{"id":556,"date":"2020-01-19T20:18:37","date_gmt":"2020-01-19T17:18:37","guid":{"rendered":"http:\/\/www.caferabbasoglu.com\/?p=556"},"modified":"2020-02-17T20:24:11","modified_gmt":"2020-02-17T17:24:11","slug":"diabetik-ayaklarda-hayat-kurtaran-isik","status":"publish","type":"post","link":"https:\/\/www.caferabbasoglu.com\/en\/2020\/01\/diabetik-ayaklarda-hayat-kurtaran-isik\/","title":{"rendered":"Diabetik Ayaklarda Hayat Kurtaran I\u015f\u0131k"},"content":{"rendered":"

LLLT<\/strong> ( Low Level Laser Terapi) tedavisi de\u011fi\u015fik dalga boylar\u0131nda, de\u011fi\u015fik frekanslarda, de\u011fi\u015fik s\u00fcre ve de\u011fi\u015fik g\u00fc\u00e7te lazer \u0131\u015f\u0131n\u0131 se\u00e7ilerek \u00e7o\u011funlukla di\u011fer tedavi metodlar\u0131 ile birlikte kombine kullan\u0131lan bir tedavi y\u00f6ntemidir.<\/p>\n\n\n\n
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Lllt poliklinik ortam\u0131nda uygulanan a\u011fr\u0131s\u0131z, ac\u0131s\u0131z ve yan etkisiz bir tedavidir\u2026<\/em><\/strong><\/h2>\n<\/blockquote>\n<\/td>\n

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\"DiyabetikDiyabetik ayak sendromu \u015feker hastal\u0131\u011f\u0131 kaynakl\u0131 ciddi kronik bir komplikasyondur. \u015eeker hastal\u0131\u011f\u0131n\u0131n damar ve sinirlerde yaratt\u0131\u011f\u0131 hasarlar zaman i\u00e7inde baz\u0131 organlarda fonksiyon bozukluklar\u0131na yol a\u00e7ar. Sinir ucu harabiyeti veya atardamar t\u0131kan\u0131kl\u0131\u011f\u0131ndan olu\u015fan yaralarla birlikte bu hastal\u0131ktan en \u00e7ok etkilenen organlar\u0131n ba\u015f\u0131nda ayaklar gelmektedir. Diyabetik ayak \u00e7o\u011funlukla hasta baca\u011f\u0131n amp\u00fctasyonuna kadar gidebilen ciddi organ kay\u0131plar\u0131na sebep olabilmektedir. G\u00fcn\u00fcm\u00fczde uygulanan standart tedavi y\u00f6ntemleriyle bu yaralar\u0131n iyile\u015fmesi olduk\u00e7a zor bazen de imkans\u0131zd\u0131r. Genellikle zor iyile\u015fen ve uzun s\u00fcren kronik cilt \u00fclseri ya\u015fatt\u0131\u011f\u0131 a\u011fr\u0131lar ile hastan\u0131n ya\u015fam kalitesini ciddi derecede etkilemektedir.<\/p>\n

Diyabetik hastalar\u0131n dopler ultrason muayenesi s\u0131ras\u0131nda Anjiografik de\u011ferlendirmeler ile birlikte tedavi edilecek yaralar\u0131n ( ven\u00f6z arteryel , diyabete ba\u011fl\u0131 lenfatik yara) ay\u0131r\u0131c\u0131 tan\u0131s\u0131na mutlaka dikkat edilmelidir. Bu tan\u0131 kullan\u0131lacak \u0131\u015f\u0131n yolu ve tedavi se\u00e7eneklerini belirlemek a\u00e7\u0131s\u0131ndan son derece \u00f6nemli ve gereklidir. Lllt baz\u0131 kliniklerde diyabete ba\u011fl\u0131 yaralar kronik,ven\u00f6z zeminde olu\u015fan yaralar ve iskemik periferik arter hastal\u0131\u011f\u0131na mesela burger hastal\u0131\u011f\u0131na ba\u011fl\u0131 olu\u015fan yaralarda da kullan\u0131lmaktad\u0131r. D\u00fc\u015f\u00fck enerjili lazer tedavisinin g\u00fc\u00e7l\u00fc etkisi yan\u0131nda herhangi bir yan etkisi de bulunmamaktad\u0131r.<\/p>\n

