RU2551190C1 - Method for managing postoperative patients after septoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: septoplasty is followed by postoperative stable-contact pulsed magnetic laser infrared exposure on the patient's skin at wavelength 890-904 nm, power 7 Wt, frequency 80 Hz for 1.5 minutes. The exposure covers four points successively two of which adjoin wings of nose, whereas the other two are found on the lateral nasal walls. The treatment is performed for 3 days daily, 1 procedure a day. After swabs are taken off from the nasal cavity, the procedure is added with endonasal low-intensity red laser exposure for another 3 days at wavelength 635 nm in a continuous mode of power 5 Wt for 1.5 minutes in each half of the nasal cavity.

EFFECT: method enables reducing the length of re-convalescence and recovery of the nasal mucosa, particularly mucociliary clearance, reducing the signs of injury-induced aseptic inflammation, eliminating an oedema, reducing the risk of postoperative haemorrhages following the septoplasty by the combined use of low-intensity red and infrared laser light.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used for the postoperative period in patients with septoplasty.

Surgical correction of curvature of the nasal septum continues to be one of the urgent problems of otorhinolaryngology due to the fact that the most common cause of surgical interventions in the nasal cavity is difficulty in nasal breathing, the pathogenesis of which is closely related to the condition of the nasal septum. During preventive examinations, a curvature of the nasal septum is detected in 68% of the adult population (Piskunov G.Z., Parakhina O.V. // Russian rhinology. 2007. - No. 2. - P.102). Deformation of the nasal septum causes not only difficulty in nasal breathing. It is usually accompanied by deformation and hypertrophy of the nasal concha, vasomotor changes, the formation of chronic rhinitis, also contributes to the development of ear pathology.

Any surgical intervention in the nasal cavity causes a bright inflammatory response, affecting both the mucous membrane and underlying tissues - cavernous, cartilage and bone. Increased exudation, decreased activity of the ciliated epithelium of the mucous membrane and severe postoperative edema of the stroma of the lower nasal concha during inflammation lead to a disorder of the respiratory function of the nose. Nasal obstruction is the cause of autonomic disorders, which, in turn, determine the patient's condition in the early postoperative period. At the moment, there is no generally accepted management technique for patients undergoing septoplasty. Postoperative treatment is usually aimed at stopping inflammation and restoring the functional status of the nose. Traditionally, anemization of the mucous membrane with subsequent toilet of the nasal cavity is used (evacuation of the wound, removal of fibrin plaque and hemorrhagic crusts). Official drugs designed to stop postoperative inflammation in the nasal cavity act superficially without penetrating into the underlying tissue. This is due to both the pharmacological properties of the drugs and the violation of the suction function of the mucous membrane of the nasal cavity (Kunelskaya N.L., Tsarapkin G.Yu., Polyaeva M.Yu. - Journal "Medical business" - No. 3 - 2012).

Laser therapy is actively and successfully developing as a highly effective method of treatment, practically without contraindications and absolutely harmless (Schindl A. et al, 2000). The technologies for the use of laser therapy are simple to implement, do not require expensive equipment, the method is effectively combined with almost all other treatment methods (both therapeutic and surgical), so any practicing doctor can use laser therapy in his work, not just a physiotherapist.

Recently, non-invasive methods of laser therapy using pulsed and continuous lasers of red and infrared radiation spectra are finding wider application. The mechanism of realization of the biological effect of these physical factors: a positive effect on processes in ischemic tissues, autonomic regulation, as well as a beneficial effect on immunity and reparative activity. The results of experimental studies confirm the stimulating effect of low-intensity laser radiation on wound healing. The positive effect of low-intensity laser radiation on the course of wound processes of soft tissues is manifested in a reduction in the exudative phase of inflammation, a decrease in the microbial contamination of a wound, an increase in the phagocytic activity of macrophages, stimulation of angio- and fibrillogenesis, wound epithelization processes, and an accelerated healing time.

Magnetolaser therapy is a combined effect on the body with a therapeutic and prophylactic purpose with a magnetic field and low-intensity laser radiation. Synergism of biological action is combined in one procedure of therapeutic physical factors. Trophic regenerative, anti-inflammatory, analgesic, decongestant, immunomodulating and other effects are inherent in both the magnetic field and laser radiation. This similarity of therapeutic effects suggests their synergism with simultaneous use. In addition, both of these physical factors unidirectionally affect a number of metabolic and physiological processes: microcirculation, blood rheology, blood formation, protein and nucleic acid metabolism, etc.

