Physiotherapy that uses the radiant energy of light to treat diseases
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Phototherapy is a physical therapy that uses the radiation of light to treat diseases.Phototherapy mainly includesultraviolet raysTherapyvisible lightTherapyinfraredTherapy andlaserTherapy.
Phototherapy is a method to prevent and cure diseases by using visible and invisible light in sunlight and artificial light sources.Phototherapy beginsHeliotherapyAs early as the 2nd century AD, there were records of solar therapy.The artificial light source began at the end of the 18th century. By the middle of the 19th century, visible light, infrared light, ultraviolet light, etc. had been formed one after another, and then it was widely used and developed in various fields of clinical treatment.
Infrared ray mainly improves local blood circulation, promotes swelling regression, analgesia, reduces muscle tension, and alleviates muscle spasm and dry exudative diseases.
Ultraviolet rays act on the human body. Light energy causes a series of chemical reactions, which have anti-inflammatory, analgesic and anti rickets effects. It is often used to treat skin suppurative inflammation and other dermatitis, pain syndrome, rickets or osteomalacia;The ultraviolet ray with the wavelength of 310-313nm is called narrow-band ultraviolet B (NBUVB), which focuses on the part of the ultraviolet ray with the strongest biological activity to directly act on the skin affected part, while filtering out the harmful ultraviolet rays of bad waveband, which have little side effects, act on the cuticle of the skin, and have short effect time and quick effect.It has been widely used in the treatment of psoriasis, vitiligo, chronic eczema, neurodermatitis, atopic dermatitis, palmoplantar pustulosis, pityriasis rosea, alopecia areata, parapsoriasis, chronic skin ulcer, mycosis fungoides and other diseases in major hospitals.
visible lightIt is the light that can be seen by the human eye.The method of treating diseases with visible light is visible light therapy.It mainly includes red light, blue light, blue violet light and multi spectrum therapy.Red light has excitatory effect;Yellow light, green light and red light have opposite effects;Blue violet light can be used to treat nuclear jaundice.
The laser is the light generated by the amplification of stimulated radiation light. It has the characteristics of small divergence angle, good directivity, pure spectrum, good monochromaticity, high energy density, large brightness, good coherence, etcheat effect, mechanical effectElectromagnetic effect。It can be used for diagnosis and treatment of many diseases[1]。
Infrared therapy
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The wavelength of infrared ray is 760 nm~50 µ m, belonging toInvisible light。The main function basis of infrared ray is thermal effect.According to biological characteristics, infrared ray can be divided into two sections. One is long wave infrared ray, with a wavelength of 1.5~15 µ m, also known asFar infrared。The second is short wave infrared, with wavelength of 760 nm~1.5 µ m, also known as near-infrared.The photon energy of infrared ray is low, and its main biological effect is thermal effect rather than photochemical effect.The human skin and subcutaneous tissue are the main areas that absorb infrared rays. Because the absorption rates of infrared rays of different wavelengths are different in each area of the skin epidermis, the long wave infrared rays can only reach a depth of 0.05~1mm, and the short wave infrared rays can reach a depth of 1~10mm. After the skin is irradiated by infrared rays, it appears hyperemia, which is manifested as red hot erythema with unclear boundary and uneven color.After stopping irradiation, the erythema disappeared completely about 1~2 hours.Uneven pigmentation may appear on the skin after repeated irradiation.It is characterized by reticular flecks along the blood vessels of the skin, shaped like marbles.
The skin and subepidermal tissue will absorb infrared energy into heat. Heat can cause blood vessel expansion, blood flow acceleration, local blood circulation improvement, tissue nutrient metabolism enhancement, blood lymph circulation acceleration, and promote the absorption and elimination of abnormal products in the tissue.The warming effect of infrared rays reduces the excitability of sensory nerves and interferes with the pain threshold, so infrared ray therapy has a certain analgesic effect on pain caused by various reasons (such as neuralgia).Heat can reduce the excitability of γ - efferent nerve fibers in muscle spindles, weaken the stretch reflex, reduce muscle tension, and relax muscles. For example, when gastrointestinal smooth muscle spasm occurs, it can weaken gastrointestinal peristalsis, relieve muscle spasm, and eliminate pain;It can also accelerate the blood circulation in the tissue, increase the exudation, appear leukocyte migration infiltration around arterioles and capillaries, enhance the function of phagocytes, and increase the formation of antibodies.Because of the enhanced immunity, it can absorb the chronic inflammation of superficial tissues.
