Upper airway obstruction-What is on the airway obstruction?
Upper airway obstruction (UAO) is severely hampered by a variety of reasons due to upper airway airflow medical emergency, its clinical manifestations are not specific, confused easy with bronchial asthma and obstructive pulmonary disease, and other diseases. The disease is more common in children and rare in adults. There is no specific clinical manifestations of upper airway obstruction, manifested as irritating dry cough, shortness of breath and difficulty breathing; mainly dyspnea breathing difficulties, activities can cause breathing difficulties increased significantly, and often occur due to changes in posture array onset seizures.
Upper airway obstruction - Description
Upper airway obstruction - DescriptionAirway obstruction in the upper airway obstruction (upperairwayobstruction, UAO) is severely hampered by a variety of reasons due to upper airway airflow medical emergency, its clinical manifestations are not specific, easy with bronchial asthma and obstructive pulmonary disease and other diseases confused. Clinically, the disease is more common in children is relatively rare in adults. Upper airway obstruction caused by many reasons, which derived foreign matter other than those caused by the most common, and the rest of the more common laryngeal movement disorders, infections, tumors, trauma, and iatrogenic. Timely understanding and treatment of upper airway obstruction has extremely important clinical implications, since the majority of patients with previously healthy, can be fully recovered by the effective treatment.Upper airway obstruction - symptoms and signs
Airway obstruction in the upper airway obstruction early general without any performance, often start blocking more serious symptoms. Acute upper airway obstruction abrupt onset, severe illness, and even lead to suffocation and death, often obvious signs and symptoms. There is no specific clinical manifestations of upper airway obstruction, manifested as irritating dry cough, shortness of breath and difficulty breathing; mainly dyspnea breathing difficulties, activities can cause breathing difficulties increased significantly, and often occur due to changes in posture array onset seizures. A small number of patients with snoring at night, awakened several times and dyspnea, manifested as sleep apnea syndrome. Caused by inhalation of foreign bodies, choking history, often obvious respiratory distress, looked very painful, from time to time scratching throat. Occasionally chronic upper airway obstruction caused by pulmonary edema and recurrent pulmonary edema performance. The symptoms and signs of upper airway obstruction and the extent and nature of the obstruction. The majority of upper airway obstruction seen in clinical incomplete obstruction. The main signs of inspiratory stridor, significantly more than in the neck, the lungs can also be heard and but weak, sniff can cause wheezing significantly increased. Stridor prompted more serious obstruction, airway diameter is often less than 5 mm. The inspiratory stridor multi prompted extrathoracic upper airway obstruction, more common on the vocal cords or vocal parts; biphasic stridor prompted obstruction breath of song's intensity changes and more tips in the subglottic trachea; curved neck obstruction occurred The thorax the entrance. Children are barking cough, especially at night appear more tips as bronchitis, throat, salivation, difficulty swallowing, fever but no cough is more common in severe epiglottitis. Some patients, there may be a change in sound, location and nature of its changing characteristics and disease, such as unilateral vocal cord paralysis hoarseness; bilateral vocal cord paralysis sound normal, but the wheezing; the glottis over parts lesions often appear low voice , but no hoarseness; the oral abscess contents like sound.
Upper airway obstruction - disease etiologyClinical, upper airway obstruction, although relatively rare, but may be caused by a variety of diseases, such main reasons include: ① airway cicatricial stenosis: multi-intubation or incision treatment; ② airway wall lesions: such as inflammation of the soft tissue of the throat, pharyngeal abscess, enlarged tonsils, vocal cord paralysis, laryngeal or tracheal tumor, tracheomalacia, recurrent polychondritis go far; ③ airway cavity lesions: airway foreign body is more common, and with pedicle endotracheal polyps or tumors and inflammatory granuloma; ④ airway the external oppression: around the airway space-occupying lesions such as thyroid cancer, abscess, hematoma or gas compression; ⑤ airway secretions retention: respiratory tract bleeding or a large number of sputum failed to cough up the large number of inhalation of gastric contents. The cause common cause of upper airway obstruction in adults and children of different anatomical sites, are summarized in Table 1, for reference in clinical diagnosis. A handful of cases, the functional vocal cord abnormalities or psychological factors, may also cause upper airway obstruction.
Upper airway obstruction - pathophysiologicalUpper airway obstruction airway anatomy: the conducting airways of the respiratory system, including the nose, throat, trachea, main bronchus, lobe bronchus and segmental bronchi, bronchioles until the terminal bronchioles part. Different mechanics and other respiratory physiological functions around the small airways and central airways of the respiratory tract is generally divided into three parts: (1) the small airways, airway diameter less than 2mm; ② large airways refers to Long protruding below to 2mm diameter airway; ③ The upper airway, from the nose to carina period of the respiratory tract, including the nose, pharynx, larynx and trachea. Usually pleural entrance or sternum notch is bounded by the upper extrathoracic upper airway and intrathoracic airway is divided into two parts of the upper airway. The extrathoracic on airway mandibular inferior vena (including a region of Ludwig angina), the retropharyngeal chamber (including the produce area retropharyngeal abscess) and throat. Generalized throat to the base of the tongue, down to the trachea, can be divided into the supraglottic larynx (epiglottis, aryepiglottic fold and false vocal cords), glottis (including the the arytenoid vocal cords plane structure) and subglottic area (about 1.5 ~ 2.0cm, cricoid surrounding the airways). The total length of the trachea for l0 ~ 13cm, wherein a length of about 6 intrathoracic ~~ 9cm. The extrathoracic tracheal length of about 2 ~ 4cm, the entrance to the chest from the lower edge of the cricoid, front chest about above the suprasternal notch 1 to 3cm. Normal endotracheal coronal diameter, male the l3 ~ 25mm, 10 ~ 21mm female. Cause tracheal diameter narrowing factors are the following: (1) Saber sheath trachea; ② amyloidosis; ③ recurrent polychondritis; ④ Wegener granulomatosis; the ⑤ tracheobronchial flat osteochondral angioplasty; of ⑥ rhinoscleroma disease; ⑦ complete cricoid ; ⑧ Down syndrome. Pathophysiology of upper airway obstruction: Under normal circumstances, when breathing, respiratory muscle contraction intrathoracic pressure lower airway pressure below atmospheric pressure, the gas from the outside world into the lungs; Instead, breath, respiratory muscle relaxation chest The increased pressure within the gas excreted by the lungs. Acute upper airway obstruction can directly affect the ventilation function of the body, the oxygen of the outside world can not be inhaled into the lungs, the carbon dioxide produced by the metabolism can not be eliminated from the body, causing acute respiratory failure, such as failure to obtain timely medical treatment, every serious shortage oxygen and carbon dioxide retention leads to death. Chest part of the upper airway at atmospheric pressure under the intrathoracic part in the pleural cavity under pressure role. The trachea both sides of the inside and outside pressure difference for the cross-wall pressure. Pleural cavity pressure greater than the outside pressure when the trachea, cross-wall positive pressure airway tend to close; pressure is greater than when the transmural pressure is negative, endotracheal the tracheal outside pressure, tracheal smooth. Upper airway obstruction affecting the patient's ventilatory function, due to the decrease in alveolar ventilation, airway obstruction can be produced in the patient's movement on Health hypoxemia, but its mostly normal dispersion function. Upper airway obstruction location, extent, nature (fixed or variable type) and expiratory or inspiratory pressure changes caused by patients with different pathophysiological changes produce inspiratory airflow limitation, expiratory airflow limitation, or both limited. Clinically, depending on the respiratory airflow obstruction of upper airway obstruction is divided into the following three kinds: variable extrathoracic airway obstruction, of variable intrathoracic upper airway obstruction and a fixed upper airway obstruction.A variable extrathoracic upper airway obstruction variable blocking the tracheal lumen of the size of the site of obstruction may be due to the tracheal changes in the internal and external pressures and changes in the upper airway obstruction. Variable extrathoracic upper airway obstruction found in patients suffering from diseases such as tracheomalacia and vocal cord paralysis. Under normal circumstances, the chest on the outer periphery of the airway pressure throughout the respiratory cycle are under atmospheric pressure, the inspiratory airway pressure decreases, causing the cross-wall pressure increases, and its direction of action grounds tube outward tube, causing chest on the gas Road tend to shrink. Variable extrathoracic upper airway obstruction in patients, sniff, the result of the Venturi effect and turbulence the obstruction distal airway pressure was significantly reduced, significantly increased transmural pressure caused by the obstruction site of airway caliber further narrow The inspiratory airflow serious disruption; contrary, when its forced expiratory endotracheal pressure increased, due to the cross-wall pressure decreases, the extent of blocking eased. Therefore, in this patient dynamic flow - volume loop tracings showed inspiratory flow limitation and showed inspiratory and expiratory flow limitation lighter does not appear platform, or even render normal graphics.Variable intrathoracic upper airway obstruction variable intrathoracic upper airway obstruction, seen in intrathoracic airway of tracheomalacia and tumor patients. Intrathoracic airway pressure around the pleural cavity pressure close to the external pressure (pleural cavity pressure) intraluminal pressure compared to the negative pressure in the lumen, the direction of action of the cross-wall pressure from the lumen to the extraluminal intrathoracic airway, leading to tend to expand. When patients with forced expiratory Venturi effect and turbulence of the obstruction proximal airway pressure reduces, further narrowing the airway caliber also cause obstruction site, but expiratory flow severely hampered. This patient dynamic flow - volume loops tracings, performance render breath platform expiratory flow limitation, inspiratory flow limitation lighter.Fixed upper airway obstruction fixed upper airway obstruction refers stiff upper airway obstructive lesion fixed, breathing changes in airway caliber cross-wall pressure change can not be caused by the obstruction was found in tracheal stenosis, and thyroid cancer patients . These patients, their inspiratory and expiratory airflow were limited and a similar level of dynamic flow - volume loop inspiratory flow and expiratory flow showed a platform. Most scholars believe that expiratory flow rate and inspiratory flow than 50% of vital capacity (FEF50% / FIF50%) is equal to 1 is the characteristics of the fixed upper airway obstruction. But variable type obstruction and airway obstructive lesions adjacent normal FEF50% / FIF50% certain, should be noted.Upper airway obstruction - diagnostic testsDiagnosis of upper airway obstruction: diagnosis of upper airway obstruction, the key is to take into account the possibility of upper airway obstruction. Clinical, should be timely and relevant examination: ① mainly shortness of breath, difficulty breathing, activity significantly worse, sometimes symptoms aggravated with postural after bronchodilator therapy invalid; ② exist on gas tract