Diyabetin ortak komplikasyonlar\u0131ndan bir tanesi de diyabetik ayak sendromudur. S\u0131kl\u0131kla sebep oldu\u011fu amp\u00fctasyonun yan\u0131nda risk fakt\u00f6rlerine bakt\u0131\u011f\u0131m\u0131z zaman multifaktoriyel n\u00f6ropatilere ba\u011fl\u0131 duyumotor ve otonomik n\u00f6ropatilere de zemin haz\u0131rlad\u0131\u011f\u0131 g\u00f6r\u00fcl\u00fcr Bacakta devaml\u0131 a\u011fr\u0131, yanma, \u00fc\u015f\u00fcme,hissizlik ,renk de\u011fi\u015fimi gibi belirtilere \u00f6zellikle dizalt\u0131nda periferik arterlerdeki daralma ve t\u0131kanmalar da eklendi\u011fi zaman diyabetik ayak sendromu ortaya \u00e7\u0131kar. Etkisi d\u00fcnyaca bilinen \u2018d\u00fc\u015f\u00fck doz lazer tedavilerinin\u2019 i\u00e7inde en \u00f6nemli yeri \u015feker hastal\u0131\u011f\u0131na ba\u011fl\u0131 diyabetik yara tedavilerinin ald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir.<\/p>\n

Diyabetik ayak tedavisinde ayaktaki \u00fclser s\u0131n\u0131fland\u0131rmas\u0131na bak\u0131p onlar\u0131 t\u00fcmden de\u011ferlendirdi\u011fimizde g\u00f6r\u00fcyoruz ki bu yaralar\u0131n temizlenmesi, debride edilmesi , deri graftlar\u0131n\u0131n konmas\u0131 , antibiyotikler ve vazodilat\u00f6r ila\u00e7larla a\u011fr\u0131n\u0131n y\u00f6netimi ve hatta sinek magotlar\u0131n\u0131n kullan\u0131lmas\u0131n\u0131 sa\u011flayan bandajlara kadar b\u00fct\u00fcn se\u00e7enekleri de\u011ferlendirdi\u011fimiz zaman \u00e7ok farkl\u0131 y\u00f6ntemler olmas\u0131na ra\u011fmen ne yaz\u0131k ki diyabetik ayak \u00fclserlerinin tedavisi hem \u00e7ok zor hem de tatminkar de\u011fildir. Bu durumdaki hastalar i\u00e7in LLLT yeni ve olduk\u00e7a etkili bir tedavi metodu olarak d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n

LLLT Uygulan\u0131\u015f\u0131 ve Etki Mekanizmas\u0131<\/strong><\/h3>\n

\"Lllt\"Tamamen poliklinik ortamda uygulanan invaziv olmayan,a\u011fr\u0131s\u0131z,ac\u0131s\u0131z ve yan etkisiz bir tedavi y\u00f6ntemidir. Diyabetik ayak sendromunun tedavisinde LLLT etkili bir tedavi y\u00f6ntemi olarak bilinmektedir. Hastal\u0131\u011f\u0131n derecesine g\u00f6re farkl\u0131 dalga boylar\u0131ndaki k\u0131rm\u0131z\u0131,mavi,ye\u015fil veya mor lazer \u0131\u015f\u0131nlar\u0131n\u0131n ince bir kan\u00fclle damar yolundan hastaya verilmesi esas\u0131na dayal\u0131 bir tedavidir. Lllt Etki mekanizmas\u0131 olarak lazer mitokondrial oksidatif zinciri i\u015fleme sokar. Mitokondriler enerji toplar ve dolay\u0131s\u0131yla enerji \u00fcretir.D\u00fc\u015f\u00fck enerjili lazer mitokondrideki enerjileri uyararak H2 o2 \u2013 H0 \u2013O2 \u2013O2 -0NOO zincirini olu\u015fturur.<\/p>\n

