Chinese name: definition of phototherapy: treating diseases by using light radiation: types of physiotherapy: ultraviolet, visible light, infrared, laser development, classification, infrared therapy, photodynamic therapy, visible light therapy, ultraviolet therapy, laser therapy, laser protection, combined application and development phototherapy are methods to prevent and treat diseases by applying visible light and invisible light in sunlight and artificial light sources. Phototherapy began with solar therapy and was recorded as early as the 2nd century AD. Artificial light source began at the end of 18 world, and in the middle of 19 century, visible light, infrared light and ultraviolet light were successively formed, and then it was widely used and developed in various fields of clinical treatment. classify
Phototherapy mainly includes ultraviolet therapy, visible light therapy, infrared therapy and laser therapy.
Infrared ray can improve local blood circulation, promote swelling, relieve pain, reduce muscle tension, relieve muscle spasm and dry exudative lesions.
Ultraviolet rays act on human body, and light energy causes a series of chemical reactions, which have anti-inflammatory, analgesic and anti-rickets effects, and are often used to treat skin suppurative inflammation and other dermatitis, pain syndrome, rickets or rickets. Ultraviolet rays with the wavelength of 3 10-3 13nm are called narrow-band ultraviolet rays (NBUVB), which concentrate the most biologically active part of ultraviolet rays, directly act on the affected part of the skin, and filter out harmful ultraviolet rays at the same time, with little side effects and short onset time and quick response when acting on the stratum corneum of the skin. It is widely used in major hospitals to treat psoriasis, vitiligo, chronic eczema, neurodermatitis, atopic dermatitis, palmoplantar pustulosis, pityriasis rosea, alopecia areata, parapsoriasis, chronic skin ulcer, mycosis fungoides and other diseases.
Visible light is the light that human eyes can see. The method of treating diseases with visible light is visible light therapy. It mainly includes red light, blue light, blue-violet light and multispectral therapy. Red light has an exciting effect; Yellow light, green light and red light have opposite effects; Blue light and purple light can be used to treat nuclear jaundice.
Laser is the light generated by stimulated radiation amplification, which has the characteristics of small divergence angle, good directivity, pure spectrum, good monochromaticity, high energy density, high brightness and good coherence, and has thermal effect, mechanical effect and electromagnetic effect. Can be used for the diagnosis and treatment of various diseases. infrared therapy
The wavelength of infrared is 760 nm ~ 50? M is invisible light. The main function of infrared ray is thermal effect. According to biological characteristics, infrared rays can be divided into two sections. One is long-wave infrared, wavelength 1.5 ~ 15? M, also known as far infrared ray. The second is short-wave infrared, the wavelength is 760 nm ~ 1.5? M, also known as near infrared. The light quantum energy of infrared ray is low, and its main biological function is thermal effect, but there is no photochemical effect. Human skin and subcutaneous tissue are the main areas that absorb infrared rays. Due to the different absorption rates of infrared rays with different wavelengths in different areas of the skin epidermis, long-wave infrared rays can only reach the depth of 0.05 ~ 1 mm, and short-wave infrared rays can reach the depth of1~10 mm. After being irradiated by infrared rays, the skin appears congestion, showing as red hot erythema with unclear boundaries and uneven colors. After stopping irradiation, the erythema completely subsided in about 1 ~ 2 hours. Uneven pigmentation will appear on the skin after repeated irradiation. It is characterized by reticular spots along the skin blood vessels, which are shaped like marble lines.
Skin and subcutaneous tissue convert absorbed infrared energy into heat, which can cause vasodilation, accelerate blood flow, improve local blood circulation, enhance tissue nutrient metabolism, accelerate blood lymphatic circulation, and promote the absorption and elimination of abnormal products in tissues. The warming effect of infrared reduces the excitability of sensory nerves and interferes with the pain threshold, so infrared 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 spindle, weaken stretch reflex, and lead to decreased muscle tension and muscle relaxation. For example, when gastrointestinal smooth muscle spasms, it can weaken gastrointestinal peristalsis, relieve muscle spasms and eliminate pain. It can also accelerate blood circulation in tissues, increase exudation, make white blood cells around arterioles and capillaries migrate and infiltrate, enhance the function of phagocytes and increase the formation of antibodies. Because immunity is enhanced, chronic inflammation of superficial tissues can be absorbed.