inflammation, injury, and in particular the history of endotracheal intubation and tracheostomy; the ③ pulmonary function tests showing maximal expiratory flow, maximal voluntary ventilation sexual decline unchanged FVC, FEV1 was not changed significantly, with the decline in maximum voluntary ventilation fails proportion; or FEV1 decreased but closing volume normal.Laboratory tests: upper airway obstruction is more common infections, such as infection, blood leukocytes may be elevated.Other laboratory examinations:Pulmonary function tests peak expiratory flow (speed) - volume curve (Central) is the preferred method of examination for the diagnosis of upper airway obstruction. Upper airway obstruction, the flow - volume curve exhibits a distinct change of diagnostic value. As mentioned earlier, can be determined according to the change of the flow - volume curve shape different upper airway obstruction. ① variable extrathoracic on, airway obstruction, its flow - volume curve showed inspiratory flow significantly restricted presented inspiratory and expiratory flow is basically normal, the therefore FEF50% / FIF50%> 1; the ② variable intrathoracic upper airway obstruction, its flow - volume curve showed expiratory flow significantly restricted render breath platform, FEF50% / FIF50%, <1; (3) fixed upper airway obstruction, its flow - volume curve showed inspiratory expiratory flow were significantly decreased, and a considerable degree of rendered as a rectangle, FEF50% / FIF50% = 1. Other indicators of lung function, such as FEV0.5, FEV1.0 reduced, PEFR, MVV progressive decline FIF50% ≤ 100L/min FEV1.0/PEFR ≥ 10 ml / (L? Min) FEVl.0/FEV0.5 ≥ 1.5. Closed volume vital capacity VC and CV normal, suggesting that the presence of upper airway obstruction. Pulmonary function tests can not be performed in patients with acute respiratory distress, and high sensitivity to upper airway obstruction.2 radiographic examination(1) plain films of the neck: plain film of the trachea, upper airway obstruction of exudative tracheitis, airway foreign body and innominate artery compression due to higher sensitivity, but on the larynx or trachea softening sensitive poor. Inspiratory neck plain film laryngotracheitis and epiglottitis has differential value. The laryngotracheitis the typical signs for the "steeple" sign. The subglottic stenosis more common in patients with laryngotracheitis, but can also be found epiglottitis. The epiglottitis the neck lateral radiographs can show swelling of the epiglottis and hypopharynx expansion. Airway plain film diagnosis of upper airway obstruction may provide important information, but less accurate, the judge should be combined with medical history and symptoms.The size and morphology of upper airway obstruction (2) Chest CT Scan: CT scan of the airway can learn obstructive lesions, the degree of airway narrowing and airway wall, as well as the situation of the lesion surrounding tissue. The enhanced scan still helps clear lesions blood supply.(3) chest MRI examination: has a good ability to distinguish, can be expected that the extent and length of the airway occlusion, as well as evaluating the mediastinal case.3 the acoustic check breathing audio spectrum analysis found that normal human peak frequency and frequency spectrum are mainly located below 200Hz.Airway obstruction in patients with chest appearance, a significant increase in the peak frequency of breath sounds, mostly three times greater than the baseline, the frequency spectrum of the group widened and moved towards the area of high-frequency greater than 200Hz. The above-mentioned changes in the inspiratory phase is greater than the expiratory phase, and the signal strength of the neck to the chest. The blocking variable thoracic breathing sound spectrum changes as compared to the expiratory than inspiratory chest signal stronger. Therefore, breathing audio spectrum analysis to determine airway obstruction has better clinical value.Endoscopy fiberoptic laryngoscope or fiberoptic bronchoscopy can directly observe the upper airway, to understand the dynamic characteristics of the lesions in the vocal cords, trachea ring the changes as well as the respiratory process, and can be collected living tissue for pathological examination, so the diagnosis decisive role. Suspected obstruction of the upper airway, should be considered for endoscopy. But the severe breathing difficulties should not be checked for biopsy and non-vascular diseases.Upper airway obstruction - Differential DiagnosisCerebrovascular accident, seizures, sleeping pill overdose, heart attack, acute laryngospasm and laryngeal edema as well as other causes of airway obstruction phase identification.Upper airway obstruction - treatment optionsUpper airway obstruction due to reasons caused by upper airway obstruction more, the choice of treatment should be determined according to its etiology and severity. Severe upper airway obstruction should take urgent measures to relieve airway obstruction, to save the lives of patients. Some type of upper airway obstruction, changes in position can make the symptoms can be alleviated; caused by infectious diseases, such as epiglottitis, pharyngeal abscess, antibiotic treatment should be timely. Acute upper airway obstruction often occurs outside the hospital can not receive timely diagnosis and treatment, lead to the death of patients. Upper airway obstruction can not allow clinical comparative study, the treatment measures are based on limited clinical observation data, and there is a big controversy.Treatment of an upper airway foreign body obstructionFirst aid techniques: (1) inhalation of foreign bodies and the first to use the dental pad or openings to open the mouth, and to clear a foreign body in the mouth; stimulate the throat with a tongue depressor or index finger, at the same time the rapid increase in patients on abdominal abdominal pressure Heimlich techniques, can be ruled out some airway foreign body; patients awake upright rescuer from the patient behind clinging to the upper abdomen, right fist, thumb pointing below the xiphoid, left hand pressed right fist rapidly up the weight several times inward; rescuer facing the patient supine patients kneeling its legs on both sides of the upper body leaning forward, right fist placed below the xiphoid, the left hand is placed on top of the right hand, rapid downward move within the weight on abdomen.(2) removal of foreign body bronchoscopy: foreign body removed by the above techniques can not remove the foreign body, or inappropriate practices such as fishbone should laryngoscope or bronchoscope peep removal of foreign body.2. Drug treatment for laryngeal or tracheal spasms caused by upper airway obstruction, and some inflammatory diseases caused by mucosal edema due to upper airway obstruction, drug therapy has a certain value. Effective drugs mainly epinephrine and glucocorticoids, these drugs poor epiglottitis treatment effect, and even lead to adverse reactions should not use this kind of upper airway obstruction.(1) adrenaline: excitable alpha adrenergic receptors causes vasoconstriction, reducing mucosal edema, throat bronchitis has good therapeutic effect, can also be used to treat laryngeal edema. Use, the use of inhalation or intratracheal instillation, each ~~ 2mg rapid onset of action, but to maintain a short time, should be repeated drug.Upper airway obstruction (2) glucocorticoids: a role in the elimination of edema, reduce local inflammation, can be used for a variety of reasons, such as endotracheal intubation edema. Viral throat bronchitis, inhaled corticosteroid effect. Durward given budesonide (budesonide) inhalation therapy, can significantly reduce the intubation rate. Hormone therapy on upper airway scar or tumor stenosis caused by invalid.3. Endotracheal intubation or tracheostomy intubation or incision can create artificial airway to keep the airway and maintain an effective respiratory conditions. Especially need referral for treatment, the intubation can significantly reduce the mortality rate of patients. Laryngeal edema, laryngospasm, functional vocal cord dysfunction, inhalation injury, angina, epiglottitis, laryngeal and tracheal tumors, etc., can be considered for endotracheal intubation or incision. Minimum nasotracheal intubation injury, the most security. But it should be marked with the meaning of airway obstruction, endotracheal intubation or incision itself can also cause upper airway obstruction, and therefore should be closely observed for patients receiving such treatment.4 mixed gas of the helium - the oxygen mixed gas of helium (80%) and oxygen (20%), its density is only 1/3 of the density of air, can reduce the resistance of the airway of turbulence to increase the gas flow rate, to improve the upper airway obstruction in patients with hypoxia. Helium - oxygen gas mixture in part, airway obstruction, such as tracheal stenosis or possession of foreign oppression, severe asthma and angioedema patients achieved a certain effect. However, this mixed gas can only relieve dyspnea, upper airway obstruction is not relieved.Surgery for laryngeal or tracheal tumor or stenosis due to upper airway obstruction, can be laryngotracheal resection and reconstruction treatment, 87% of patients receive good treatment. Airway obstruction, tonsillar hypertrophy on tonsillectomy its symptoms improve. Caused by oropharyngeal stenosis, to pharyngeal surgery has a therapeutic effect.Laser treatment laser treatment allows the tumor, granulomatous lesions carbonation, narrow, and partial resection of tracheal tumors, so as to achieve the lifting of tracheal stenosis, to relieve symptoms, has a therapeutic effect. It can be used by fiberoptic bronchoscopy.The tracheal stent use in recent years nitinol tracheal stent prepared to have a better clinical effect in experimental animal and human resettlement, and long-term placement without deformation and rust color, do not have serious airway inflammatory response and stimulation received wide attention. For tracheal granuloma, cicatricial stenosis due to benign stricture, or tumor-induced malignant stricture. General first stent placed in ice water cooling and shaping fine tubular and loaded into the inserter, the guide wire into a narrow airway by fiberoptic bronchoscopy, so patients with head thrown back as far as possible, and will be placed along the guide wire placement airway stenosis, and then pull out the guide wire. Again fiberoptic bronchoscopy determine the stent placed stenosis. After implantation, the stent body temperature, restored to its original shape and airway snug fit, the stenosis and gradually softened expansion, to achieve the lifting of the narrow effect.Upper airway obstruction - complicationsPulmonary edema.Upper airway obstruction - prognosis and prevention
Prognosis: the majority of patients with previously healthy, fully recovered after early diagnosis and effective treatment.
Prevention: aggressive treatment of the primary disease of the airway infarction.
Upper airway obstruction - Epidemiology
The disease was first upper airway obstruction Gross wrote in 1854, usually occurs in the restaurants restaurants coronary heart disease "(CafeCoronary) term to describe cause sudden death due to food asphyxiation. After 100 years in 1963 Hauqen this also described. Haugen and others, to anyone, at any time, such as swallowing, sudden loss of consciousness, upper airway obstruction should be the first suspect. If death ensuing diagnosis of "coronary heart disease" or "natural causes" should be questioned. After 20 years of development in 1974 cardiopulmonary resuscitation step description widely used, the 1976 thoracic surgeon Heimlich his operation, the lifting of a complete airway obstruction has been described as the Heimlich practices.
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Epistaxis-Nose bleeding
Epistaxis/Nose bleeding-What is nose bleeding?
Nasal bleeding (epistaxis), also known as epistaxis, is one of the common clinical symptoms, nasal bleeding due to nasal lesions caused by systemic diseases may also be caused, and occasional bleeding nasal outflow due to the nasal cavity adjacent lesions. Epistaxis, unilateral, can also be bilateral; intermittent recurrent bleeding, but also sustainable bleeding; number of different amount of bleeding, the light only blood in the nose, severe cases can lead to hemorrhagic shock; repeated bleeding can lead to anemia. Most bleeding can be self-only.