Infrared therapy has a wide range of indications, mainly used to relieve muscle spasm, improve blood circulation, and relieve pain.For example, lumbar muscle strain, lumbar disc herniation, tendinitis, chronic gastritis, chronic hepatitis, neuritis, skin ulcers, contracture scars, etc.The contraindications are patients with high fever, bleeding tendency, active pulmonary tuberculosis and severe arteriosclerosis.
Infrared radiators are mainlyInfrared lamp, quartz infrared ray (formed by tungsten wire stretching into the inflatable quartz tube), light bath box[2]。
photodynamic therapy
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That is, the combination of UVA and some photosensitive drugs is used to treat skin diseases, or black light therapy or photochemical therapy.Photosensitive drugs such as 8-methoxypsoralen and trimethylpsoralen (TMP) can be taken orally. The drug molecules are activated by absorbing their energy under the irradiation of long wave ultraviolet light, and covalently combine with two thymines on the DNA chain in the cell to form thymine dimer. Through the photoaddition effect, the photosensitizer and thymine base form C4 cyclobutyl type photoaddition,Cause cell damage, suffering or death.
Visible light therapy
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Visible light can cause light perception in the retina. Its wavelength is 760-400nm, and it is composed of red, orange, yellow, green, green, blue, purple and other seven color light.Visible light therapy includes red light, blue light, blue violet light and multi spectrum therapy.The therapeutic effects of visible light are mainly thermal effect and photochemical thermal effect.Visible light can cause vision.The circadian rhythms of humans and animals, as well as a series of physiological function rhythms, are closely related to the natural lighting rhythms (alternating day and night).Red, orange and yellow light can accelerate and deepen respiration and increase pulse rate;Green, blue and purple light can cause slow breathing and light pulse rate;Blue light and purple light reduce nerve excitability and have sedative effect;Red light can improve the excitability of nerves and stimulate them.At the same time, visible light can also strengthen glucose metabolism, promote the oxidation process, strengthen the pituitary function, improve the function of the cerebral cortex, enhance the excitability of the sympathetic nervous system, and enhance the immunity of the body.Since the 1970s, visible light has been used to treat neonatal nuclear jaundice.Bilirubin has the strongest absorption of light with a wavelength of about 400~500nm, and the maximum absorption band is 420~460nm, belonging to the blue violet light band.After absorbing blue violet light, bilirubin is decomposed into a series of conversions, gradually turning into yellowish low molecular weight water-soluble compounds, which are rapidly discharged from urine.When exposed to light, the skin blood flow can increase by 224%, which is conducive to bringing the deep bilirubin of the body to the superficial tissue of the skin for irradiation.After blue light irradiation, jaundice subsided, serum bilirubin decreased, and green and dark brown dilute feces were excreted.
The indications and contraindications of visible light therapy are basically the same as infrared therapy.The thermal effect requiring deeper action, larger range and more uniform cutting is mainly visible light.
The visible light source for clinical application is mainly tungsten filament lamp, with a spectrum of 4.8% visible light and 95% infrared light.If it is illuminated by monochromatic light, a filter plate can be added under the lamp head[3]。
Ultraviolet therapy
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Ultraviolet is the invisible light outside the purple light in the spectrum, whose wavelength is less than the purple light, and its wavelength is 400-180nm.Photon has high energy and obvious photochemical effect.
The medical ultraviolet ray is divided into three sections: ① long wavelength ultraviolet ray (400 ～ 320nm); ②UVB (320~250nm); ③Short wave ultraviolet (250~180nm).There are a lot of ultraviolet rays in the sunlight, but the atmosphere almost absorbs the short wave ultraviolet rays, so only the long wave and medium wave ultraviolet rays radiate to the ground.Short wave ultraviolet reliable artificial light source.