Infrared therapy has a wide range of indications, mainly used to relieve muscle spasm, improve blood supply and relieve pain. Such as lumbar muscle strain, lumbar disc herniation, tendinitis, chronic gastritis, chronic hepatitis, neuritis, skin ulcer, contracture scar, etc. Contraindications are high fever, bleeding tendency, active pulmonary tuberculosis and severe arteriosclerosis.
Infrared radiators are mainly infrared lamps, timely infrared rays (formed by tungsten wires extending into inflatable quartz tubes) and light bath boxes. Photodynamic therapy is a combination of long-wave ultraviolet rays and some photosensitive drugs to treat skin diseases, or black light therapy or photochemical therapy. Oral photosensitive drugs, such as 8- methoxysarin and trimethoprim (TMP), are activated by absorbing their energy under long-wave ultraviolet irradiation, and combine with two thymines on the DNA chain of cells to form thymine dimer. Through photoaddition effect, photosensitizer and thymine form C4- cyclobutyl photoadduct, which leads to cell damage, acceptance or death. Visible light therapy
Visible light can cause the light sensation of retina, and its wavelength is 760 ~ 400 nm, which is composed of seven colors of light, such as red, orange, yellow, green, cyan, blue and purple. Visible light therapy includes red light, blue light, blue-violet light and multispectral therapy. The therapeutic effects of visible light are mainly thermal effect and photochemical thermal effect. Visible light can cause vision. The circadian rhythm and a series of physiological function rhythms of human and animals are closely related to the natural light rhythm (day and night alternation). Red, orange and yellow light can accelerate and deepen breathing and increase pulse rate; Green, blue and purple light can cause slow and shallow breathing and slow pulse rate; Blue light and purple light reduce the excitability of nerves and have sedative effect; Red light improves the excitability of nerves and has a * * * effect. At the same time, visible light can also strengthen glucose metabolism, promote oxidation process, strengthen pituitary function, improve cerebral cortex function, strengthen the excitability of sympathetic nervous system and enhance immunity. Starting from 1970, neonatal nuclear jaundice was treated with visible light. Bilirubin has the strongest absorption of light with a wavelength of about 400 ~ 500 nm, and the maximum absorption band is 420 ~ 460 nm, which belongs to the blue-purple band. Bilirubin is decomposed into a series of transformants after absorbing blue-violet light, and gradually becomes a light yellow low molecular weight water-soluble compound, which is quickly excreted from urine. The blood flow of skin can be increased by 22.4% under illumination, which is beneficial to bring bilirubin from deep body to skin surface tissue for irradiation. After blue light irradiation, jaundice subsided, serum bilirubin decreased, and green and dark brown thin feces were discharged.
The indications and contraindications of visible light therapy are basically the same as those of infrared therapy. Visible light is the main thermal effect, which needs deeper effect, wider range and more uniform cutting.
The visible light source used in clinic is mainly tungsten filament incandescent lamp, and its spectrum is about 4.8% visible light and 95% infrared light. If monochromatic light is irradiated, a filter plate can be added under the lamp holder. Ultraviolet radiation therapy
Ultraviolet light is an invisible light with a wavelength less than that of violet light, with a wavelength of 400 ~ 180 nm. Optical quantum energy is high and has obvious photochemical effect.