Epistaxis - OverviewNosebleeds are many reasons, but about half of the people can not find the reason. The distribution of the tiny blood vessels in the nasal mucosa is very dense, is a very sensitive and fragile, easily broken Erzhi bleeding. In the phenomenon of preschool children common nasal bleeding. Nosebleeds, most people are accustomed to head back, nostrils upward, think that it can effectively stop the bleeding, but they are wrong to do so just the sight of blood outflow, but in fact blood or continue in the inward flow.Nose bleeding - cause ofEpistaxis - partly due toA. Trauma. Nose their own digging. Two. Barotrauma. 3. Deviated nasal septum. The nasal septum perforation often the Epistaxis symptoms. 4. Inflammation: ① non-specific inflammation: dry rhinitis, atrophic rhinitis, acute rhinitis, acute maxillary go far, often for epistaxis reasons. ② specific infection: nasal tuberculosis, nasal diphtheria, nasal syphilis, prone to cause nasal bleeding due to mucosal ulceration. 5 Tumors. 6. Others: nasal foreign bodies, nasal leeches can cause repeated heavy bleeding. The plateau region, the relative humidity is too low, the extra risk of dry rhinitis, an important reason for the region epistaxis.Epistaxis - systemic reasonsA. Blood diseases: abnormal of ① platelet quantity or quality. ② clotting mechanism abnormalities. Two. Acute infectious diseases. 3. Cardiovascular disease: ① arterial pressure is too high: such as hypertension, atherosclerosis, nephritis, associated with hypertension, eclampsia, etc.. ② increased venous pressure: such as mitral stenosis, the great mass of the chest or mediastinum and neck, pulmonary emphysema, pulmonary edema and bronchial pneumonia. 4. Vitamin A deficiency: vitamin C, K, P, and trace elements calcium deficiency are prone to nose bleeding. 5 Chemicals and drug poisoning: phosphorus, mercury, arsenic, benzene poisoning can damage the function of the hematopoietic system causing epistaxis. Long-term use of salicylic acid drugs, can cause prothrombin to reduce the bleeding of obviousness. 6. Endocrine disorders: compensatory menstruation, threatened epistaxis often occurs in puberty, usually caused by estrogen in the blood content decreased, caused by nasal blood vessels to dilate. 7. Hereditary hemorrhagic telangiectasia, liver, chronic renal disease and rheumatic fever, etc., may be associated with nasal bleeding.
Nose bleeding - symptomsSigns: bleeding can occur in any part of the nasal cavity, but the anterior subventricular zone of the nasal septum is the most common, sometimes visible injection or pulsatile arterial bleeding. Response to nasal bleedingNasal cavity bleeding often rapidly into the pharynx, from out of the mouth. In general, nasal bleeding caused by local disease, and more limited to the side of the nasal cavity, caused by systemic diseases, may alternately or simultaneously on both sides of the nasal bleeding. Complications: epistaxis difficult to control, whether it is ferocious severe bleeding, or prolonged healing of the intractable bleeding, can cause serious harm to the body, effects: blood loss, anemia, acute hemorrhagic shock, the cardiovascular system complications, cerebrovascular accidents, asphyxia, fetal distress, severe cases can be life-threatening.Nose bleeding - hazards1, pregnant women, nosebleeds often involving the health of the fetus, severe nosebleeds can cause fetal distress, and even premature delivery or stillbirth. 2, causing blood loss, anemia, blood loss caused by acute blood loss anemia in the short term, long-term repeated small amount of nosebleeds caused by chronic blood loss anemia. 3, causing hemorrhagic shock, occurs mainly in the elderly and infirm, because of its heart, lung, kidney compensatory function, acute massive blood loss or nosebleeds sustained more than, easily lead to shock. 4, blood loss anemia is caused by inner ear ischemia and hypoxia, caused by presbycusis. The hazards of epistaxis5, resulting in a sudden drop in blood pressure, acute coronary insufficiency, more likely to promote the onset or worsening the original cardiovascular insufficiency. Frequent nosebleeds can also be induced congestive heart failure and pulmonary edema, severe anemia can also lead to myocardial infarction, is one of the frequent nosebleeds cause of death. 6, hypertension, atherosclerosis is the main reason of high blood pressure in patients with nosebleeds, such as abuse of the haemostatic and procoagulant agents and antihypertensive drugs, nosebleeds may cause cerebrovascular accidents. 7, frequent nosebleeds nasal blood into the maxillary sinus cavity, sinuses have potential foci of infection, the blood into the sinuses of the lesion core solidification, the formation of onion-like pale yellow tumor tissue, it is referred to as necrotic false tumor. Mass of its surrounding tissue, especially the long-term oppression of the medial wall of bone, enable the destruction of bone absorption, inflammatory necrotic tissue to stimulate the local but also cause bleeding. 8, frequent nosebleeds caused by asphyxia most direct reason is the aspiration of blood, the hypopharynx blood clots, larynx and hypopharynx mucosal surface of the blood dirty off. Frail, coma or throat mucosal surface anesthesia patients, nosebleeds are more prone to suffocation. 9, nosebleeds often can cause myocardial infarction, subarachnoid hemorrhage, cerebral hemorrhage, pneumonia and sepsis, small bowel infarction, osteosarcoma, liver cirrhosis, amyloidosis, and blood aspiration, which led to death. 10 children with nosebleeds often easy to anemia, cerebral insufficiency in children memory loss, decreased visual acuity, low immunity, meaning power is not concentrated, poor academic performance; nosebleeds excessive nutrient loss in the 12-16 year-old adolescent outstanding performance for short stature.Complication
Nasal bleeding should not be underestimated, except for nasal bleeding injury, for the cause can prevent avoid, while others need to pay attention. Because of the long-term nasal bleeding may cause the following complications: one, nasal bleeding due to blood loss anemia, acute, chronic, the former because of the short-term blood loss due to the latter is the long-term repeated occurrence of a small amount of nasal bleeding caused by chronic blood loss caused. Such hazards attention to the occurrence in a year older, the body is weak. Cardiovascular complications in case of a lot of nose bleeding, blood pressure dump, can lead to acute coronary insufficiency, more likely to promote the onset or worsening the original cardiovascular insufficiency. The occurrence of severe anemia also lead to the possibility of myocardial infarction, this is also a major cause of nose bleeding to death. If the situation is more serious, then also lead to congestive heart failure and pulmonary edema. Third, the ear of repeated epistaxis prone to age-related hearing loss, mainly due to blood loss anemia caused by inner ear ischemia and hypoxia. Necrotizing maxillary sinus inflammatory pseudotumor When nasal repeated bleeding, nasal blood through the natural maxillary sinus to open the door into the maxillary sinus cavity, sinuses potentially infected lesions of blood into the sinuses to the lesion core from the surrounding wrapped solidification, so repeatedly. Blood coagulation machine, the formation of onion-like pale yellow tumor tissue, it is called necrotic pseudotumor. Mass of its surrounding tissue, especially the long-term oppression of the medial wall of bone, can absorb bone destruction; inflammatory necrotic tissue to stimulate the local but also cause bleeding. The clinical manifestations are very similar to the sinus malignancies, often misdiagnosed. Fetal distress: pregnant women, severe nosebleeds, can affect the health of the fetus, severe cases can lead to fetal distress, and even premature birth or stillbirth. In the treatment of pregnant women, serious nosebleeds of Obstetricians and Gynecologists consultation, pay close attention to the safety of pregnant women and fetuses.InspectionBefore rhinoscopy can not find the bleeding site, such as bleeding does not play practicable after the nose or fiber-optic nasopharyngoscopy. Sinus bleeding, the blood often outflow from the meatus or olfactory cleft. In addition to finding the bleeding point, and make the necessary systemic examination (blood pressure measurement, blood tests, bleeding time and clotting time determination, capillary fragility test and platelet count, etc.). Fashion consultation with the departments concerned to find the cause. The diagnosis is based on: (1) due to local causes such as trauma, ulcers, foreign bodies, tumors, rhinitis, or systemic disease such as blood diseases, cardiovascular disease, poisoning, vitamin deficiency, endocrine disorders, acute infectious disease caused by. One side or both sides of the nasal cavity of a small amount or heavy bleeding, quantity often flow through the nose and mouth, bleeding for a long time accompanied by symptoms of shock and anemia. Check the site of bleeding, and more generally at the bottom of the anterior nasal septum of a vascular plexus or nasopharynx vascular plexus (more common in middle-aged over the age of 40 here). (4) Check the causes of bleeding, to rule out local causes, should pay special attention to the systemic causes and blood tests. Necessary when doing a sinus X-ray examination and sinus endoscope examination to rule out sinus lesions. Repeated severe head trauma bleeding, angiography should be done to exclude the internal carotid artery pseudoaneurysm.
Nasal bleeding (epistaxis), also known as epistaxis, is one of the common clinical symptoms, nasal bleeding due to nasal lesions caused by systemic diseases may also be caused, and occasional bleeding nasal outflow due to the nasal cavity adjacent lesions. Epistaxis, unilateral, can also be bilateral; intermittent recurrent bleeding, but also sustainable bleeding; number of different amount of bleeding, the light only blood in the nose, severe cases can lead to hemorrhagic shock; repeated bleeding can lead to anemia. Most bleeding can be self-only.
Epistaxis - OverviewNosebleeds are many reasons, but about half of the people can not find the reason. The distribution of the tiny blood vessels in the nasal mucosa is very dense, is a very sensitive and fragile, easily broken Erzhi bleeding. In the phenomenon of preschool children common nasal bleeding. Nosebleeds, most people are accustomed to head back, nostrils upward, think that it can effectively stop the bleeding, but they are wrong to do so just the sight of blood outflow, but in fact blood or continue in the inward flow.Nose bleeding - cause ofEpistaxis - partly due toA. Trauma. Nose their own digging. Two. Barotrauma. 3. Deviated nasal septum. The nasal septum perforation often the Epistaxis symptoms. 4. Inflammation: ① non-specific inflammation: dry rhinitis, atrophic rhinitis, acute rhinitis, acute maxillary go far, often for epistaxis reasons. ② specific infection: nasal tuberculosis, nasal diphtheria, nasal syphilis, prone to cause nasal bleeding due to mucosal ulceration. 5 Tumors. 6. Others: nasal foreign bodies, nasal leeches can cause repeated heavy bleeding. The plateau region, the relative humidity is too low, the extra risk of dry rhinitis, an important reason for the region epistaxis.Epistaxis - systemic reasonsA. Blood diseases: abnormal of ① platelet quantity or quality. ② clotting mechanism abnormalities. Two. Acute infectious diseases. 3. Cardiovascular disease: ① arterial pressure is too high: such as hypertension, atherosclerosis, nephritis, associated with hypertension, eclampsia, etc.. ② increased venous pressure: such as mitral stenosis, the great mass of the chest or mediastinum and neck, pulmonary emphysema, pulmonary edema and bronchial pneumonia. 4. Vitamin A deficiency: vitamin C, K, P, and trace elements calcium deficiency are prone to nose bleeding. 5 Chemicals and drug poisoning: phosphorus, mercury, arsenic, benzene poisoning can damage the function of the hematopoietic system causing epistaxis. Long-term use of salicylic acid drugs, can cause prothrombin to reduce the bleeding of obviousness. 6. Endocrine disorders: compensatory menstruation, threatened epistaxis often occurs in puberty, usually caused by estrogen in the blood content decreased, caused by nasal blood vessels to dilate. 7. Hereditary hemorrhagic telangiectasia, liver, chronic renal disease and rheumatic fever, etc., may be associated with nasal bleeding.