\u0130kinci mekanizmas\u0131 ise Cytochrom C \u2013oxidase zinciri aktive ederek NO oxidativ sa\u011flar. Bacakta bu enerjinin sayesinde \u00e7ok ince arteryoller seviyesinde damarlar olu\u015farak kan ak\u0131m\u0131nda artma sa\u011flan\u0131r. Lazer \u0131\u015f\u0131n\u0131 uygulanan b\u00f6lgede oksijenlenme ve beslenme yaratarak yaran\u0131n iyile\u015fmesinde b\u00fcy\u00fck etki sa\u011flar.<\/p>\n

D\u00fc\u015f\u00fck enerjili lazerlerden k\u0131rm\u0131z\u0131 lazer mitokondrileri efektif hale getirerek dokuda yenilenme ve canlanma sa\u011flar. K\u0131rm\u0131z\u0131 \u0131\u015f\u0131k lazeri 630 nanometre blue mavi \u0131\u015f\u0131k lazerine g\u00f6re 470 nanometre daha iyi bir perf\u00fczyon sa\u011flamaktad\u0131r. Nitikosit asitin sal\u0131n\u0131m\u0131yla hemoglobinlerden art\u0131r\u0131lm\u0131\u015f g\u00fc\u00e7l\u00fc epitelizasyon ve keratinin art\u0131r\u0131lmas\u0131yla daha iyi bir epitelizasyon perfizyon sa\u011flanmaktad\u0131r.<\/p>\n

Mavi lazerin dalga boyunda dokudaki \u015fi\u015flik, \u00f6dem ve enfeksiyonlar h\u0131zla azalmaktad\u0131r. \u00d6zellikle metabolik sendromda yani \u015feker hastalar\u0131nda efektif bir \u015fekilde \u015fekeri ,enfeksiyonu, \u00f6demi ,a\u011fr\u0131y\u0131, \u015fi\u015fli\u011fi ve yara iyile\u015fmesini \u00f6nemli derecede etkilemektedir.<\/p>\n

Mavi \u0131\u015f\u0131k mitokondrialarda salg\u0131lanan nitojen mavi \u0131\u015f\u0131kta mitokondria kompleksini kendinin tedavi etmesinde h\u0131zland\u0131rd\u0131\u011f\u0131n\u0131 ona ortam haz\u0131rlad\u0131\u011f\u0131n\u0131 g\u00f6r\u00fcyoruz. Mitokondrideki duru\u015f inhivisyon mitokondri kompleksinden sal\u0131nan NO gaz\u0131na ba\u011fl\u0131 olmakta ve bu durumda yara iyile\u015fmesi NO peltvi yolundan oldu\u011fu zaman bunlar endotel\u00fcel h\u00fccrelerin oraya g\u00f6\u00e7 etmesini engellemektedir. \u0130\u015fte b\u00f6ylece mavi \u0131\u015f\u0131k bunun g\u00f6\u00e7\u00fcn\u00fc azaltarak yaran\u0131n iyile\u015fmesini sa\u011flamaktad\u0131r. Antienflamatuar etkisi de lazer tedavisinin prostaglendinlerini inhibe ederek olmaktad\u0131r.<\/p>\n\n\n\n
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K\u0131rm\u0131z\u0131 infrared veya infrarede yak\u0131n \u0131\u015f\u0131nlar \u00e7ok g\u00f6r\u00fclebilir olmamas\u0131na ra\u011fmen k\u0131rm\u0131z\u0131 \u0131\u015f\u0131\u011fa g\u00f6re infraredlerin insan dokusunda daha derine gitti\u011fi ispatlanm\u0131\u015f durumdad\u0131r.<\/h3>\n<\/blockquote>\n<\/td>\n

