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Sülük Tedavisinin Tarihçesi

Sülükle tedavi anlamına gelen Hirudoterapi, antik çağlardan beri hekimler tarafından tedavi aracı olarak kullanılmıştır. Sülük tedavisi ile ilgili ilk kaynaklar MÖ. 15. yüzyılda yaşamış Babil’li hekimlere kadar gitmektedir. Yine MÖ. 3. yüzyılda Mısır hekimlerinin vazgeçilmez tedavi yöntemleri arasında yer aldığı bilinmektedir. Ayrıca MÖ. 2. yüzyılda Ege kıyılarında yaşamış olan hekim Nikandros, MS. 1. yüzyılda Yunan hekim Pliniy ve MS. 2. yüzyılda yaşamış olan Galen sülük tedavisi uygulamışlardır. İbn-i Sina’nın kitaplarında da sülük tedavisi yerini almıştır. Ne var ki, 20. yüzyılda doğadan elini çeken insanlık sülük tedavisini unutmuştur. Amerikalı araştırmacı Roy Sawyer sülüklerin potansiyel tedavi edici etkilerini ortaya koyup dünyanın ilk modern sülük üretim çiftliğini (Biopharm – İngiltere) kurmakla, sülüğün tıbbi kullanımı günümüzde tekrar hatırlanmıştır.

Günümüzde Sülük Tedavisi

Günümüzde sülük tedavisi biyolojik etkileri açısından “benzeri olmayan” bir tedavi yöntemi olarak nitelendirilmektedir. Almanya’da 300′ü aşkın Hirudoterapi Kliniği vardır. Hirudo Medicinalis, Alman Tıbbi İlaçlar Kanunu’nun (TİK) 2.Maddesinin 1.bendi gereği ilaç olarak kabul edilmiştir. Daha sonra ilave edilen 4.madde ile de hazır tıbbi ilaç  olarak tanımlanmıştır. Bunun , uygulama olarak ,enjektöre çekilen ilaçtan farkı , ‘’ bu ilacın enjeksiyon şeklinde bizim tarafımızdan değil, Hirudo Medicinalis adı verilen  canlının ağzından bizzat verilmesidir “. Sadece Avrupa yılda 100 milyon sülük kullanmaktadır. Amerika’da sülük tedavisi uygulayan hekimlerin kurduğu derneğin 1000′den fazla üyesi vardır ve 2004′ de Amerikan İlaç ve Gıda Dairesi (FDA) sülük tedavisini akredite etmiş ve Avrupa’daki gibi eczanelerde satılmasına izin vermiştir.

Sülüğün Anatomisi ve Diğer  Özellikleri

Sülükler, 15.000′den fazla türü bulunan Annelida filumundandır. Çoğu ektoparazit olup, kan emerek beslenen canlılardır. Bunların yaklaşık 650′den fazla türü Hirudinea sınıfındadır. Bu sınıfta genellikle deniz, tatlı su ve kara sülükleri yer alır. Bütün sülükler kan emici değildir. Bazı türleri omurgasızları, Annelida’ya ait diğer sınıfların bireylerini, salyangozları ve böcek larvalarını yerler. Kan emenler balık, kurbağa, kaplumbağa, salyangoz ve kabuklu su canlıları ile omurgalı hayvanlarda ektoparazit olarak yaşarlar. Omurgalıların hemen her grubu konakçı olmasına karşın, balıklar en çok saldırıya uğrayan gruptur. Sivrisineklere benzer şekilde, ağrı oluşturmadan deriyi ağızlarında yer alan üç adet çenenin üstünde bulunan keskin dişleriyle ensize ederek kan emmeye başlarlar ve salyasındaki çeşitli mediatörleri (lokal anestezik, histamin benzeri vazodilatatörler, pıhtılaşmayı engelleyici maddeler, yayılma faktörleri, antibiyotikler vb.) bu bölgeye salarlar.
Hastalıklarda tedavi edici özelliği bulunan sülüklerin birkaç türü olup H. medicinalis, Hirudo verbana bunlardandır. Bu sülüklere “tıbbi sülük” adı verilir.Tıbbi sülüklerin birkaç türü olup, Türkiye’de H. medicinalis ve H. verbana’nın yaşadığı bilinmektedir.   Sülüklerin anatomisi dikkat çekecek derecede tek örnektir. Vücut tipik olarak dorso-ventral yassılaşmıştır. Segmentler anterior ve posteriorde çekmen biçimine dönüşmüştür. Anterior çekmen genellikle posterior çekmenden daha küçüktür ve üç çeneli ağzın etrafı çekmenle çevrilidir. Çenelerde bir sıra halinde dizilmiş 50-100 diş bulunur. Posterior çekmen, sekiz segmentin birleşmesiyle oluşmuş, disk şeklinde ve ventrale dönüktür, çekmenler yapışmaya ve harekete yardımcı olur. Vücutları daima sabit sayıda 34 segmentten oluşur. Sülüklerin ağzı ön uçta, ya bir çekmenin dibinde veya kaşık şeklinde bir üst dudağın altındadır.