Biological function of ultraviolet ray
① Erythema reaction: refers to a clear and uniform hyperemia reaction on the irradiated skin after a certain amount of ultraviolet radiation has been applied to the skin for a certain period of time.The absorption of ultraviolet rays by skin is related to its wavelength.The shorter the UV wavelength, the shallower the penetration depth into the skin. Therefore, most of the short wave UV and medium and long wave UV are absorbed by the skin cuticle and acanthocyte layer.Erythema reaction can only occur after ultraviolet irradiation for a certain period of time, which is the incubation period.The length of incubation period is related to the wavelength of ultraviolet ray.The incubation period of long wave ultraviolet erythema is longer, generally 4-6 hours, while that of short wave ultraviolet erythema is shorter, generally 1, 5 to 2 hours. The erythema reaction reaches its peak in 12 to 24 hours, and then gradually decreases.The essence of ultraviolet erythema is a kind of actinic dermatitis, which belongs to non-specific inflammation.There are four theories about the mechanism of UV induced erythema: one is the histamine theory.The denaturation and decomposition of ultraviolet rays on tissue proteins can decompose histidine in the tissue to form histamine. The release of histamine can cause the expansion and permeability of capillaries in the dermal papillary layer, which is manifested by skin congestion and erythema reaction.However, the formation of erythema is not simply caused by histamine;Ultraviolet rays act on lysosomal membrane of spike cells, releasing hydrolases and other enzymes, which can decompose proteins and dilate blood vessels to form erythema;Prostaglandins are important active substances that cause UV erythema, while kinin and histamine are auxiliary factors;Ultraviolet rays denature vascular endothelial cells, resulting in kinin production and erythema.
The blood vessels in the erythema are dilated, blood pressure is reduced, white blood cells are increased, phagocytosis is enhanced, and immunity is significantly improved.Therefore, ultraviolet radiation has anti-inflammatory, analgesic, analgesic and anti infection effects;It can also accelerate tissue regeneration, and can be used for chronic ulcers where wounds do not heal.It has good effect on rheumatic inflammation of muscles and nerves or superficial acute and chronic suppurative inflammation, but it can aggravate the spread of focus on tuberculous inflammation, so it is not suitable for use.
After a certain dose of ultraviolet radiation, different degrees of skin pigmentation can occur after a certain period of time.Melanin deposition is strong after UVA irradiation, and weak after UVA irradiation.Melanin can combine with free electrons and other chemical free radicals generated by skin photochemical process under ultraviolet radiation to prevent their damage to the body.The mechanism of skin pigmentation is that ultraviolet rays can act on the pituitary adrenal cortex system, strengthen the secretion of melanocyte stimulating hormone, thus promoting the melanin particles in melanocytes (secretory cells between epidermis and dermis) to change from a reduced state to an oxidized state, strengthening the phagocytosis of epidermal cells on melanin particles, and strengthening skin pigmentation.The pigmentation effect of ultraviolet light can be used to treat vitiligo, especially the combination of ultraviolet light and photosensitizer.
② Effects on calcium and phosphorus metabolism.Ultraviolet rays can transform 7-dehydrocholesterol in human skin into vitamin D3, which can promote the absorption of calcium and phosphorus in the intestine and calcification of bone tissue.It can treat infantile rickets and adult rickets.In addition, the effect of calcium ion on reducing vascular permeability and nerve excitability can reduce allergic reaction, which is one of the mechanisms of ultraviolet desensitization.
③ Adjust and improve the functions of nervous, endocrine, digestive, circulatory, respiratory, blood, immune and other systems.
④ Sterilization of ultraviolet light: DNA mainly exists in the chromosomes of the nucleus, and is the core of cell reproduction, development and growth.DNA has a strong absorption effect on medium and short wavelength ultraviolet rays.Therefore, the ultraviolet ray with the wavelength of 220~300nm has bactericidal effect.With the bactericidal effect of ultraviolet ray, it can disinfect and clean the wound surface, and treat various infections of skin, mucosa, wound, sinus, fistula, etc.
High dose UV can cause RNA destruction, protein decomposition and protein denaturation, which is consistent with DNA destruction, and is one of the mechanisms of UV disinfection and wound cleaning.Using photosensitizers to strengthen the inhibition of UV on DNA and RNA can treat psoriasis and other proliferative skin diseases.
In addition, when the ultraviolet reaches a certain intensity, it can destroyhistidine, methionineTyrosineThese amino acids are the active center of the enzyme. Once they are destroyed, the enzyme function will be lost, thus affecting the cell function, which is also one of the ultraviolet sterilization mechanisms.
