappearance of the perifocal edema zone, and restoration of the ventricular pattern.

6 months after the treatment, the patient's condition is satisfactory, there are no cerebral, focal, meningeal symptoms, asthenovegetative manifestations of the trauma were not revealed.

Claims (1)

A method of treating intracranial hematomas of small volume, characterized in that from the third day after the injury, a comprehensive treatment is carried out, including contact laser exposure to the area of the front surface of the neck in the projection of the synocarotid zone in the autoresonance mode with red radiation with a wavelength of 0.63-0.66 μm , with a power of 24-26 mW for 7-10 minutes and infrared radiation with a wavelength of 0.87-0.89 microns, a power of 9-10 W for 10-15 minutes and the implementation of pharmacological neuroprotection by performing intranasal trophoresis with neuroprotective drugs with a current strength of 0.5-2.0 mA for 15-20 minutes, and treatment is carried out for 14-20 days, alternating every other day: execution on the first day - sequentially one after another with a break of 15-20 minutes of laser exposure to red radiation and intranasal electrophoresis in the morning, laser exposure to infrared radiation in the evening; on the second day in the morning - laser exposure to red radiation, in the evening - sequentially one after another with a break for 15-20 minutes of laser exposure to infrared radiation and intranasal electrophoresis.