D.T.A. Medical Service
Il termine “carbossiterapia” venne introdotto da Luigi Parassoni
nel 1995, in occasione del XVI Congresso Nazionale di Medicina
Estetica di Roma organizzato dalla Società Italiana di Medicina
Estetica.
Negli anni 20, a Parigi, vennero effettuate le prime
somministrazioni di anidride carbonica per via sottocutanea. Lo
scopo iniziale delle somministrazioni sottocutanee di CO2 fu
quello di valutarne l’innocuità.
Nel 1932, presso la stazione termale di Royat (Clermont Ferrand),
in Francia, si iniziò ad iniettare anidride carbonica per via
sottocutanea per sfruttarne gli effetti farmacologici.
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Uno dei principi fondamentali della funzione circolatoria è la capacità di
ciascun distretto tessutale di regolare il proprio flusso ematico tessutale
locale in relazione alle esigenze metaboliche tessutali stesse. Così, come
i bisogni tessutali mutano, anche il flusso ematico tessutale locale si
modifica.
Le necessità specifiche dei tessuti alle quali il flusso ematico tessutale
locale si deve adeguare sono molteplici:
l’apporto di ossigeno
 l’apporto di nutrienti (glucosio, aminoacidi, acidi grassi, …)
 la rimozione di CO2 dai tessuti
 il mantenimento di un’appropriata concentrazione di svariati ioni nei
tessuti;
 il trasporto di diversi ormoni e di altre specifiche sostanze ai diversi
tessuti;
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I
fattori locali che regolano il flusso ematico
tessutale locale a breve termine sono l’anidride
carbonica, l’adenosina, l’acido lattico, i composti di
adenosina, i fosfati, l’istamina, gli ioni potassio, gli
ioni idrogeno.
I fattori locali che regolano il flusso ematico
tessutale locale a lungo termine sono i fattori di
crescita delle cellule endoteliali, i fattori di crescita
dei fibroblasti, l’angiogenina.
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Una unità tessutale è costituita da una metarteriola, un singolo capillare e
dal tessuto circostante.
All’origine del capillare c’è lo sfintere precapillare e intorno alla metarteriola
parecchie fibre muscolari lisce.
Se si osserva al microscopio un tessuto sottile come quello dell’ala di un
pipistrello si nota che gli sfinteri precapillari sono o completamente aperti o
completamente chiusi e che il grado di costrizione della metarteriola varia
con il tempo. Il numero degli sfinteri precapillari che sono aperti in un dato
periodo è all’incirca proporzionale alla richiesta di ossigeno (e di altri
nutrienti) dei tessuti. Inoltre gli sfinteri precapillari e le metarteriole si
aprono spesso in modo ciclico per parecchie volte al minuto e la fase di
apertura è anch’essa proporzionale alle necessità metaboliche dei tessuti.
Questo aprirsi e chiudersi ciclico delle metarteriole e degli sfinteri
precapillari è detto vasomotion. Poiché i muscoli lisci richiedono ossigeno
per rimanere in contrazione si può ritenere che la forza di contrazione degli
sfinteri aumenta con l’incremento della concentrazione dell’ossigeno.
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La carbossiterapia serve a riequilibrare la microcircolazione quando la
stessa è alterata come in svariate situazioni cliniche: nelle angiopatie
organiche e funzionali, nella pannicolopatia edemato-fibro-sclerotica
(PEFS), nella psoriasi.
Con la carbossiterapia si effettua un trattamento riabilitativo della
microcircolazione.
La carbossiterapia esplica i suoi effetti interferendo sia con i fattori che
regolano a breve termine il flusso ematico tessutale locale, sia con i
fattori
che regolano a lungo termine il flusso ematico tessutale locale.