Medical ultraviolet is divided into three sections: ① long-wave ultraviolet (400 ~ 320 nm); ②UVB(320 ~ 250nm)； ③ Short-wave ultraviolet (250 ~ 180 nm). Sunlight contains a lot of ultraviolet rays, but the atmosphere almost absorbs short-wave ultraviolet rays, so only long-wave and medium-wave ultraviolet rays radiate to the ground. Short-wave ultraviolet rays can be obtained by artificial light sources. Biological effects of ultraviolet rays
(1) Erythema reaction: that is, after a certain dose of ultraviolet rays irradiate the skin, after a certain period of time, a hyperemia reaction with clear and uniform boundaries appears on the irradiated skin. The absorption of ultraviolet rays by skin is related to its wavelength. The shorter the wavelength of ultraviolet rays, the shallower the depth of penetration into the skin. Therefore, most short-wave ultraviolet rays and medium-wave ultraviolet rays are absorbed by the stratum corneum and spinous cells of the skin. After ultraviolet irradiation, erythema reaction takes some time, which is the incubation period. The incubation period is related to the wavelength of ultraviolet light. The incubation period of long-wave ultraviolet erythema is longer, usually 4 ~ 6 hours, and that of short-wave ultraviolet erythema is shorter, usually 1 and 5 ~ 2 hours. Erythema reaction reached its peak in 12 ~ 24 hours, and then gradually decreased. The essence of ultraviolet erythema is an actinic dermatitis, which belongs to nonspecific inflammation. There are four theories about the mechanism of ultraviolet erythema: one is histamine theory. Ultraviolet rays denature and decompose tissue proteins, leading to the decomposition of histidine in tissues and the formation of histamine. The release of histamine causes the expansion and permeability enhancement of capillaries in dermis, showing skin congestion and erythema reaction. However, the formation of erythema is not a simple histamine effect; Ultraviolet rays act on the lysosomal membrane of spinous cells, releasing many enzymes such as hydrolase, decomposing protein, dilating blood vessels and forming erythema. Prostaglandin is an important active substance causing ultraviolet erythema, and kinin and histamine are auxiliary factors. Ultraviolet rays denature vascular endothelial cells, leading to the production of kinin and erythema.
Blood vessels in erythema dilate, blood pressure drops, leukocytosis increases, phagocytosis increases, and immunity improves obviously. 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 with unhealed wounds. It has a good effect on rheumatic inflammation of muscles and nerves or superficial acute and chronic suppurative inflammation, but it can aggravate the spread of tuberculosis inflammation, so it is not suitable for use.
After a certain dose of ultraviolet radiation, different degrees of skin pigmentation can appear after a certain period of time. Black pigmentation is stronger after long-wave ultraviolet radiation and weaker after short-wave ultraviolet radiation. Melanin can combine with free electrons and other chemical free radicals produced by skin photochemical process under ultraviolet radiation to prevent them from damaging the body. The mechanism of skin pigmentation is that ultraviolet rays can act on the pituitary-adrenal cortex system to enhance the secretion of melanin in melanocytes, thus promoting the melanin particles in melanocytes (secretory cells between epidermis and dermis) to change from reduced state to oxidized state, strengthening the phagocytosis of melanin particles by epidermal cells and strengthening skin pigmentation. Vitiligo can be treated by ultraviolet pigmentation, especially by the combination of long-wave ultraviolet and photosensitizer.
② Effect on calcium and phosphorus metabolism. Ultraviolet light can convert 7- dehydrocholesterol in human skin into vitamin D3, which can promote the absorption of calcium and phosphorus in intestine and calcification of bone tissue. Can be used for treating rickets in children and adults. In addition, the effect of calcium ion on reducing vascular permeability and nerve excitability can alleviate allergic reaction, which is one of the mechanisms of ultraviolet desensitization.
③ Adjust and improve the functions of nervous system, endocrine system, digestive system, circulatory system, respiratory system, blood system and immune system.
④ Sterilization of ultraviolet rays: 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 short-wave ultraviolet rays. Therefore, ultraviolet with wavelength of 220 ~ 300 nm has bactericidal effect. Using the sterilization effect of ultraviolet rays, wounds can be disinfected and cleaned, and various infections such as skin, mucosa, wounds, sinuses and fistulas can be treated.
High-dose ultraviolet rays can cause RNA destruction, protein decomposition and protein degeneration, which is consistent with DNA destruction and is one of the mechanisms of ultraviolet disinfection and wound cleaning. Using photosensitizer to strengthen the inhibition of ultraviolet rays on DNA and RNA can treat proliferative skin diseases such as psoriasis.
In addition, when ultraviolet reaches a certain intensity, it can destroy histidine, methionine, tyrosine and so on. These amino acids are the active centers of enzymes, and once they are destroyed, the functions of enzymes will be lost, thus affecting cell functions, which is also one of the sterilization mechanisms of ultraviolet rays.