\"K\u0131rm\u0131z\u0131<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

LLLT direk v\u00fccut h\u00fccrelerindeki hafif enerjiyi sit\u00fcmile eden bir sistem olarak d\u00fc\u015f\u00fcn\u00fclebilir. Emilen lazer molek\u00fcldeki enerjiyi sit\u00fcmile (uyarma) edebilir. Lllt v\u00fccutta h\u0131zl\u0131 anlamda bir doku \u0131s\u0131s\u0131n\u0131 artt\u0131rmadan h\u00fccrenin atomlar\u0131n\u0131 uyar\u0131r. Farkl\u0131 lazer dalga boyutlar\u0131n\u0131n insan dokusunda de\u011fi\u015fik farkl\u0131 derinliklere inebildi\u011fi bilinmektedir. \u00d6rne\u011fin k\u0131rm\u0131z\u0131 lazer mora g\u00f6re daha derin bir penatrasyon sa\u011flar. Hatta k\u0131rm\u0131z\u0131 lazer mor,mavi, ye\u015fil ve sar\u0131ya g\u00f6re daha derin etki yarat\u0131r. K\u0131rm\u0131z\u0131 infrared veya infrarede yak\u0131n \u0131\u015f\u0131nlar \u00e7ok g\u00f6r\u00fclebilir olmamas\u0131na ra\u011fmen k\u0131rm\u0131z\u0131 \u0131\u015f\u0131\u011fa g\u00f6re infraredlerin insan dokusunda daha derine gitti\u011fi ispatlanm\u0131\u015f durumdad\u0131r. Mesela k\u0131rm\u0131z\u0131 \u0131\u015f\u0131k 685 nanometre , infrared ise 785 nanometre \u0131\u015f\u0131n verebilir. Gerekti\u011finde bunlar\u0131n ikisi de birle\u015ftirilebilir. \u0130nsan v\u00fccudunda deriye 2- 3 cm kadar girebilen biyokromatik lazer i\u011fneleriyle tedavinin ba\u015f\u0131nda bir \u015fey hissetmeyen hastalar\u0131n ortalama 5- 10 dakika sonra hafif bir \u0131s\u0131nma livrasyon hissi ya\u015fad\u0131\u011f\u0131 g\u00f6r\u00fclmektedir.<\/p>\n

Diyabetik \u00fclserlerin tedavisinde LLLT \u2018nin doku yenileme mekanizmas\u0131 h\u00fccre \u00e7al\u0131\u015fmalar\u0131 yara iyile\u015fmesinin h\u0131zland\u0131r\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6sterirken , biyometrik ve histolojik \u00e7al\u0131\u015fmalarda erken h\u0131zla lezyonlar\u0131n k\u00fc\u00e7\u00fcld\u00fc\u011f\u00fc ve konek ba\u011f dokusunun oralarda kolajen liflerle artarak yaran\u0131n tedavi edildi\u011fi g\u00f6r\u00fclmektedir. Ayr\u0131ca bunlar h\u0131zla epitelizasyonu sa\u011flayarak yara iyile\u015fmesinin h\u0131z\u0131 ve de etkisini ortaya \u00e7\u0131karmaktad\u0131r. Lazer terapisi inflamasyonu da azaltmas\u0131n\u0131n yan\u0131nda miyofibrobilaslar\u0131 derideki o yaralardaki miyofibraliyaslar\u0131n da h\u0131zla polifera olmas\u0131 i\u00e7in uyar\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. H\u00fccre b\u00f6l\u00fcm\u00fcn\u00fc uyarmas\u0131 h\u00fccre i\u00e7indeki fibrobilaslar\u0131n b\u00fcy\u00fcmesi yara iyile\u015fmesinde de ciddi bir role sahip farkl\u0131 dalga boylar\u0131na g\u00f6re yap\u0131lan lazer \u0131\u015f\u0131nlamas\u0131n\u0131n h\u00fccre g\u00f6\u00e7\u00fc varl\u0131\u011f\u0131 ve probilasyanu geli\u015fmesi a\u00e7\u0131s\u0131ndan diyabetik ayakta g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