Nose bleeding - symptomsSigns: bleeding can occur in any part of the nasal cavity, but the anterior subventricular zone of the nasal septum is the most common, sometimes visible injection or pulsatile arterial bleeding. Response to nasal bleedingNasal cavity bleeding often rapidly into the pharynx, from out of the mouth. In general, nasal bleeding caused by local disease, and more limited to the side of the nasal cavity, caused by systemic diseases, may alternately or simultaneously on both sides of the nasal bleeding. Complications: epistaxis difficult to control, whether it is ferocious severe bleeding, or prolonged healing of the intractable bleeding, can cause serious harm to the body, effects: blood loss, anemia, acute hemorrhagic shock, the cardiovascular system complications, cerebrovascular accidents, asphyxia, fetal distress, severe cases can be life-threatening.Nose bleeding - hazards1, pregnant women, nosebleeds often involving the health of the fetus, severe nosebleeds can cause fetal distress, and even premature delivery or stillbirth. 2, causing blood loss, anemia, blood loss caused by acute blood loss anemia in the short term, long-term repeated small amount of nosebleeds caused by chronic blood loss anemia. 3, causing hemorrhagic shock, occurs mainly in the elderly and infirm, because of its heart, lung, kidney compensatory function, acute massive blood loss or nosebleeds sustained more than, easily lead to shock. 4, blood loss anemia is caused by inner ear ischemia and hypoxia, caused by presbycusis. The hazards of epistaxis5, resulting in a sudden drop in blood pressure, acute coronary insufficiency, more likely to promote the onset or worsening the original cardiovascular insufficiency. Frequent nosebleeds can also be induced congestive heart failure and pulmonary edema, severe anemia can also lead to myocardial infarction, is one of the frequent nosebleeds cause of death. 6, hypertension, atherosclerosis is the main reason of high blood pressure in patients with nosebleeds, such as abuse of the haemostatic and procoagulant agents and antihypertensive drugs, nosebleeds may cause cerebrovascular accidents. 7, frequent nosebleeds nasal blood into the maxillary sinus cavity, sinuses have potential foci of infection, the blood into the sinuses of the lesion core solidification, the formation of onion-like pale yellow tumor tissue, it is referred to as necrotic false tumor. Mass of its surrounding tissue, especially the long-term oppression of the medial wall of bone, enable the destruction of bone absorption, inflammatory necrotic tissue to stimulate the local but also cause bleeding. 8, frequent nosebleeds caused by asphyxia most direct reason is the aspiration of blood, the hypopharynx blood clots, larynx and hypopharynx mucosal surface of the blood dirty off. Frail, coma or throat mucosal surface anesthesia patients, nosebleeds are more prone to suffocation. 9, nosebleeds often can cause myocardial infarction, subarachnoid hemorrhage, cerebral hemorrhage, pneumonia and sepsis, small bowel infarction, osteosarcoma, liver cirrhosis, amyloidosis, and blood aspiration, which led to death. 10 children with nosebleeds often easy to anemia, cerebral insufficiency in children memory loss, decreased visual acuity, low immunity, meaning power is not concentrated, poor academic performance; nosebleeds excessive nutrient loss in the 12-16 year-old adolescent outstanding performance for short stature.Complication
Nasal bleeding should not be underestimated, except for nasal bleeding injury, for the cause can prevent avoid, while others need to pay attention. Because of the long-term nasal bleeding may cause the following complications: one, nasal bleeding due to blood loss anemia, acute, chronic, the former because of the short-term blood loss due to the latter is the long-term repeated occurrence of a small amount of nasal bleeding caused by chronic blood loss caused. Such hazards attention to the occurrence in a year older, the body is weak. Cardiovascular complications in case of a lot of nose bleeding, blood pressure dump, can lead to acute coronary insufficiency, more likely to promote the onset or worsening the original cardiovascular insufficiency. The occurrence of severe anemia also lead to the possibility of myocardial infarction, this is also a major cause of nose bleeding to death. If the situation is more serious, then also lead to congestive heart failure and pulmonary edema. Third, the ear of repeated epistaxis prone to age-related hearing loss, mainly due to blood loss anemia caused by inner ear ischemia and hypoxia. Necrotizing maxillary sinus inflammatory pseudotumor When nasal repeated bleeding, nasal blood through the natural maxillary sinus to open the door into the maxillary sinus cavity, sinuses potentially infected lesions of blood into the sinuses to the lesion core from the surrounding wrapped solidification, so repeatedly. Blood coagulation machine, the formation of onion-like pale yellow tumor tissue, it is called necrotic pseudotumor. Mass of its surrounding tissue, especially the long-term oppression of the medial wall of bone, can absorb bone destruction; inflammatory necrotic tissue to stimulate the local but also cause bleeding. The clinical manifestations are very similar to the sinus malignancies, often misdiagnosed. Fetal distress: pregnant women, severe nosebleeds, can affect the health of the fetus, severe cases can lead to fetal distress, and even premature birth or stillbirth. In the treatment of pregnant women, serious nosebleeds of Obstetricians and Gynecologists consultation, pay close attention to the safety of pregnant women and fetuses.InspectionBefore rhinoscopy can not find the bleeding site, such as bleeding does not play practicable after the nose or fiber-optic nasopharyngoscopy. Sinus bleeding, the blood often outflow from the meatus or olfactory cleft. In addition to finding the bleeding point, and make the necessary systemic examination (blood pressure measurement, blood tests, bleeding time and clotting time determination, capillary fragility test and platelet count, etc.). Fashion consultation with the departments concerned to find the cause. The diagnosis is based on: (1) due to local causes such as trauma, ulcers, foreign bodies, tumors, rhinitis, or systemic disease such as blood diseases, cardiovascular disease, poisoning, vitamin deficiency, endocrine disorders, acute infectious disease caused by. One side or both sides of the nasal cavity of a small amount or heavy bleeding, quantity often flow through the nose and mouth, bleeding for a long time accompanied by symptoms of shock and anemia. Check the site of bleeding, and more generally at the bottom of the anterior nasal septum of a vascular plexus or nasopharynx vascular plexus (more common in middle-aged over the age of 40 here). (4) Check the causes of bleeding, to rule out local causes, should pay special attention to the systemic causes and blood tests. Necessary when doing a sinus X-ray examination and sinus endoscope examination to rule out sinus lesions. Repeated severe head trauma bleeding, angiography should be done to exclude the internal carotid artery pseudoaneurysm.
Monday, June 25, 2012
Stroke Hemiplegia
Stroke Hemiplegia-What is a stroke hemiplegia?
Stroke hemiplegia is the most common sequelae of stroke.Stroke hemiplegic limb weakness, adverse activities or totally unable to. Hemiplegic patients is often accompanied by ipsilateral limb sensory disturbances such as hot and cold I do not know, such as pain feel. Sometimes can be accompanied by ipsilateral visual field defect, performance level as the front can not see the paralyzed side of the items or come to his head toward the paralyzed side to see.
Stroke hemiplegia - auraStroke hemiplegia (1) dizziness, sudden dizziness;⑵ headache weekdays headache headache suddenly increase or intermittent headache to persistent severe headache;⑶ numbness, suddenly felt the side of the face or hands and feet numbness, and some for tongue hemp lip hemp or side of the lower limb tingling;⑷ sudden unilateral weakness or activity is not flexible, when the hair stops;⑸ temporarily slurred speech, or speech is not working;⑹ sudden unexplained falls or fainting;⑺ mental changes, a brief loss of consciousness, sudden change in personality and short-term judgment or mental retardation;⑻ drowsiness, that is sleepy all day;⑼ suddenly appeared only temporary blurred vision or conscious in front a blackout, and even sudden blindness of the moment;⑽ nausea and vomiting, or hiccups, or blood pressure fluctuations accompanied by dizziness, vertigo, tinnitus;⑾ side or a limb twitching involuntarily;⑿ nose bleeding, frequent nose bleeding.Stroke hemiplegia - Disease OverviewOther risk factors of stroke hemiplegic stroke hemiplegia there are many, have a relationship with age, habits, etc.. The older, more dangerous, incidence rates increased significantly after the age of 55. Smoking, drinking and other bad habits will increase the risk of stroke.The elderly prone to stroke, but it is not only the elderly will occur stroke. Stroke can occur at any age, from children, young adults to the elderly can occur, but more common in the elderly. Why, then, would be more common in the elderly it? Understanding on this issue, we must first know the basic cause of the stroke.Generally speaking, it is the basic cause of two aspects: the hemodynamic basis of vascular disease basis and vascular flow. The former to artery atherosclerosis or (and) hypertensive small arteriosclerosis, arteritis is more common; the latter is the main change for blood components and blood pressure factors, including hemodynamic changes. When the rough wall, blood flow is slow, low blood pressure, is conducive to blood clotting, that is caused by ischemic stroke; If the flow of blood containing the emboli (emboli from the heart, artery atherosclerosis small plaques, and even tumor cell mass), they can be the same as the stopper, the corresponding diameter of blood vessel blockages in the flow process, resulting in ischemic stroke.Stroke hemiplegia - risk factors⑴ hypertension: cause of stroke risk factors, 80%? Of stroke patients have a history of hypertension. Sharp rise in diastolic blood pressure or blood pressure fluctuations and more prone to stroke.(2) heart disease: coronary artery disease often accompanied by cerebral arteriosclerosis; rheumatic heart disease could easily cause a brain embolism.⑶ diabetes: about 10% to 30% of stroke patients with diabetes? Diabetic patients with high blood viscosity, and more atherosclerosis.⑷ cerebral arteriosclerosis: the basis of the stroke. That arteriosclerotic cerebral infarction and increased blood cholesterol and elevated low-density lipoprotein.⑸: cervical disease, pregnancy, age, gender, obesity, smoking and drinking, brash, climate and seasons are all risk factors.