A known prototype is a technique of laser therapy in the postoperative period after rhinosurgical interventions (Nasedkin AN, Moskvin SV Laser therapy in otorhinolaryngology. - M. - Tver YuOO Publishing House Triada, 2011. - S.160-161) . Exposure to low-intensity laser radiation in the postoperative period is carried out in order to stimulate the immune system, improve regional microcirculation and the quality of healing by conducting 3-5 daily laser procedures in the morning. The procedures are carried out on a Matrix or LAZMIK laser therapy apparatus, a laser emitting laser head (radiation wavelength 890-904 nm, pulse power 3-7 W), the procedure time is 0.5-2 minutes on each side.

The contact-mirror technique (mirror nozzle ZN-35) acts externally on the projection of the area of operation (external nose slope). The main disadvantage of the known method is the use of laser radiation only in the infrared range. However, it is known that for diseases of the nasal cavity, including traumatic genesis, the positive effect will be higher from the combined effects of low-intensity laser radiation in the red and infrared ranges, in contrast to the use of only the infrared spectrum. In the prototype there is also no effect directly on the postoperative area. During the procedures, a magnetolaser infrared contact stable cutaneous effect is used based on penetration into the tissues and absorption in it.

The inventive method of maintaining the postoperative period in patients with septoplasty is new and is not described in the literature.

The present invention is aimed at accelerating the time of convalescence and restoring the physiology of the mucous membrane of the nasal cavity after septoplasty as a result of the combined use of low-intensity laser radiation in the red and infrared spectrum of exposure.

The specified technical result in the invention is achieved by the fact that in the postoperative period after septoplasty, a magnetolaser infrared contact stable skin action is performed in a pulsed mode with a wavelength of 890-904 nm, a power of 7 W, a frequency of 80 Hz for 1.5 minutes, sequentially at four points, from of which two are located on the wings of the nose, and two on the slopes of the nose, the treatment is carried out for 3 days daily, 1 procedure per day, and after removing the tampons from the nasal cavity, the technique is supplemented with an endonasal low-int with active laser radiation in the red range with a wavelength of 635 nm, continuous mode with a power of 5 W for 1.5 minutes in each half of the nasal cavity.

The procedure can be carried out using laser therapeutic devices that generate radiation of the red (wavelength 635-670) and infrared (wavelength 890-904 nm) parts of the optical spectrum in the continuous and pulsed mode of generation of this radiation.

The treatment was carried out on the Matrix laser therapeutic device. In the first three days for the laser-laser infrared exposure, a laser emitting head LOS and a mirror magnetic nozzle ZN-50 were used. The simultaneous combination of a magnetic field and laser radiation leads not only to a summation of the effect of both effects, but also to an increase in the effect of each other. The procedure was carried out according to the contact-stable cutaneous technique in a pulsed mode with a wavelength of 890-904 nm, power 7 W, frequency 80 Hz. The physiotherapy scheme is based on the optimization of laser therapy for diseases of the ear, throat and nose (Nasedkin A.N., Zenger V.G., 2000).

For endonasal laser exposure, a CLOSE emitting head with a nasal attachment L-1-2 was used. The procedure is carried out in the red spectrum of exposure with a wavelength of 635 nm, continuous mode, power 5 watts.

The exposure time per biological field is 1.5 minutes. This exposure duration was selected based on the work carried out by Professor A.N. Nasedkin. et al., who showed the leading role of calcium ions in triggering the primary mechanisms of therapeutic action of low-intensity laser radiation and the associated optimal exposure time (Nasedkin AN, Moskvin SV. Laser therapy in otorhinolaryngology. - M. - Tver Publishing House LLC Triad ”, 2011. - S.175-176).

The combined use of low-intensity laser radiation in the red and infrared spectrum of the effect leads to the combined effect of two wavelengths, resulting in not only a larger number of “target cells”, but also a larger volume of tissues that “respond” to the effect (Moskvin SV. System analysis of the effectiveness of controlling biological systems with low-energy laser radiation: Abstract of thesis ... Dr. Biol.Sci. - Tula, 2008. - 38 p.)