La carbossiterapia determina:
Aumento della velocità del flusso ematico tessutale locale:
 aumento dell’entità del letto vascolare della microcircolazione tessutale
(angiogenesi)
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Agendo sulla vis a tergo della microcircolazione, sul “cuore” della
microcircolazione, cioè, a livello arteriolare e metarteriolare,
determinando una vasodilatazione arteriolare e metarteriolare e la
conseguente retrazione elastica delle pareti arteriolari e
metarteriolari, determinando, insomma, un aumento della sfigmicità
arteriolare e metarteriolare ;
agendo sugli sfinteri precapillari della microcircolazione
determinando un rilassamento delle fibrocellule muscolari lisce che
caratterizzano strutturalmente gli sfinteri precapillari e, quindi,
favorendo un aumento della velocità del flusso ematico tessutale
locale;
determinando un aumento della deformabilità eritrocitaria.
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La CO2 determina un rilassamento della muscolatura liscia
delle metarteriole, degli sfinteri precapillari, quindi un aumento
della velocità del flusso ematico tessutale locale e, di
conseguenza, un aumento della entità del flusso ematico
tessutale locale.
Nel caso di una situazione di PEFS, ha un ruolo importante
proprio il
“cuore” della microcircolazione: è l’iposfigmia delle arteriole e
delle
metarteriole
la
causa
principale
della
stasi
microcircolatoria veno-linfatica distrettuale.
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Già negli anni 20 venne dimostrato che la somministrazione
sottocutanea di CO2 era priva di tossicità. In medicina, in
particolare nella chirurgia ginecologica per via laparoscopica, la
CO2, viene utilizzata per distendere Il cavo endoaddominale. In
tali casi si introducono nel cavo endoaddominale 2-4 litri di
anidride carbonica senza alcun problema di tossicità.
Insomma il nostro organismo in condizioni di riposo elimina 200
ml/minuto di CO2 mentre in condizioni di iperventilazione elimina
4500 ml/minuto di CO2.
Quando si effettua una seduta di carbossiterapia si
somministrano, per via sottocutanea, in media, 50 ml/minuto.
E’ facilmente comprensibile come una lieve iperventilazione alla
fine del trattamento di carbossiterapia possa eliminare del tutto il
rischio di una ipotetica ipercapnia (acidosi).
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LA CARBOSSITERAPIA NEL TRATTAMENTO DELLA
CELLULITE
La cellulite il più delle volte è di tipo misto ed è caratterizzata
dal punto di vista istopatologico sia da una situazione di
adiposità localizzata (AL) ipertrofica-iperplasica in accesso, sia
da una situazione di pannicolopatia edemato-fibro-sclerotica
(PEFS).
Il trattamento della cellulite, pertanto, per essere adeguato
deve essere sia di tipo lipolitico, sia di tipo riabilitativo della
microcircolazione.
La carbossiterapia realizza:
un’azione riabilitativa della microcircolazione;
 un’azione lipolitica
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L’azione riabilitativa della microcircolazione torna vantaggiosa nel
trattamento della cellulite perché agisce sulla componente
vascolare che caratterizza la fisiopatologia microcircolatoria della
PEFS.
Intervenendo sulla vis a tergo della microcircolazione,
correggendo, cioè, l’iposfigmia delle metarteriole e delle arteriole si
risolve quella situazione di stasi veno-linfatica che caratterizza,
appunto, la PEFS.
L’azione lipolitica della carbossiterapia torna vantaggiosa nel
trattamento della cellulite perché agisce sulla componente
adiposa, cioè sulla adiposità localizzata ipertrofica-iperplasica in
eccesso determinando la lipolisi dei trigliceridi intradipocitari in
acidi grassi e glicerolo.
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L’azione lipolitica della carbossiterapia è legata
principalmente a tre meccanismi:
Aumento del flusso ematico tessutale locale
Attivazione recettoriale
 amplificazione
dell’effetto”Bohr”
e
effetto
“Haldane”
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LE TECNICHE DI SOMMINISTRAZIONE.
Le
tecniche
di
somministrazione
di
CO2
sono
principalmente due:
 Percutanea
 Iniettiva
La
somministrazione
percutanea
prevede
diverse
metodiche: bagni di gas secco o acqua carbonica e docce di
gas secco puntiforme o loco- regionale (trattamento ulcere
distrofiche degli arti inferiori).