⑤ The sensitivity of the body to ultraviolet light is often affected by many factors (season, age, skin color, physical condition, medication, etc.).The sensitivity of the body to ultraviolet light is higher in spring and lowest in summer.People who often work outdoors, athletes, farmers, students and soldiers have low sensitivity to ultraviolet light, while those who work indoors and in tunnels have high sensitivity.Adolescence has a high sensitivity to ultraviolet radiation, while children and the elderly have a low sensitivity.Those with light skin pigment have high sensitivity, while those with deep skin color have low sensitivity.Women have high sensitivity before menstruation and low sensitivity after menstruation.High sensitivity during pregnancy and low sensitivity after delivery.Those with good nutrition have high sensitivity, while those with poor nutrition have low sensitivity.Patients with pulmonary tuberculosis, hyperthyroidism, eczema, lupus erythematosus, acute myocarditis, acute nephritis, malignant tumors, porphyria, niacin deficiency, etc., have increased sensitivity to ultraviolet light;The patients with chronic disease, hypothyroidism and nervous system injury have low sensitivity.The sensitivity to ultraviolet ray is also different after taking different drugs.Such as vitamin B1, sulfa drugschlorpromazine, promethazineGriseofulvin, tetracyclineDihydrochlorothiazideIt can increase the sensitivity to ultraviolet ray.The sensitivity of various parts of the body to ultraviolet rays is also different. The sensitivity of the trunk, chest and abdomen is high, and the sensitivity of the face, neck, hands, feet and back is low.
Pathological effects of ultraviolet radiation
It has carcinogenic (skin cancer) and photoallergic effects (the photosensitizer in the body works together with light to damage the body tissues).Therefore, UV workers should protect their eyes and skin by using light protective agents (such as phenols) or wearing gloves and protective glasses.
Clinical Application of Ultraviolet
It is divided into preventive application and therapeutic application.In cold, flu, whooping coughScarlatina, diphtheriaRheumatic feverDuring the epidemic period, ultraviolet radiation can alleviate the symptoms of patients, and radiation to healthy people, especially children, has a preventive effect.Ultraviolet radiation can also prevent rickets.Argon mercury quartz lamp is often used for ultraviolet treatment.
Indications for therapeutic application are
① Internal diseases, such as respiratory diseases, including chronic bronchitis, pneumonia, bronchial asthma and tuberculosis.For patients with pulmonary tuberculosis, the dose should be small and gradually increased. When the temperature exceeds 37.5 ℃ or hemoptysis occurs, the radiation should be stopped.
② Surgical diseases, such as trauma, burns, subcutaneous suppurative inflammation, postoperative infection, lymphadenitismastitis, erysipelas, etc.
③ Neuropsychiatric diseases, such as peripheral neuritis, polyneuritis, neuralgia and neurosis, can be treated with suberythema dose or erythema dose.
④ Dermatological diseases, such as skin suppurationPsoriasis, pityriasis rosea, alopecia areata, eczema, vitiligo, etc.In addition, after ultraviolet radiation of herpes zoster, the activity of enzymes in the tissue increases, material metabolism increases, inflammatory exudation is absorbed, and herpes subsides, which has the effect of analgesia and prevention of secondary infection.
⑥ Pediatric diseases, bronchitis, pneumonia, rickets, etc.
⑦ Five sense organs diseases, such as pharyngitis, tonsillitis, external auditory canal inflammation, etc.
Contraindications are
Severe heart and kidney disease, active tuberculosis, photosensitive disease, poisoning with fever, local acute tumor.
The ultraviolet radiation dose is usually measured by biological dosimetry (the minimum time required for ultraviolet radiation to produce erythema on the skin is a biological dose).Ultraviolet irradiation can be divided into whole body irradiation and local irradiation. The local irradiation dose is usually calculated by the amount of suberythema (no visible erythema reaction), the amount of erythema (with visible erythema reaction), etc.
Laser therapy
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The laser is stimulated radiation light with small divergence angle, good directivity, pure spectrum, good monochromaticity, high energy density, large brightness, good coherence and other characteristics, and has thermal, mechanical and electromagnetic effects.It can be used for diagnosis and treatment of many diseases.
Biological effects of laser
Thermal effect: mainly caused by laser in visible and infrared light areas.The temperature rise of tissue caused by thermal action increases with the increase of laser energy.When using laser thermal effect in clinical treatment, appropriate laser energy should be selected according to specific conditions.
Pressure effect: the energy density of laser is extremely high, resulting in great pressure.Use laser pressure to treat diseases such as tattoo removal, urinary system stones can also be broken and discharged by laser pressure.