Stroke hemiplegia - treatment of diseaseStroke hemiplegia - treatment after suffering a stroke, most patients are left over from paralysis, not only because life can not take care of themselves also imposes a heavier burden to families and society, how to make paralyzed limbs to restore function to patients suffering patients and their families the most urgent desire. We mainly in combination therapy, and achieved satisfactory results. It includes aspects of traditional Chinese medicine dialectical theory of governance, acupuncture, massage and massage.A, Chinese dialectical therapy1, Qi and Blood: dried up do not, or numbness, both Kouyanwaixie, language disadvantage, looking minimalist, shortness of breath, weakness, purple tongue or ecchymosis, white coating, thready pulse astringent or weakness.Governing Law: Yiqihuoxue stasis meridians.Recipe: Buyanghuanwu Decoction. Astragalus, Angelica, Chuanxiong, peach, red peony root, earthworm, Cyathula, Millettia, papaya, loofah, etc.2, Yin wind Yang interference type: dizzy tinnitus, hemiplegia, Kouyanwaixie,, language incomprehensible, red tongue, yellow, pulse a few strings.Governing Law: Yuk Yin yang, promoting blood circulation network.Recipe: Tianmagouteng decoction. Tianma, abalone, Tribulus terrestris, gun turtle shell, silkworm, skullcap, gardenia, Achyranthes, Angelica, Chuanxiong, red peony root, earth elementSecond, the acupuncture treatmentNeedle body: upper extremity: shoulder Yu, Qu pool, external relations, gu, in the example of lower extremity: rank side Yanglingquan, foot Three Mile, Xie River, the Taichong new face acupuncture: District of upper limb, lower limb area, liver, spleen Scalp: contralateral motor areas of the scalpThe three of massage and massage, massage, and massagePatients prone position, press the back of the cases, liver Yu, the gall Yu, Geshu Shenshu, rank side, then roll the France release.Patients lateral position (affected side) using the rubbing method, rolling the treatment of ipsilateral site.To take France to the treatment of limb soft tissue.Acupuncture, such as knee eyes, the Committee, Cheng-shan, V rabbit, wind, Xie River and so on.Finally, twist the law and an end.Second, cerebral vascular accident (stroke) have a higher prevalence in the elderly, mostly associated with hemiplegia. Exercise therapy in the treatment of stroke, paralysis is an important means of which the toe of the exercise and training is crucial. Because the toe is the end of the entire lower extremity motor and sensory, motor and sensory recovery can affect the entire lower extremity motor and sensory extent. And stimulate the muscle response induced by dorsiflexion ankle dorsiflexion ability to speed up the recovery of lower limb motor function.Toe early training by the physician or family members to help patients toes with both hands, so that it repeatedly feel the toe flexion and extension movements, friction foot on the back muscles to stimulate the feeling of patients with right toe flexion, extension. 20 times each, 2 or 3 times daily training.When the patient can feel the toe flexor stretch position, the help of therapists or family members, and gradually promote the patients to increase the power of independent movement, completed toe stretching and ankle dorsiflexion movement, and then bring the whole foot dorsiflexion This process requires the daily insisted, step by step, patients and their families should have the patience.Stroke hemiplegic patients toe training should begin early, can be carried out after the danger period. Of course, the exercise therapy for hemiplegia to be comprehensive, not only the toe and ankle, should also include the extension of the knee joint movement and hip adduction and external rotation, and upper extremity joint movement, so that parties can make patients in a relatively the greatest degree of recovery in the short period of time.Stroke hemiplegia - diagnosis and treatmentStroke, paralysis, hemiplegia early; sent to the hospital where contention points wins the banknote, fight for thrombolysis within the validity period, lowering blood pressure, lowering blood pressure, diuretic, reducing the intracranial pressure, treatment of the primary disease, control of cerebral edema and necrosis. reduce brain tissue damage and reduce complications. Stable condition after the second stage, which takes about 2-7 days, depending on the illness.Stage II to continue the treatment of primary disease. Plus rehabilitation treatment with traditional Chinese medicine, this disease is the key to the treatment of the key, depending on the prognosis of patients with good or bad, related to the level of quality of life in patients after as soon as possible. Doctors to be highly clinically effective drugs available, the medical profession is trying to power off to solve this common problem. Heads of medical advertisements or rain, doubtful, and difficult to deal with patients and their families. Really effective drugs Quo, the people, is more beneficial to society as a whole. On the contrary, the hazards and large, the harm to patients is irreversible. Cerebral blood through oral solution used for this stage, a significant effect of rehabilitation, clinical thrombolysis blank to fill in this period, the wise man does not imitate a try, including three hospitals, 2 -6 days effective to improve the efficacy of a visible Medication 6 Sky One course of treatment, 2-6 treatment all the more self-care, reduce morbidity, improve quality of life. During this period, patients need help to stand up activity massage the joints of the paralyzed limb, to strengthen the cognitive, swallowing, language and motor function training; strengthening exercises must be able to come down to earth, but also the combination of acupuncture, physiotherapy, medicine bath comprehensive measures for rehabilitation to to cure eyesight. About 20-40 days.III: the third stage, some patients after the treatment, is leaving some of the fallout. Must adhere to continue rehabilitation, convinced that the concept of rehabilitation, strengthening physical exercise until the symptoms disappear or improve. After six months, the after-effects would be difficult to restore, but not lose confidence, so return to top condition. Must adhere to the late blood pressure, anticoagulation, regular thrombolysis (preferably every six months, each 1 - or 2 courses) to prevent recurrence.Secondly, a comprehensive and thorough rehabilitation stroke, paralysis, the the triple Zhitan from three aspects combined treatment of diseases, good to solve the problem can not be fully recovered.I wake up: stasis CROOFirst clear the brain deposition of waste, gradually resurrected the already damaged brain cells, the brain of the dominant features of the human body recovered, so to speak, express, and so the language barrier is solved;2, two-way: through the meridiansRepair it well to get through the meridian system of patients with impaired function of the movement is dominated by by meridians conduction to the meridian conduction unblocked and restored, you will be able to go active, they do not someone else side feces urine side, life will also be able to is the basic self-care;3, three broken: broken bolt clear the bloodQuickly cleared the thrombus to blood a good environmental governance, the formation of blood clots to eliminate hidden dangers, you no longer have to worry about the risk of secondary recurrence.It is precisely because [Banger health musk anti tied pill] when I wake up two pass broken special effects, and allows patients to the three-level, complete three-level, the family will also be able to completely freed.
Stroke hemiplegia - family first aidFamily emergency stroke, paralysis can occur at any place, but more common in the home, home sudden stroke hemiplegia how to do? No matter what form of stroke, family members do not panic, to realize that emergency rescue in the home is very important, handled timely and properly related to the future condition of development, so to grasp some of the primary family emergency very necessary.Once the home occurred in stroke, paralysis, to try to put the patient carried the bed, the patient propped correct handling two to three individuals at the same time lift, one boosting the patient's head and shoulders, keep your head from the shock , boosting the patient's back and buttocks of another person, a person boosting the patient's buttocks and legs department, so the patient quiet and lying down, head slightly higher and slightly backwards, if there is vomiting, then head to one side. so as not to vomit choke into the trachea. Then unlock the collar of the patient, if dentures should be removed, if snoring can hand hold the lower jaw of the patient, the patient's tongue with gauze or a handkerchief to wrap pull to the front, so that the patient's airway to maintain good ventilation condition .At this point, you can ask the doctor to come to first aid, can also be a slight improvement in stable condition timely rescue the evacuation hospital, the patient should be sent to a hospital, to avoid long bumps caused by exacerbations. Upstairs down handling patients, we must maintain the head at the top, feet below, in order to reduce the brain congestion, it is best to allow patients to lie flat on a stretcher handling. Remember that the removal action should be gentle, but also minimize unnecessary handling.Stroke hemiplegia - prevention measuresCounseling, mental activity, the performance of neural functional activity in the brain. Sudden stroke, paralysis, makes brain function by a sudden injury, often results in varying degrees of psychological reactions. One usually looks good, hand, foot and suddenly in a short period of time not to obey orders, life can not take care of themselves, to speak the people do not understand. Such drastic changes in the scene, the patient would have caused a lot of psychological trauma.Stroke hemiplegic patients are most concerned about the healthy than the paralysis of the limbs, they can all day To this end anxiety. Excessive emotional tension, a long day, do not think of tea, rice do not want to, it will cause poor nutritional status of the body's weakened immune system complications also increasing. Some patients due to paralysis of limbs, life can not take care of themselves, often depressed, low self-esteem, life of people all day long depression, sadness, young people, paralysis of limbs to worry about the breakdown of the marriage, the elderly, fear of "chronic illness dutiful son", and the sad look, saddened; treatment is not satisfactory over a period of time, some patients feel the impatience and annoyance, often a trifle angry; some patients the presence of family members, everything dependent on, would have its own cuisine, but also let others to do.Stroke hemiplegic patients to enter psychological treatment and care is very important. In psychotherapy to help patients learn to actively engage in psychological adjustment and self-control, the right to treat the disease, and establish the confidence to overcome the disease. Allow them to maintain a happy and optimistic mood, eliminate the fear and pessimism, and swing off a distracting and actively cooperate with medical treatment, and adhere to the active exercise and passive exercise.To patients in psychotherapy and psychological care, the best to create a quiet, comfortable environment, which will help to improve the patient's physical and mental health and maintain