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L’iniezione sottocutanea è la tecnica più utilizzata. Mentre i bagni
di gas secco, i bagni in acqua carbonica, le docce di gas secco, le
docce di acqua carbonica sono metodiche curative termali, quella
iniettiva è una metodica curativa che può essere effettuata in un
ambulatorio medico.
Inizialmente, per le somministrazioni sottocutanee, veniva utilizzato
uno strumentario spartano: una bombola di CO2 e una siringa.
Oggi si possono utilizzare apparecchiature sofisticate di ultima
generazione( D.T.A. CARBO2), erogatore elettronico con controlli di
retroazione che permette non solo di poter dosare l’anidride
carbonica ma anche di poter assicurare al gas un certo grado di
purezza, pressione e temperatura per mezzo di particolari valvole
proporzionali brevettate: una serie di filtri purificano la CO2 da
possibili contaminanti come, ad esempio, dalle spore di Clostridium
sporogenes.
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Il gas dosato da un apparecchio centrale e purificato da una serie di
filtri, arriva in un deflussore che termina con un ago 30 G(anche 27,
28) da 13 mm.
Mediante l’attivazione dell’apparecchiatura inizia
l’erogazione
dell’anidride carbonica., si infigge l’ago stesso nel sottocutaneo
provocando un graduale enfisema sottocutaneo.
Una volta che la CO2 comincia a diffondere nel sottocutaneo si fissa
l’ago sulla pelle con un cerotto e si lascia che la diffusione
sottocutanea, attraverso percorsi virtuali, si realizzi fino alle quantità
stabilite. La facilità di diffusione dell’anidride carbonica nel
sottocutaneo dipende dal grado di lassità del tessuto sottocutaneo
stesso per cui è variabile da soggetto a soggetto.
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GENEX S.r.l.
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IL DOSAGGIO
Si somministrano da pochi millilitri sino a 2000 ml (1000
massimo per lato) di CO2 per seduta. La dose dipende dalla
patologia e dall’estensione dell’area da trattare. In genere si
eroga la CO2 erogando un flusso medio di 50/150ml/min
con possibilità (con strumentazioni specifiche e di nuova
generazione come CARBO2 D.T.A.) di erogare sino a
150ml/min.(REALI 450CC/MIN grazie al brevetto delle
valvole proporzionali) Inizialmente l’erogazione inizia con
quantità ridotte per raggiungere in pochi minuti il flusso
prestabilito.
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LE SEDI DELL’INIEZIONI.
Nella cellulite le iniezioni vengono effettuate a livello sottotrocanterico o a
livello peritrocanterico o a livello dei fianchi. Solitamente si effettua una
sola infissione per emilato. Si fissa l’ago sulla pelle con un cerotto e si
lascia che il gas diffonda fino a 1000 ml per emilato con un flusso medio
di 50 ml/ minuto. In tal modo il gas si distribuisce a tutto l’arto inferiore
e
fino ai fianchi. Nei casi di insufficienza venosa cronica si può adottare la
stessa strategia utilizzata per il trattamento della cellulite: stessa tecnica
di
somministrazione e stesso dosaggio del gas. Nelle reumoartropatie del
rachide le iniezioni sottocutanee si effettuano a livello paravertebrale.
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Nelle flogosi acute (periartriti, epicondiliti, tendiniti, reumoartropatie
acute,…) le iniezioni si effettuano in prossimità della parte interessata
dal
processo infiammatorio. Nella psoriasi localizzata le iniezioni si
effettuano
in prossimità della lesione psoriasica mentre nella psoriasi diffusa si
può
adottare la medesima metodica adottata per il trattamento della
cellulite.
Nelle
arteriopatie
l'iniezione
viene
effettuata
in
prossimità
dell’arteriopatia
stessa: nelle arteriopatie degli arti inferiori a livello della coscia o della
gamba. Nell’acrocianosi l’iniezione viene effettuata a livello dei polsi, del
dorso della mano, del dorso dei piedi. Nel fenomeno di Raynaud
l'iniezione viene effettuata, previo bagno in acqua tiepida delle mani, a
livello dei polsi.
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GENEX S.r.l.
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