Photochemistry: Biomacromolecules absorb the energy of laser photons and are activated to produce excited atoms, molecules and free radicals, causing a series of chemical changes in the body, called photochemical reactions.Photochemical reaction can lead to the reduction or inactivation of enzyme, amino acid, protein, nucleic acid and other activities.
Electromagnetic effect: laser is an electromagnetic wave with high electric field strength, which can be used to treat tumors.
Biological stimulation: Low intensity laser irradiation can affect the immune function of the body, play a two-way regulatory role, and enhance the phagocytosis of white blood cells.Appropriate dosage can inhibit the growth of bacteria, promote the synthesis of red blood cells, strengthen the movement of intestinal villi, promote hair growth, accelerate the healing of wounds and ulcers, promote the growth of callus of fractures, accelerate the healing, accelerate the repair of nerve tissue damage, enhance the adrenal function, enhance the activity of proteins, etc.
The role of laser in clinical treatment
High intensity laser
High intensity laser refers to the irreversible damage caused by laser action on biological tissues, and its output power is above the wattage.In clinical practice, strong laser is mainly used to coagulate, stop bleeding, fuse and vaporize the irradiated tissue, or remove the pathological tissue.
It is widely used in surgical operations, such as esophageal diseases, gastrointestinal anastomosis, hepatobiliary diseases requiring surgery, escharectomy for burns, urethral stricture, prostate cancer, thyroid surgery, breast surgery, intracranial tumor surgery, various anal surgery, and various dermatological diseases, such as warts and verrucous deposits, vascular diseases, skin malignancies, etc.
Low intensity laser
Low intensity laser can regulate the immune function of the body, accelerate ulcer and wound healing, accelerate fracture healing, have obvious anti-inflammatory and analgesic effects, and can promote the secretion of bile, the hematopoietic function of the spleen, and regulate the endocrine system.
It is applied to skin diseases such as herpes zoster, rosacea, erythema multiforme, urticaria, cervical spondylosis, lumbar disc herniation, shoulder periarthritis, myofibrositis, acute and chronic injuries, acute mastitis, cystic hyperplasia of breast, bronchial asthma, arthritis, cervical erosion, chronic pelvic inflammation, facial paralysis, vascular headache, neuralgia, eczema of external auditory canal, allergic rhinitisPharyngitis, etc.
Laser protection
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High power lasers with output power above 500 mV are harmful to human body, and the diffuse reflected light in visible and near infrared regions is also dangerous.
For the laser that exceeds the threshold value, wear white work clothes and gloves. Do not let the laser directly shine on the skin to prevent reflected and scattered light from shining on the skin
Laser workers should have regular health checks.
Joint application
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After low dose ultraviolet irradiation, the synthesis of DNA and RNA was first inhibited and then accelerated, which can promote the growth of granulation, epithelial tissue and wound healing.It has good curative effect in treating all stages of pressure sore.In addition, ultraviolet radiation can also expand blood vessels, accelerate blood flow, improve local blood circulation, strengthen local nutrition, and improve
Body immune function.A large number of animal experiments and clinical practices have shown that low-energy laser irradiation has good anti-inflammatory and tissue repair functions, can expand blood vessels, improve microcirculation, increase the oxygen carrying capacity of red blood cells, enhance the immune capacity of the body, stimulate the phagocytosis of macrophages and the regeneration of granulation tissue, thus promoting wound healing.In recent years, foreign scholars have found that semiconductor laser has better anti-inflammatory and anti infection effects than other low-energy lasers. Its mechanism of action is mainly to reduce the permeability of blood vessel wall, reduce the exudation, congestion and edema of inflammation, and improve the whole body and local immunity of the human body by activating the function of the macrophage system, so as to play an anti-inflammatory and anti infection role,Laser irradiation promotes the formation and growth of new blood vessels, and increases the content of ribonucleic acid and glycogen in cells, fibroblast proliferation, granulation tissue growth, leading to the regeneration of new epithelial tissue. Semiconductor laser can also increase the content of RNA in cytoplasm and DNA in nucleus, promote protein synthesis, and thus stimulate wound healing.Ultraviolet combined with semiconductor laser treatment of bedsore has good antibacterial and anti-inflammatory effects, can accelerate the speed of wound healing, and is not easy to repeat. It is effective for bedsore treatment, and is simple and safe to operate. It is worthy of clinical promotion and combined application.However, for mild and moderate bedsores, the cure rate is higher and the cure time is faster, suggesting that clinical nursing should find out in time and treat as soon as possible.