a good state of mind, emotional stability, and can increase the effect of psychological treatment.All family members should actively care, thoughtfulness, respect and understanding of patients so that patients feel the warmth and care of the family. Before the patient must not be agitated, hate or random reprimanded patients, nor dumb, ignore the patient. To treat the patient's reasonable needs, to try to try to meet it.Stroke hemiplegia patient's mental disorder is often barriers to raising activities, and further cause of mental retardation and emotional disorders. Alone can not rely on the use of drugs to restore the patient's cranial nerve function and, more importantly, according to the patients of different educational level, from simple to complex, guiding patients to carry out the analysis, summarized, judgment, reasoning, and help him to re-understanding of the surrounding things.As long as the condition, stroke patients are also encouraged to ambulation, appropriate exercise, and daily life as far as possible take care of themselves, and whatever some housework, learning, entertainment and social activities, and gradually restore the community to adapt to this patient has a positive impact on the psychological.Stroke hemiplegia - NursingHome care of stroke hemiplegiaFirst of all, psychological care to patients. Hemiplegic patients due to slow recovery, limited mobility and despair, mental depression and various psychological. Compassion and patience in the care of such patients should be respected and thoughtful care for them so that they muster the courage to live, and actively cooperate with treatment and self-exercise.Second, to prevent the occurrence of various complications. First to prevent bedsores from occurring due to the patients' physical activity is limited, prolonged bed rest, it is easy to cause hypostatic pneumonia and bone protruding parts of bedsores, so regular turning, generally once every two hours to turn over, to replace its supine .Never stand up when the drag, to prevent abrasion of skin on the bed. And bedsores prone parts such as sacral, hip, shoulder, elbow, lateral malleolus, heel, occipital and other parts of the examination, with 50% safflower alcohol massage, massage the palm of your hand or your thumb close to the skin, the pressure from light to weight from heavy to light, circular massage. Prominent bone at the available balloon or cotton ring mat, so that the protruding parts vacant, reducing pressure. Have to choose the right mattress, usually with a sponge pad or cushion bed. Incontinent patients should pay attention to maintaining skin and bedding dry. Give the patient a sponge bath with warm water on a regular basis, Cabei, local massage to promote blood circulation, improve the local nutritional status. For sweaty, wet mattresses be replaced at any time, after scrubbing the back, the sacrococcygeal rushed talcum powder.Third, we should prevent the limb muscle contractures and joint deformities. Should enable the patient to maintain good lying posture type to assist in its passive movement. Such as prevention of upper limb adduction, a pillow can be placed in the patient armpit; to prevent foot drop, splint can be given in the limb. Passive movement should be carried out as soon as possible to patients, daily passive motion of the joints 2 or 3 times, each time the direction of movement of each joint more than five times, the movement should be gentle, and should not rude, so as not to cause pain and damage tissue.The fourth, but also to prevent urinary tract infection. Sterile drainage bag of patients treated with indwelling catheter, change daily, close observation of urine color, odor, turbidity, if any, odor, compared with urinary tract infection, should be timely so that patients spend antibiotics. To encourage patients to drink more water to dilute the urine.Stroke hemiplegia Note1, create a good living room environment, so that patients feel happy and helps to stabilize the patient's mood, promote mental health.To maintain the patient's psychological balance, first to create a harmonious and warm atmosphere in the family, the lifting of patients with a variety of concerns and emotional burden and to avoid emotional stimuli.3, focusing on the prevention of the occurrence of complications. Common complication of pressure ulcers, urinary tract infections, pneumonia, limb deformities, skin burns, intensive care should be under the guidance of a doctor.4, adhere to the rehabilitation training. Stroke patients with hemiplegia paralysis of limbs, language and mental retardation, and therefore should adhere to the rehabilitation training, to prevent the patient's muscle disuse atrophy and joint stiffness. Language and intelligence training.5, shall be provided with a nutritious and digestible food, meet the supply of proteins, salts and heat the water and eat a semi-liquid food, the paralyzed patients are often afraid of the urine as little as possible to the psychology of drinking water it is not right patients early in the morning of the paralyzed patients should have sufficient water supply, drink 1-2 cups of the salt water can prevent constipation. The food can not be too fine, pay attention to the dietary fiber intake, increased gastric motility, in order to prevent the occurrence of constipation. Avoid drinking tea, wine, coffee and fortunately irritant spicy food.In addition, patients with hemiplegia need for a long time lying on beds, and the action difficult, long duration and cause many patients to despair, loss of confidence in treatment, or even refuse treatment. Thus, helping patients with hemiplegia establish confidence is very important.Stroke hemiplegia food taboos(1) low-fat. Forbidden to eat food: fat, fat duck, fat goose, poultry skin, organ meats (liver, kidney, heart, brain), egg yolk, roe, bacon, sausage, shrimp, whole milk, cheese, chocolate, Crab , preserved eggs, yellow, lard, butter, cocoa butter, olive oil, cashew nuts, etc., because its ingredients mainly containing saturated fatty acid, allows cholesterol molecules into the liver to make blood cholesterol concentrations were significantly increased.(2) avoid using sucrose, fructose, sweets, sugary drinks, control the heat, because the sweets can be converted to fat. With diabetes in particular should pay attention to.(3) salt should not be too much daily control in less than five grams.(4) should not be smoking, drinking, tobacco and alcohol can accelerate the development of cerebral arteriosclerosis, and alcohol can make blood pressure rise induced stroke.(5) should not be fed, not to eat too much. Overeating, metabolism is strengthened, so that myocardial oxygen consumption increased significantly, increasing the burden on the heart.In addition, should not eat fried, fried and spicy spicy food.
Stroke hemiplegia - hazardsStroke hemiplegia of harm can not be ignored, sensory disturbances are many.Stroke hemiplegia one of the most common is the side of the body pain and hot and cold hypoesthesia;Second, limb paresthesia, such as numbness, tingling, sense of ant line, an electric shock, heaviness, cold or burning, etc.;Third, is the pain felt over-sensitive, if the patient is gently touched will feel the pain, even without the stimulus will have the feeling of pain.In short, the variety of sensory disturbances caused by stroke, paralysis, longer duration, sometimes more so than the hands and feet paralyzed patient suffering. Severe, the patient to eat is not fragrant, sleep well, affecting the rehabilitation of the ill. Health care workers and their families must be considerate to the patient, to try to alleviate the suffering of the patients. For example, gently massage the sick limbs, talk with the patient happy topic to distract the proper use of sedative analgesics. With the improvement of stroke disease, sensory disturbances will gradually disappear.
Stroke hemiplegia is the most common sequelae of stroke.Stroke hemiplegic limb weakness, adverse activities or totally unable to. Hemiplegic patients is often accompanied by ipsilateral limb sensory disturbances such as hot and cold I do not know, such as pain feel. Sometimes can be accompanied by ipsilateral visual field defect, performance level as the front can not see the paralyzed side of the items or come to his head toward the paralyzed side to see.
Stroke hemiplegia - auraStroke hemiplegia (1) dizziness, sudden dizziness;⑵ headache weekdays headache headache suddenly increase or intermittent headache to persistent severe headache;⑶ numbness, suddenly felt the side of the face or hands and feet numbness, and some for tongue hemp lip hemp or side of the lower limb tingling;⑷ sudden unilateral weakness or activity is not flexible, when the hair stops;⑸ temporarily slurred speech, or speech is not working;⑹ sudden unexplained falls or fainting;⑺ mental changes, a brief loss of consciousness, sudden change in personality and short-term judgment or mental retardation;⑻ drowsiness, that is sleepy all day;⑼ suddenly appeared only temporary blurred vision or conscious in front a blackout, and even sudden blindness of the moment;⑽ nausea and vomiting, or hiccups, or blood pressure fluctuations accompanied by dizziness, vertigo, tinnitus;⑾ side or a limb twitching involuntarily;⑿ nose bleeding, frequent nose bleeding.Stroke hemiplegia - Disease OverviewOther risk factors of stroke hemiplegic stroke hemiplegia there are many, have a relationship with age, habits, etc.. The older, more dangerous, incidence rates increased significantly after the age of 55. Smoking, drinking and other bad habits will increase the risk of stroke.The elderly prone to stroke, but it is not only the elderly will occur stroke. Stroke can occur at any age, from children, young adults to the elderly can occur, but more common in the elderly. Why, then, would be more common in the elderly it? Understanding on this issue, we must first know the basic cause of the stroke.Generally speaking, it is the basic cause of two aspects: the hemodynamic basis of vascular disease basis and vascular flow. The former to artery atherosclerosis or (and) hypertensive small arteriosclerosis, arteritis is more common; the latter is the main change for blood components and blood pressure factors, including hemodynamic changes. When the rough wall, blood flow is slow, low blood pressure, is conducive to blood clotting, that is caused by ischemic stroke; If the flow of blood containing the emboli (emboli from the heart, artery atherosclerosis small plaques, and even tumor cell mass), they can be the same as the stopper, the corresponding diameter of blood vessel blockages in the flow process, resulting in ischemic stroke.Stroke hemiplegia - risk factors⑴ hypertension: cause of stroke risk factors, 80%? Of stroke patients have a history of hypertension. Sharp rise in diastolic blood pressure or blood pressure fluctuations and more prone to stroke.(2) heart disease: coronary artery disease often accompanied by cerebral arteriosclerosis; rheumatic heart disease could easily cause a brain embolism.⑶ diabetes: about 10% to 30% of stroke patients with diabetes? Diabetic patients with high blood viscosity, and more atherosclerosis.⑷ cerebral arteriosclerosis: the basis of the stroke. That arteriosclerotic cerebral infarction and increased blood cholesterol and elevated low-density lipoprotein.⑸: cervical disease, pregnancy, age, gender, obesity, smoking and drinking, brash, climate and seasons are all risk factors.