LLLT d\u00fc\u015f\u00fck doz lazerle 415 nanometrenin antibakteriel etkisi oldu\u011fu g\u00f6r\u00fclmektedir. Bunlar\u0131n s.aureus ve e.koli bakteriyel \u00fczerinde \u00f6nemli etkileri mevcuttur. LLLT ayr\u0131ca perifer arterlerdeki kan ak\u0131m\u0131n\u0131 yani \u00f6zellikle dizalt\u0131ndaki damarlar\u0131 geni\u015fleterek ve kandaki h\u0131z\u0131 art\u0131rarak bacaktaki damarlar \u00fczerinde de b\u00fcy\u00fck etki yaratmaktad\u0131r.<\/p>\n

Ayakta ve Zahmetsiz Tedavi ‘D\u00fc\u015f\u00fck Enerjili Lazer’<\/strong><\/h3>\n

\"Lllt\"Lazer tedavisi hastaya ayaktan tedavi \u015feklinde olduk\u00e7a zahmetsiz bir y\u00f6ntemle uygulanmaktad\u0131r. A\u011fr\u0131s\u0131z ,ac\u0131s\u0131z ve ameliyats\u0131z bir tedavi \u015feklidir. Hastanede yatmaya gerek olmadan seanslara y\u00fcr\u00fcyerek yani ayakta gidip gelinebilmektedir.<\/p>\n

Lazer uygulamas\u0131n\u0131n hasta b\u00f6lge \u00fczerinde olu\u015fturdu\u011fu iyile\u015fme ilk g\u00fcnden itibaren fark edilmektedir. Tedavi esnas\u0131nda kana emdirilen de\u011fi\u015fik dalga boylar\u0131ndaki \u0131\u015f\u0131nlar\u0131n etkisi uygulama bittikten sonra aylarca s\u00fcrmekle birlikte g\u00fcnden g\u00fcne yeni ince k\u0131lcal damarlar yani arteryoller olu\u015fturarak da hastan\u0131n \u015fikayetlerini azaltmaktad\u0131r.<\/p>\n

Uzun y\u0131llard\u0131r Avrupa ve Amerikada uygulanan, iyi neticeler al\u0131nan FDA onayl\u0131 d\u00fc\u015f\u00fck enerjili lazer tedavisi yan etkisiz olarak tan\u0131mlanm\u0131\u015ft\u0131r.<\/p>\n

Son y\u0131llarda \u00fclkemizde de kullan\u0131lmakta de\u011fi\u015fik dalga boylar\u0131nda ve g\u00fc\u00e7te ve spektromda mitokondri etkileyerek ve etki mekanizmalar\u0131yla oksijenizasyonu \u00e7o\u011faltarak enerji h\u00fccreleri yaratarak arteryollar seviyesinde geni\u015fleme olu\u015fturur. Hastalar\u0131n bacaklar\u0131 amp\u00fctasyona yani kesilmeye gitmeden kurtar\u0131lmaktad\u0131r. Bu tedavi s\u0131ras\u0131nda hastan\u0131n a\u011fr\u0131 \u015fikayetlerinde \u00f6nemli derecede azalma , yaras\u0131nda ilk g\u00fcnden beri iyile\u015fmeye g\u00f6stermedir. G\u00f6zle g\u00f6r\u00fcl\u00fcr renk de\u011fi\u015fikli\u011fi ve iyile\u015fme g\u00f6r\u00fcld\u00fc\u011f\u00fc de yap\u0131lan \u00e7al\u0131\u015fmalarda g\u00f6sterilmi\u015ftir.<\/p>\n