Sülüklerin vücudu muhtelif renklerde görünebilen ince ve düz bir örtü ile sarılmıştır. H. medicinalis’in sırtı bozumsu zeytin renginde olup, az çok belirgin altı tane boyuna uzanan kırmızımsı-sarı şeride sahiptir. Kenarlar açık zeytin rengindedir. Karnın her iki yanında düz siyah birer şerit bulunur. H. medicinalis’in sindirim kanalı florasında bir cins bakteri olan Aeromonas hydrophila bulunur. Bu ekstraselüler simbiontun emilen kanın sindirimine yardım ettiği, ürettiği antibiyotiklerle diğer bakterilerin ölümünü sağladığı ve diğer bazı faydaları olduğu bildirilmektedir. H. medicinalis’in boyu 10-15 cm olup, 34 segmentten oluşur. Ağırlığı 3-6.5 g’dır. Vücut ağırlığının 3-10 katı kadar kan emer vücut ağırlığı arttıkça emdiği kan miktarı da artar ve bir yıla kadar beslenmeksizin yaşamını sürdürebilir.

Yapılan bir çalışmada insandan kan emme süresi ortalama 68±26 dk; emilen kanla artan vücut ağırlığı %460 olarak bulunmuş, bu türün diğer bazı sülük türlerine göre (örn. Macrobdella decora) crude eksraktlarından daha fazla antitrombik ünit hirudin ihtiva ettiği bildirilmiştir. Hermafrodit olan sülüklerin çoğu yaklaşık bir yıl kadar yaşarlar. Baharda yumurtadan çıkan sülükler, takip eden yılda olgunlaşırlar. Hayat devri, beslenme alışkanlıkları ile yaşam ortamına bağlıdır. H. medicinalis diğer türlere göre daha uzun yaşar. Bazı sülükler denizlerde olsa da çoğu akuatik türler yüzeysel bitki bulunan havuz, göl ve hafif akan çayların kenarı gibi tatlı sularda yaşarlar. Sülükler dünyanın her tarafına yayılmışlarsa da (kutup okyanuslarından çöllerdeki su kaynaklarına kadar) daha çok ılıman göl ve havuz sularında bulunurlar. Kuzey Amerika sülük faunasının çoğu Avrupa ile benzerdir. Ülkemiz, sülük türleri açısından dünyanın en zengin yerlerinden biridir. H. medicinalis ve H. verbana’ya yurdumuzda ve bölgemizde yaygın olarak rastlanmaktadır. Sülüklerin koku ve tat alma duyusu vardır. Görme ve işitme organı yoktur. Termoreseptör,  baroreseptör sistemleri ve sonar donanımı mevcuttur.

Sülüğün Tıbbi Etkileri

Hastalıklarda tedavi edici özelliği bulunan sülüklerin Hirudo Medicinalis ve Hirudo Verbana türlerine ‘’ Tıbbi Sülük ‘’ adı verilir.

Sülüğün tıbbi etkileri 3 ana maddeye ayrılabilir:
– Flebotomi (içindeki pıhtıyı yok etmek üzere bir damara müdahale)
– Refleks Uyarım
– Biyoaktif Salgı İçeriği

Sülükler, kan emerken vücuda kendi ürettikleri salgıyı verirler. Bu salgı şu ana kadar izole edilebildiği kadarıyla 100′e yakın biyoaktif madde içermektedir. Bu maddelerin bir kısmı kanın pıhtılaşmasını engellerken bir kısmı oluşmuş pıhtıları eritmekte, birkaçı ağrı kesici özellikler sergilemekte, bir bölümü de kan basıncını dengelemektedir. Ayrıca sülük tedavisinin antidepresan, antibakteriyel, antioksidan etkinliği de yapılan çalışmalarla ortaya konmuştur.