Stroke hemiplegia - treatment of diseaseStroke hemiplegia - treatment after suffering a stroke, most patients are left over from paralysis, not only because life can not take care of themselves also imposes a heavier burden to families and society, how to make paralyzed limbs to restore function to patients suffering patients and their families the most urgent desire. We mainly in combination therapy, and achieved satisfactory results. It includes aspects of traditional Chinese medicine dialectical theory of governance, acupuncture, massage and massage.A, Chinese dialectical therapy1, Qi and Blood: dried up do not, or numbness, both Kouyanwaixie, language disadvantage, looking minimalist, shortness of breath, weakness, purple tongue or ecchymosis, white coating, thready pulse astringent or weakness.Governing Law: Yiqihuoxue stasis meridians.Recipe: Buyanghuanwu Decoction. Astragalus, Angelica, Chuanxiong, peach, red peony root, earthworm, Cyathula, Millettia, papaya, loofah, etc.2, Yin wind Yang interference type: dizzy tinnitus, hemiplegia, Kouyanwaixie,, language incomprehensible, red tongue, yellow, pulse a few strings.Governing Law: Yuk Yin yang, promoting blood circulation network.Recipe: Tianmagouteng decoction. Tianma, abalone, Tribulus terrestris, gun turtle shell, silkworm, skullcap, gardenia, Achyranthes, Angelica, Chuanxiong, red peony root, earth elementSecond, the acupuncture treatmentNeedle body: upper extremity: shoulder Yu, Qu pool, external relations, gu, in the example of lower extremity: rank side Yanglingquan, foot Three Mile, Xie River, the Taichong new face acupuncture: District of upper limb, lower limb area, liver, spleen Scalp: contralateral motor areas of the scalpThe three of massage and massage, massage, and massagePatients prone position, press the back of the cases, liver Yu, the gall Yu, Geshu Shenshu, rank side, then roll the France release.Patients lateral position (affected side) using the rubbing method, rolling the treatment of ipsilateral site.To take France to the treatment of limb soft tissue.Acupuncture, such as knee eyes, the Committee, Cheng-shan, V rabbit, wind, Xie River and so on.Finally, twist the law and an end.Second, cerebral vascular accident (stroke) have a higher prevalence in the elderly, mostly associated with hemiplegia. Exercise therapy in the treatment of stroke, paralysis is an important means of which the toe of the exercise and training is crucial. Because the toe is the end of the entire lower extremity motor and sensory, motor and sensory recovery can affect the entire lower extremity motor and sensory extent. And stimulate the muscle response induced by dorsiflexion ankle dorsiflexion ability to speed up the recovery of lower limb motor function.Toe early training by the physician or family members to help patients toes with both hands, so that it repeatedly feel the toe flexion and extension movements, friction foot on the back muscles to stimulate the feeling of patients with right toe flexion, extension. 20 times each, 2 or 3 times daily training.When the patient can feel the toe flexor stretch position, the help of therapists or family members, and gradually promote the patients to increase the power of independent movement, completed toe stretching and ankle dorsiflexion movement, and then bring the whole foot dorsiflexion This process requires the daily insisted, step by step, patients and their families should have the patience.Stroke hemiplegic patients toe training should begin early, can be carried out after the danger period. Of course, the exercise therapy for hemiplegia to be comprehensive, not only the toe and ankle, should also include the extension of the knee joint movement and hip adduction and external rotation, and upper extremity joint movement, so that parties can make patients in a relatively the greatest degree of recovery in the short period of time.Stroke hemiplegia - diagnosis and treatmentStroke, paralysis, hemiplegia early; sent to the hospital where contention points wins the banknote, fight for thrombolysis within the validity period, lowering blood pressure, lowering blood pressure, diuretic, reducing the intracranial pressure, treatment of the primary disease, control of cerebral edema and necrosis. reduce brain tissue damage and reduce complications. Stable condition after the second stage, which takes about 2-7 days, depending on the illness.Stage II to continue the treatment of primary disease. Plus rehabilitation treatment with traditional Chinese medicine, this disease is the key to the treatment of the key, depending on the prognosis of patients with good or bad, related to the level of quality of life in patients after as soon as possible. Doctors to be highly clinically effective drugs available, the medical profession is trying to power off to solve this common problem. Heads of medical advertisements or rain, doubtful, and difficult to deal with patients and their families. Really effective drugs Quo, the people, is more beneficial to society as a whole. On the contrary, the hazards and large, the harm to patients is irreversible. Cerebral blood through oral solution used for this stage, a significant effect of rehabilitation, clinical thrombolysis blank to fill in this period, the wise man does not imitate a try, including three hospitals, 2 -6 days effective to improve the efficacy of a visible Medication 6 Sky One course of treatment, 2-6 treatment all the more self-care, reduce morbidity, improve quality of life. During this period, patients need help to stand up activity massage the joints of the paralyzed limb, to strengthen the cognitive, swallowing, language and motor function training; strengthening exercises must be able to come down to earth, but also the combination of acupuncture, physiotherapy, medicine bath comprehensive measures for rehabilitation to to cure eyesight. About 20-40 days.III: the third stage, some patients after the treatment, is leaving some of the fallout. Must adhere to continue rehabilitation, convinced that the concept of rehabilitation, strengthening physical exercise until the symptoms disappear or improve. After six months, the after-effects would be difficult to restore, but not lose confidence, so return to top condition. Must adhere to the late blood pressure, anticoagulation, regular thrombolysis (preferably every six months, each 1 - or 2 courses) to prevent recurrence.Secondly, a comprehensive and thorough rehabilitation stroke, paralysis, the the triple Zhitan from three aspects combined treatment of diseases, good to solve the problem can not be fully recovered.I wake up: stasis CROOFirst clear the brain deposition of waste, gradually resurrected the already damaged brain cells, the brain of the dominant features of the human body recovered, so to speak, express, and so the language barrier is solved;2, two-way: through the meridiansRepair it well to get through the meridian system of patients with impaired function of the movement is dominated by by meridians conduction to the meridian conduction unblocked and restored, you will be able to go active, they do not someone else side feces urine side, life will also be able to is the basic self-care;3, three broken: broken bolt clear the bloodQuickly cleared the thrombus to blood a good environmental governance, the formation of blood clots to eliminate hidden dangers, you no longer have to worry about the risk of secondary recurrence.It is precisely because [Banger health musk anti tied pill] when I wake up two pass broken special effects, and allows patients to the three-level, complete three-level, the family will also be able to completely freed.
Stroke hemiplegia - family first aidFamily emergency stroke, paralysis can occur at any place, but more common in the home, home sudden stroke hemiplegia how to do? No matter what form of stroke, family members do not panic, to realize that emergency rescue in the home is very important, handled timely and properly related to the future condition of development, so to grasp some of the primary family emergency very necessary.Once the home occurred in stroke, paralysis, to try to put the patient carried the bed, the patient propped correct handling two to three individuals at the same time lift, one boosting the patient's head and shoulders, keep your head from the shock , boosting the patient's back and buttocks of another person, a person boosting the patient's buttocks and legs department, so the patient quiet and lying down, head slightly higher and slightly backwards, if there is vomiting, then head to one side. so as not to vomit choke into the trachea. Then unlock the collar of the patient, if dentures should be removed, if snoring can hand hold the lower jaw of the patient, the patient's tongue with gauze or a handkerchief to wrap pull to the front, so that the patient's airway to maintain good ventilation condition .At this point, you can ask the doctor to come to first aid, can also be a slight improvement in stable condition timely rescue the evacuation hospital, the patient should be sent to a hospital, to avoid long bumps caused by exacerbations. Upstairs down handling patients, we must maintain the head at the top, feet below, in order to reduce the brain congestion, it is best to allow patients to lie flat on a stretcher handling. Remember that the removal action should be gentle, but also minimize unnecessary handling.Stroke hemiplegia - prevention measuresCounseling, mental activity, the performance of neural functional activity in the brain. Sudden stroke, paralysis, makes brain function by a sudden injury, often results in varying degrees of psychological reactions. One usually looks good, hand, foot and suddenly in a short period of time not to obey orders, life can not take care of themselves, to speak the people do not understand. Such drastic changes in the scene, the patient would have caused a lot of psychological trauma.Stroke hemiplegic patients are most concerned about the healthy than the paralysis of the limbs, they can all day To this end anxiety. Excessive emotional tension, a long day, do not think of tea, rice do not want to, it will cause poor nutritional status of the body's weakened immune system complications also increasing. Some patients due to paralysis of limbs, life can not take care of themselves, often depressed, low self-esteem, life of people all day long depression, sadness, young people, paralysis of limbs to worry about the breakdown of the marriage, the elderly, fear of "chronic illness dutiful son", and the sad look, saddened; treatment is not satisfactory over a period of time, some patients feel the impatience and annoyance, often a trifle angry; some patients the presence of family members, everything dependent on, would have its own cuisine, but also let others to do.Stroke hemiplegic patients to enter psychological treatment and care is very important. In psychotherapy to help patients learn to actively engage in psychological adjustment and self-control, the right to treat the disease, and establish the confidence to overcome the disease. Allow them to maintain a happy and optimistic mood, eliminate the fear and pessimism, and swing off a distracting and actively cooperate with medical treatment, and adhere to the active exercise and passive exercise.To patients in psychotherapy and psychological care, the best to create a quiet, comfortable environment, which will help to improve the patient's physical and mental health and maintain a good state of mind, emotional stability, and can increase the effect of psychological treatment.All family members should actively care, thoughtfulness, respect and understanding of patients so that patients feel the warmth and care of the family. Before the patient must not be agitated, hate or random reprimanded patients, nor dumb, ignore the patient. To treat the patient's reasonable needs, to try to try to meet it.Stroke hemiplegia patient's mental disorder is often barriers to raising activities, and further cause of mental retardation and emotional disorders. Alone can not rely on the use of drugs to restore the patient's cranial nerve function and, more importantly, according to the patients of different educational level, from simple to complex, guiding patients to carry out the analysis, summarized, judgment, reasoning, and help him to re-understanding of the surrounding things.As long as the condition, stroke patients are also encouraged to ambulation, appropriate exercise, and daily life as far as possible take care of themselves, and whatever some housework, learning, entertainment and social activities, and gradually restore the community to adapt to this patient has a positive impact on the psychological.Stroke hemiplegia - NursingHome care of stroke hemiplegiaFirst of all, psychological care to patients. Hemiplegic patients due to slow recovery, limited mobility and despair, mental depression and various psychological. Compassion and patience in the care of such patients should be respected and thoughtful care for them so that they muster the courage to live, and actively cooperate with treatment and self-exercise.Second, to prevent the occurrence of various complications. First to prevent bedsores from occurring due to the patients' physical activity is limited, prolonged bed rest, it is easy to cause hypostatic pneumonia and bone protruding parts of bedsores, so regular turning, generally once every two hours to turn over, to replace its supine .Never stand up when the drag, to prevent abrasion of skin on the bed. And bedsores prone parts such as sacral, hip, shoulder, elbow, lateral malleolus, heel, occipital and other parts of the examination, with 50% safflower alcohol massage, massage the palm of your hand or your thumb close to the skin, the pressure from light to weight from heavy to light, circular massage. Prominent bone at the available balloon or cotton ring mat, so that the protruding parts vacant, reducing pressure. Have to choose the right mattress, usually with a sponge pad or cushion bed. Incontinent patients should pay attention to maintaining skin and bedding dry. Give the patient a sponge bath with warm water on a regular basis, Cabei, local massage to promote blood circulation, improve the local nutritional status. For sweaty, wet mattresses be replaced at any time, after scrubbing the back, the sacrococcygeal rushed talcum powder.Third, we should prevent the limb muscle contractures and joint deformities. Should enable the patient to maintain good lying posture type to assist in its passive movement. Such as prevention of upper limb adduction, a pillow can be placed in the patient armpit; to prevent foot drop, splint can be given in the limb. Passive movement should be carried out as soon as possible to patients, daily passive motion of the joints 2 or 3 times, each time the direction of movement of each joint more than five times, the movement should be gentle, and should not rude, so as not to cause pain and damage tissue.The fourth, but also to prevent urinary tract infection. Sterile drainage bag of patients treated with indwelling catheter, change daily, close observation of urine color, odor, turbidity, if any, odor, compared with urinary tract infection, should be timely so that patients spend antibiotics. To encourage patients to drink more water to dilute the urine.Stroke hemiplegia Note1, create a good living room environment, so that patients feel happy and helps to stabilize the patient's mood, promote mental health.To maintain the patient's psychological balance, first to create a harmonious and warm atmosphere in the family, the lifting of patients with a variety of concerns and emotional burden and to avoid emotional stimuli.3, focusing on the prevention of the occurrence of complications. Common complication of pressure ulcers, urinary tract infections, pneumonia, limb deformities, skin burns, intensive care should be under the guidance of a doctor.4, adhere to the rehabilitation training. Stroke patients with hemiplegia paralysis of limbs, language and mental retardation, and therefore should adhere to the rehabilitation training, to prevent the patient's muscle disuse atrophy and joint stiffness. Language and intelligence training.5, shall be provided with a nutritious and digestible food, meet the supply of proteins, salts and heat the water and eat a semi-liquid food, the paralyzed patients are often afraid of the urine as little as possible to the psychology of drinking water it is not right patients early in the morning of the paralyzed patients should have sufficient water supply, drink 1-2 cups of the salt water can prevent constipation. The food can not be too fine, pay attention to the dietary fiber intake, increased gastric motility, in order to prevent the occurrence of constipation. Avoid drinking tea, wine, coffee and fortunately irritant spicy food.In addition, patients with hemiplegia need for a long time lying on beds, and the action difficult, long duration and cause many patients to despair, loss of confidence in treatment, or even refuse treatment. Thus, helping patients with hemiplegia establish confidence is very important.Stroke hemiplegia food taboos(1) low-fat. Forbidden to eat food: fat, fat duck, fat goose, poultry skin, organ meats (liver, kidney, heart, brain), egg yolk, roe, bacon, sausage, shrimp, whole milk, cheese, chocolate, Crab , preserved eggs, yellow, lard, butter, cocoa butter, olive oil, cashew nuts, etc., because its ingredients mainly containing saturated fatty acid, allows cholesterol molecules into the liver to make blood cholesterol concentrations were significantly increased.(2) avoid using sucrose, fructose, sweets, sugary drinks, control the heat, because the sweets can be converted to fat. With diabetes in particular should pay attention to.(3) salt should not be too much daily control in less than five grams.(4) should not be smoking, drinking, tobacco and alcohol can accelerate the development of cerebral arteriosclerosis, and alcohol can make blood pressure rise induced stroke.(5) should not be fed, not to eat too much. Overeating, metabolism is strengthened, so that myocardial oxygen consumption increased significantly, increasing the burden on the heart.In addition, should not eat fried, fried and spicy spicy food.