Diyabetik Ayakta Di\u011fer Tedavi Y\u00f6ntemleri<\/strong><\/h3>\n

\"DiabetikDiyabetik yaralarda genelde diyabete ba\u011fl\u0131 dizalt\u0131nda atardamarlarda boydan boya t\u0131kanmalar ve yer yer kritik daralmalar anjiografik olarak g\u00f6r\u00fclmektedir. Dolay\u0131s\u0131yla dizalt\u0131na \u00f6zellikle parmaklara ve topu\u011fa yeteri kadar kan gelmemesi neticesinde bacakta a\u011fr\u0131, yanma y\u00fcr\u00fcd\u00fc\u011f\u00fc zaman duraklama ve bazen a\u00e7\u0131k yaralar olu\u015fmaktad\u0131r. Bu t\u00fcr hastalarda arteryel stentleme veya bypass imkan\u0131 olmad\u0131\u011f\u0131ndan alternatif tedaviler olarak k\u00f6k h\u00fccre tedavisi PRP hiperbarik oksijen tedavisi ve ozon tedavisi s\u00fcl\u00fck tedavisi kurt\u00e7uk tedavisi ve baz\u0131 medikal tedaviler mevcuttur..<\/p>\n

G\u00fcn\u00fcm\u00fczde ayr\u0131ca standart tedavi y\u00f6ntemleri ve LLLT ye ilaveten bir\u00e7ok de\u011fi\u015fik tedavi yakla\u015f\u0131mlar\u0131 da bulunmaktad\u0131r. Bunlar\u0131n i\u00e7inde yara debritman\u0131, antimikrobiyallerin kullan\u0131m\u0131, yaralar\u0131n \u00fcst\u00fcnde kullan\u0131lan diresingler , yara kapamalar , topikal negatif bas\u0131n\u00e7lar, hiperbarik oksijen tedavileri, elektrik ve elektromanyetik dalga \u015foklu\u011fu, ultrason tedavileri, h\u00fccre b\u00fcy\u00fcmeleri biyolojik fakt\u00f6rlerle h\u00fccre b\u00fcy\u00fcmeleri h\u00fccrelerde h\u00fccre ve dokular\u0131n yenilenmesi deri graflar\u0131n\u0131n derilerin biyoenjilerin biyo m\u00fchendislikle ortaya \u00e7\u0131kan deri graflar\u0131 di\u011fer yan tedavilerdir. Bazen debritman veya yaran\u0131n temizlenmesi ve \u00c7in bitki merhemlerinin yara kapamalar\u0131 da kullan\u0131lmaktad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

LLLT ( Low Level Laser Terapi) tedavisi de\u011fi\u015fik dalga boylar\u0131nda, de\u011fi\u015fik frekanslarda, de\u011fi\u015fik s\u00fcre ve de\u011fi\u015fik g\u00fc\u00e7te lazer \u0131\u015f\u0131n\u0131 se\u00e7ilerek \u00e7o\u011funlukla di\u011fer tedavi metodlar\u0131 ile birlikte kombine kullan\u0131lan bir tedavi y\u00f6ntemidir. Lllt poliklinik ortam\u0131nda uygulanan a\u011fr\u0131s\u0131z, ac\u0131s\u0131z ve yan etkisiz bir tedavidir\u2026 Diyabetik ayak sendromu \u015feker hastal\u0131\u011f\u0131 kaynakl\u0131 ciddi kronik bir komplikasyondur. \u015eeker hastal\u0131\u011f\u0131n\u0131n damar […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"two_page_speed":null,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-556","post","type-post","status-publish","format-standard","hentry","category-genel"],"translation":{"provider":"WPGlobus","version":"3.0.0","language":"en","enabled_languages":["tr","en"],"languages":{"tr":{"title":true,"content":true,"excerpt":false},"en":{"title":false,"content":false,"excerpt":false}}},"yoast_head":"\nDiabetik Ayaklarda Hayat Kurtaran I\u015f\u0131k - Opr.Dr.Cafer Abbaso\u011flu<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.caferabbasoglu.com\/2020\/01\/diabetik-ayaklarda-hayat-kurtaran-isik\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diabetik Ayaklarda Hayat Kurtaran I\u015f\u0131k - 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