The choice of treatment regimen: the first three days - magnetolaser infrared contact stable cutaneous exposure sequentially at four points, two of which are located on the wings of the nose, and two on the slopes of the nose. The need for exposure to infrared laser radiation at several points, two of which are located near the wings of the nose, is based on previous studies (Korepanov V.I. Laser therapy in cardiology, ENT pathology and pulmonology. M., 1998, p. 28-29) who have proven multifactorial, including anti-inflammatory effects on the mucous membrane of the nasal cavity. Then, for another 3 days, an endonasal low-intensity laser radiation in the red range in each half of the nasal cavity is additionally performed. Earlier exposure in the red spectrum is not possible due to the fact that in the first three days of the postoperative period in patients with septoplasty, gauze swabs are located in the nose to stop nosebleeds and fix the nasal septum in the middle position to prevent the formation of postoperative hematomas, as a result, carrying out any intranasal manipulations in the first three days is technically impossible. After removal of the tamponade of the nasal cavity (3 days of the postoperative period), any intranasal interventions are possible.

The proposed method for managing the postoperative period in patients with septoplasty has been used since May 2013 in the conditions of the Astrakhan branch of the Federal Scientific and Clinical Center for Otorhinolaryngology of the FMBA of Russia and the ENT department of the Alexander Mariinsky Regional Clinical Hospital in Astrakhan and was tested on 36 patients.

The following is the result of testing. Patient Sh., Born in 1983 (medical history No. 813), turned to the Astrakhan branch of the Federal Scientific-Clinical Center for Otorhinolaryngology of the FMBA of Russia on 10/07/2013 with complaints of severe difficulty in nasal breathing for 5 years, regardless of the time of year or time of day. A history of nasal trauma in 2008. When otorhinolaryngological examination: the outer nose of the correct form. The nasal septum is S-shaped. The nasal passages are sharply narrowed. Nasal breathing is difficult. Palpation and percussion of the nose and paranasal sinuses are painless. On the roentgenogram of the paranasal sinuses without disturbing the pneumatization of the paranasal sinuses. Under local anesthesia Sol. Lidocaini 10% - 4.0 ml (application) performed endoscopy of the nasal cavity. Marked curvature of the nasal septum with a block of the lunar fissure. With anterior rhinomanometry, the total volume flow is 176 cubic centimeters of air per second. Other ENT organs without features.

10/08/2013 septoplasty was performed under local anesthesia Sol.Lidocaini 10% -4 ml and Sol.Novocaini l% -40ml. In order to stop nasal bleeding, anterior tamponade of the nasal cavity was applied. From 09.10.2013, the patient began carrying out laser therapy treatment. On 09.10, 10.10, 11.10.13, the magneto-laser infrared contact-stable cutaneous exposure was performed once in a pulsed mode with a wavelength of 890-904 nm, a power of 7 W, a frequency of 80 Hz for 1.5 minutes, four points in succession, two of which are located near the wings of the nose , and two - directly on the slopes of the nose. 10/11/13 tampons from the nasal cavity removed. Epistaxis did not recur. 12.10, 13.10 and 14.10.13 cutaneous low-intensity laser exposure is supplemented by endonasal laser radiation in the red range with a wavelength of 635 nm, continuous mode with a power of 5 W for 1.5 minutes in each half of the nose. By the time of discharge from the hospital (7 days after surgery), complete restoration of nasal breathing was noted. Objectively: the mucous membrane of the nasal cavity is slightly swollen, pale pink. In the nasal passages, single hemorrhagic crusts that do not impede nasal breathing. With endoscopy of the nasal cavity, the mucous membrane is slightly swollen, pale pink. With anterior rhinomanometry, the total volumetric flow is 606 cubic centimeters of air per second. With recovery, the patient was discharged from the hospital under outpatient observation of an ENT doctor at the place of residence.

The following positive result was achieved: acceleration of the time for reconvalescence with restoration of the physiology of the nasal cavity compared with the control group of patients in which restoration of nasal breathing is achieved by 9-12 days after surgery.

Claims (1)

A method of maintaining the postoperative period in patients with septoplasty by laser therapy, characterized in that in the postoperative period after septoplasty, a magnetolaser infrared contact stable skin action is performed in a pulsed mode with a wavelength of 890-904 nm, a power of 7 W, a frequency of 80 Hz, 1.5 minutes in succession to four points, of which two are located on the wings of the nose, and two on the slopes of the nose, the treatment is carried out for 3 days daily, 1 procedure per day, and after removing tampons from the nasal cavity, the method for another 3 days, supplemented with endonasal low-intensity laser radiation in the red range with a wavelength of 635 nm, continuous mode with a power of 5 W for 1.5 minutes in each half of the nasal cavity.