⑤ The sensitivity of the body to ultraviolet rays is often influenced by many factors (season, age, skin color, physical condition, drug use, etc.). The sensitivity of human body to ultraviolet rays is higher in spring and lowest in summer. People who often work outdoors, athletes, farmers, students and soldiers are less sensitive to ultraviolet rays, while those who work indoors and in tunnels are more sensitive. Adolescence is highly sensitive to ultraviolet rays, while young children and the elderly are less sensitive. People with light skin color have high sensitivity, while those with dark skin color have low sensitivity. Women have higher premenstrual sensitivity and lower premenstrual sensitivity. High sensitivity during pregnancy and low sensitivity after delivery. People with good nutrition have high sensitivity, while those with poor nutrition have low sensitivity. Patients with tuberculosis, hyperthyroidism, eczema, lupus erythematosus, acute myocarditis, acute nephritis, malignant tumor, porphyria, nicotinic acid deficiency, etc. Increased sensitivity to ultraviolet rays; However, patients with chronic diseases, hypothyroidism and nervous system injury have low sensitivity. The sensitivity to ultraviolet rays is different after taking different drugs. For example, vitamin B 1, sulfanilamide, chlorpromazine, promethazine, griseofulvin, tetracycline and dihydrochlorothiazide can increase the sensitivity to ultraviolet rays. Different parts of the body have different sensitivities to ultraviolet rays. The sensitivity of trunk, chest and abdomen is high, but the sensitivity of face, neck, hands, feet and back is low. The pathological effects of ultraviolet rays include carcinogenesis (skin cancer) and photosensitization (photosensitizer in the body works with light to damage body tissues). Therefore, ultraviolet workers should protect their eyes and skin, use photoprotective agents (such as phenols) or wear gloves and protective glasses. The clinical application of ultraviolet can be divided into preventive application and therapeutic application. In the common cold, flu, whooping cough, scarlet fever, diphtheria, rheumatic fever and other epidemic periods. Patients can be relieved by ultraviolet rays, and healthy people, especially children, can be prevented by ultraviolet rays. Ultraviolet radiation can also prevent rickets. Argon-mercury emergency tube is used for ultraviolet therapy. Indications for treatment are ① medical diseases, such as respiratory diseases, including chronic bronchitis, pneumonia, bronchial asthma, tuberculosis, etc. The dose of pulmonary tuberculosis patients should be small and gradually increased, and radiotherapy should be stopped when the body temperature exceeds 37.5℃ or hemoptysis occurs. ② Surgical diseases, such as trauma, burns, subcutaneous suppurative inflammation, postoperative infection, lymphadenitis, mastitis, erysipelas, etc. ③ Neuropsychiatric diseases, such as peripheral neuritis, polyneuritis, neuralgia and neurosis, can be treated with erythema dose or erythema dose. ④ Dermatosis, such as skin suppuration, psoriasis, pityriasis rosea, alopecia areata, eczema, vitiligo, etc. In addition, after ultraviolet irradiation, the activity of enzymes in tissues increases, the metabolism of substances increases, inflammation oozes and absorbs, and herpes subsides, which has the functions of relieving pain and preventing secondary infection. ⑤ Gynecological diseases, such as adnexitis, cervicitis and * * * inflammation. Pediatric diseases, bronchitis, pneumonia, rickets, etc. ⑦ ENT diseases, such as pharyngitis, tonsillitis, otitis externa, etc. Contraindications are severe heart and kidney diseases, active tuberculosis, photosensitive diseases, poisoning with fever and acute tumors.
The dose of ultraviolet radiation is usually measured by biological dosimetry (the time required for ultraviolet radiation to produce the smallest erythema is one biological dose). Ultraviolet irradiation can be divided into whole body irradiation and local irradiation, and the dose of local irradiation is usually calculated as sub-erythema (no erythema reaction with naked eyes) and erythema (erythema reaction with naked eyes). Laser therapy
Laser is stimulated radiation, which has the characteristics of small divergence angle, good directivity, pure spectrum, good monochromaticity, high energy density, high brightness and good coherence, and has thermal effect, mechanical effect and electromagnetic effect. Can be used for the diagnosis and treatment of various diseases. Biological effects of laser
Thermal action: mainly caused by laser in visible light and infrared light. The heating of tissue by thermal action increases with the increase of laser energy. When using the thermal effect of laser in clinical treatment, it is necessary to choose the appropriate laser energy according to the specific situation.
Pressure effect: the energy density of laser is extremely high, which produces great pressure. Laser pressure can also be used to treat diseases such as tattoo removal and urinary calculi.