Sülüğün tıbbi etkilerinin tamamı şu şekilde sıralanabilir:

– Antibakteriyel
– Analjezik
– Antiromatizmal
– Antihipertansif (yüksek tansiyon karşıtı)
– Antidepresan
– Myorelaksan (kas gevşetivi)
– Antioksidan
– Nörotrofik (sinir hücresi yenileyici)

Sülüğün Biyoaktif  Salgı İçeriği:

– Hirudin: Antikoagülan
– Hementin: Fibrinolitik
– Hementerin: Fibrinolitik
– Ghilanten: Protrombinaz İnh.
– Anti-statin: Protrombinaz İnh.
– Piyatin: Nörotrofik
– Calin: Tr. Agg. İnh.
– Decorsin: Tr. Agg. İnh.
– Destabilase: F XIII İnh.

Hangi Hastalıklara Sülük Tedavisi Uygulanır?

Bu özellikleri itibariyle sülük tedavisi kliniğimizde; varis, hemoroid, derin ven trombozu ve periferik arter tıkanıklıkları gibi damarsal sorunlarda, artroz ve artrit gibi iskelet sistemi hastalıklarında, egzama, sedef hastalığı başta olmak üzere birçok cilt hastalığında, glokom ve retinal arter tıkanıklığı gibi tedavisi neredeyse imkansız göz hastalıklarında başarıyla kullanılmaktadır.

Sülük tedavisinin etkin bir şekilde kullanıldığı hastalıklar aşağıdaki gibi sıralanabilir:

– Bazı Göz Hastalıkları  (Behçet hastalığı, Üveitler, Glokom, Makulopatiler, Sarı nokta hastalığı, Diyabetik retinopatiler,Hipertansif retinopatiler, Retinitis pigmentosa , Optik sinire ait problemler ve Optik atrofiler gibi gözün damar,sinir,makula ve retina hastalıkları)
– Varis ve venöz  damar sorunları
– Romatoid artrit ve diğer romatizmal hastalıklar
– Artroz ve eklem kireçlenmeleri
– Migren ve gerilim baş ağrıları
– Baş dönmesi,kulak çınlamaları ve meniere sendromu
– Her türlü kas ağrıları, fibromyaljiler, huzursuz bacak sendromu
– Boyun fıtığı, bel fıtığı,tendinit- tenosivonit- bursit iltihap ve ağrıları
– Dejeneratif sinir sistemi hastalıkları ve felçler (MS,ALS,PARKİNSON gibi…)
– Egzama,ürtiker,kronik deri hastalıkları,sedef hastalığı ve akneler
– Kronik hepatit ve karaciğer hastalıkları
– Depresyon ve fobiler
– Tüm bağışıklık sistemi hastalıkları ve kronik yorgunluk sendromu

Hangi Durumlarda Sülük Tedavisi Uygulanmaz?

Sülük tedavisi uygulamasında dikkat edilmesi gereken noktaların başında hastanın anemi (kansızlık) sorununun olmaması, kan sulandırıcı ilaç kullanmıyor olması, pıhtılaşmaya engel bir hastalığının bulunmaması ve vücudunda aktif bir kanama odağının bulunmaması gelir. Ayrıca gebelerde ve emziren annelerde, kontrolsüz diyabet hastalığı veya kalp yetmezliği olanlarda da sülük tedavisi uygulanmaz.

– Kanama Diyatezleri (Hemofili gibi)
– Aktif Kanama Odağının Varlığı
– Ciddi Anemi (Hb < 10)
– Cerrahi Girişim Öncesi
– Kan Sulandırıcı İlaç Kullanımı
– Gebelik ve emzirme durumlarında sülük tedavisi uygulanmamaktadır.

Vücudun Hangi Bölgelerine Sülük Uygulanabilir?

Vücudun aşağıdaki bölgeler dışındaki her yerine sülük tedavisi uygulanabilir; aşağıdaki bölgelere sülük uygulanması ise çok sakıncalıdır.

– Yumuşak Cilt Bölgeleri (Göz kapağı çevresi gibi)
– Keratinize Bölgeler (Avuç içi, ayak tabanı gibi)
– Önemli Damarların Üzeri (Boyun, çene altı, koltuk altı, kasık gibi)
“dışında” her bölgeye sülük uygulanabilir.

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