Photochemistry: biological macromolecules are activated by absorbing the energy of laser photons, producing excited atoms, molecules and free radicals, which cause a series of chemical changes in the body, called photochemical reactions. Photochemical reaction will lead to the decrease or inactivation of enzymes, amino acids, protein, nucleic acids, etc.
Electromagnetic action: Laser is an electromagnetic wave with high electric field intensity, which can be used to treat tumors.
Biological effect: Low-intensity laser irradiation can affect the immune function of the body, play a two-way regulation 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 fracture callus, accelerate the healing, accelerate the repair of nerve tissue damage, enhance adrenal function and enhance the activity of protein. The role of laser in clinical treatment
High intensity laser
High-intensity laser refers to the irreversible damage caused by laser acting on biological tissues, and its output power is above watt level. Clinically, intense laser is mainly used to coagulate, stop bleeding, melt and vaporize irradiated tissues, or to remove diseased tissues.
It is widely used in surgical operations, such as esophageal diseases, gastrointestinal anastomosis, hepatobiliary diseases requiring surgery, burn escharectomy, urethral stricture, prostate cancer, thyroid surgery, intracranial tumor surgery, and various skin diseases such as warts and verrucous warts, vascular diseases, skin malignant tumors, etc.
Low intensity laser
Low-intensity laser can regulate the immune function of the body, accelerate the healing of ulcers and wounds, accelerate the healing of fractures, have obvious anti-inflammatory and analgesic effects, promote the secretion of bile, the hematopoietic function of the spleen, and regulate the endocrine system.
Can be used for treating dermatoses such as herpes zoster, rosacea, erythema multiforme, urticaria, cervical spondylosis, lumbar disc herniation, scapulohumeral periarthritis, myofibrositis, acute and chronic injury, acute mastitis, cystic hyperplasia of mammary glands, bronchial asthma, arthritis, cervical erosion, chronic pelvic inflammatory disease, facial paralysis, vascular headache, neuralgia, eczema of external auditory canal, allergic rhinitis, pharyngitis, etc. Laser protection
High-power laser with output power above 500mV is harmful to human body, and its diffuse reflection in visible light and near infrared region is also dangerous.
Eye protection
Eye protection mainly uses protective glasses (reflective, absorptive, color-changing and warning).
Skin protection
When the laser exceeds the threshold, wear white work clothes and gloves. Don't let the laser shine directly on the skin to prevent reflection and scattered light from shining on the skin.
Laser workers should have regular health checks. Joint application
After low-dose ultraviolet irradiation, the synthesis of DNA and RNA is inhibited first and then accelerated, which can promote the growth of granulation and epithelial tissue and the healing of wounds. Can be used for treating pressure sores at various stages with good curative effect. In addition, ultraviolet irradiation can also dilate blood vessels, speed up blood flow, improve local blood circulation, strengthen local nutrition and improve
The immune function of the body. A large number of animal experiments and clinical practice show that low-energy laser irradiation has good anti-inflammatory and tissue repair functions, which can dilate blood vessels, improve microcirculation, increase the oxygen carrying capacity of red blood cells, enhance immunity, phagocytosis of macrophages and regeneration of granulation tissue, thus promoting wound healing. In recent years, foreign scholars have found that the anti-inflammatory and anti-infection effects of semiconductor lasers are better than other low-energy lasers. Its mechanism is mainly to activate the function of macrophage system, reduce the permeability of blood vessel wall, reduce the exudation, congestion and edema of inflammation, improve the general and local immunity of human body, and play an anti-inflammatory and anti-infective role. Laser irradiation promotes the formation and growth of new blood vessels, increases the contents of glyconucleic acid and glycogen in the nucleus, and leads to the proliferation of fibroblasts. The growth of granulation tissue leads to the regeneration of new epithelial tissue. Semiconductor laser can also increase the balance between RNA content in cytoplasm and DNA content in nucleus, and promote the synthesis of protein, thus healing the wound. Ultraviolet combined with semiconductor laser in the treatment of bedsore has good antibacterial and anti-inflammatory effects, can accelerate wound healing, is not easy to repeat, is accurate and effective in the treatment of bedsore, is simple and safe to operate, and is worthy of clinical promotion and joint application. However, the cure rate of mild and moderate bedsore is higher and the cure time is faster, which suggests that clinical nursing should be found in time and treated as soon as possible.