Stroke hemiplegia - hazardsStroke hemiplegia of harm can not be ignored, sensory disturbances are many.Stroke hemiplegia one of the most common is the side of the body pain and hot and cold hypoesthesia;Second, limb paresthesia, such as numbness, tingling, sense of ant line, an electric shock, heaviness, cold or burning, etc.;Third, is the pain felt over-sensitive, if the patient is gently touched will feel the pain, even without the stimulus will have the feeling of pain.In short, the variety of sensory disturbances caused by stroke, paralysis, longer duration, sometimes more so than the hands and feet paralyzed patient suffering. Severe, the patient to eat is not fragrant, sleep well, affecting the rehabilitation of the ill. Health care workers and their families must be considerate to the patient, to try to alleviate the suffering of the patients. For example, gently massage the sick limbs, talk with the patient happy topic to distract the proper use of sedative analgesics. With the improvement of stroke disease, sensory disturbances will gradually disappear.
Hyperthyroidism
Hyperthyroidism-What is Hyperthyroidism?
Hyperthyroidism, also known as Graves' disease or diffuse toxic goiter.Hyperthyroidism is an autoimmune disease, clinical manifestations are not limited to the thyroid, but a multi-system syndrome, including: the group of high metabolic disease, diffuse goiter, eye symptoms, skin lesions and thyroid extremitiesdiseases. The majority of patients also have high metabolic disease and goiter. Thyroid other than the performance of invasive endocrine exophthalmos can stand alone and not accompanied by a high metabolic disease.
Hyperthyroidism - disease descriptionFemale endocrine disorders can also cause hyperthyroidism typical cases the diagnosis is generally not difficult. In patients with mild cases of elderly and children, clinical manifestations of less rather than the typical diagnosis often be through laboratory tests.(A) The diagnostic significance of clinical manifestations and special attention to heat intolerance, sweating, agitation, satisfied Kang associated with weight loss, resting heart rate too fast, special eye sign, and goiter. Found in the thyroid vascular murmur, tremor, even with diagnostic significance.
(B) Under normal circumstances, the thyroid function tests in patients with hyperthyroidism T3, rT3 and and T4 increased blood concentrations of elevated T3 than T4, obviously. TSH below normal only seen in the more sensitive immunoradiometric assay.
The etiology of this disease is unknown, it is therefore not a cause of treatment and control of high metabolic disease group. Net of mental stress and other negative factors of the disease. The beginning of treatment, be proper rest and a variety of supportive therapy, and add enough calories and nutrients such as sugar, protein and various vitamins to correct the disease caused by consumption. Control hyperthyroidism disease group: ① anti-thyroid drugs; ② radioisotope iodine; ③ surgery.
Hyperthyroidism from all causes loss of feedback control mechanism of the normal thyroid secretion, caused by the abnormal increase of the main features of the disease a general term systemic hypermetabolism circulating thyroid hormone.
Hyperthyroidism - symptoms and signsThe clinical manifestations of the the exophthalmos therapy of hyperthyroidism hyperthyroidism include goiter, brash, easily agitated, insomnia, his hands trembling, heat intolerance, sweating, skin moist but weight loss, appetite, hyperactivity, weight loss, heart palpitations, rapid pulse, strong (regular pulse rate above 100 beats per minute, rest and sleep is still faster), increased pulse pressure (mainly due to elevated systolic blood pressure), endocrine disorders (such as menstrual disorders), as well as weakness, fatigue, and limb-side muscle atrophy and so on. Pulse rate and pulse pressure is particularly important, and often can be used as an important symbol to determine severity and treatment effects.
Hyperthyroidism is a common endocrine disease caused by excessive secretion of thyroid hormone caused by a variety of factors. The main clinical manifestations of food, weight loss, fear of heat, sweating, palpitations, agitation high excitability of the metabolic syndrome, nerves and blood vessels to enhance, as well as varying degrees of goiter and exophthalmos, and other characteristics. The disease is more common and women into a few years the incidence of childhood hyperthyroidism upward trend. Slow onset, more than six months to one year after the onset of treatment. Typical cases are often the following performance: a high metabolic syndrome; 2, goiter; 3, exophthalmos;, nervous system symptoms; symptoms of the cardiovascular system; 6, the symptoms of the endocrine system; 7 digestive symptoms; 8, symptoms of blood and hematopoietic system; reproductive system symptoms; 10 motor system symptoms; 11, symptoms of the skin and extremities. Integrative Medicine, what method of treatment, according to medical advice. Must not casually buy drugs to cope with, be sure to doctors under the guidance system, the entire full amount of treatment. Avoid not treated early, inappropriate, not change card profusion. Western medicine is convenient, safe, usually does not cause irreversible thyroid damage, but its long course of treatment, recurrence rate, remission rate was 40% -60%, and Integrative Medicine and low recurrence rate, remission rate
Hyperthyroidism - Diseases etiologyThe hyperthyroidism characterization can be divided into: primary, secondary and high-functioning adenomas into three categories according to the cause of the hyperthyroidism.(1) primary hyperthyroidism is the most common symptoms of hyperthyroidism in a goiter at the same time. Patient age in between 20 to 40 years. Swollen glands, diffuse, bilaterally symmetrical, often accompanied by exophthalmos, it is also known as Graves' disease.② secondary hyperthyroidism is less common, such as secondary hyperthyroidism in nodular goiter; the patient is first nodular goiter for many years, appeared after the symptoms of hyperthyroidism. The age of onset more than 40 years. Glands showed a nodular swelling on both sides more than asymmetric, no eye, and prone to myocardial damage.③ high-functioning adenomas, rare, single, autonomous high-functioning nodules, nodules surrounding thyroid tissue in the thyroid gland showed atrophy changes. Patients had no exophthalmos.Hyperthyroidism - pathophysiologyGestational hyperthyroidism primary hyperthyroidism cause has not yet completely clear. TSH concentration in the blood of patients is not high, and some lower than normal; even applications of TSH promote shock wrapped also failed to stimulate the TSH concentration in the blood of these patients later found in the blood of patients with two types stimulate the thyroid gland autoantibodies, primary hyperthyroidism - kind of autoimmune disease.Types of antibodies, one is to stimulate thyroid function with TSH, but the substance of the role of time lasting than that of TSH (TSH half-life of only 30 minutes and the substance for 25 days) so called "long-acting thyroid hormone; another thyroid stimulating immunoglobulin, two types of substances belong to the class G immunoglobulin, derived from lymphocytes, can inhibit TSH and TSH receptor binding, and thus strengthen the thyroid cell function, secretion of a large number of T3 and T4 .As for the cause of secondary hyperthyroidism and high-functioning adenomas, but also not entirely clear. Patient straight in the long-acting thyroid stimulating hormone, such as the concentration is not high, perhaps with nodular itself autonomous secretion disorder.Hyperthyroidism - hyperthyroidism typeThere are many types of hyperthyroidism, one of the most common diffuse toxic goiter, Graves' disease. Diffuse toxic goiter incidence and genetic and autoimmune factors, but whether the symptoms of hyperthyroidism and a number of predisposing factors (environmental Kang Su). If you avoid these triggers may not be the symptoms of hyperthyroidism, or delay the symptoms of hyperthyroidism, or alleviate the symptoms of hyperthyroidism.In addition to the typical hyperthyroidism on clinical common:(1) T3 hyperthyroidism. T3 hyperthyroidism is the clinical manifestation of hyperthyroidism, serum TT4 and FT4 is normal or even low, only T3 increased a class of hyperthyroidism.(2) T4 in hyperthyroidism, also known as thyroxine hyperthyroidism by serum of TT4 and FT4 increased, TT3, FT3 normal type of hyperthyroidism. In 1975, Turner First report the name of the T4 hyperthyroidism, its clinical manifestations and typical of hyperthyroidism, can occur in Graves' disease, toxic nodular goiter, subacute thyroiditis, more common in middle-aged general poor, such as severe infection, surgery, malnutrition and other patients. Of TT3 and FT3, normal laboratory tests of serum TT4 and FT4 increased. Thyroid photo 131I rate was significantly higher thyroid tablets or T3 suppression test abnormalities.The needs of this disease and acute stress-induced hyperthyroidism (false T4 hyperthyroidism) identification. Stress in patients with hyperthyroidism is suffering from various acute or chronic systemic disease, because of the relationship of these diseases, the serum TT4, FT4 increased, TT3, FT3 normal or reduced, with the exception of a small number of patients with goiter outside other no hyperthyroidism evidence, when the primary disease is cured, the above-mentioned laboratory parameters in the near future return to normal.(3) children with hyperthyroidism. The incidence gradually increased to 3 years of age the highest incidence rate of 11-16-year-old girls than boys, a few call all children have a diffuse goiter and typical metabolic syndrome, exophthalmos is more common.(4) age-related hyperthyroidism. Due to physiological changes in the elderly, the function of body organs have varying degrees of loss, fibrosis and atrophy of the thyroid tissue to a certain degree of reduction in thyroid hormone secretion and peripheral tissue responses to thyroid hormone changes, senile hyperthyroidism clinical features: often not enlarged thyroid, or mild swelling, many accompanied by nodules; sudden eye or no obvious exophthalmos, high metabolic syndrome is not obvious, lack of appetite, hyperactivity, heat intolerance, sweating and irritability symptoms; often associated with other heart disease such as angina or myocardial infarction, and prone to arrhythmias and heart failure, more common in persistent AF; patients showed apathy was no desire like severe cases, lethargy, or was stupor, coma.(5) Apathetic hyperthyroidism. The type is a the hyperthyroidism special performance type. Contrary to the symptoms associated with typical symptoms of hyperthyroidism, manifested as a kind of nervous depression hyperthyroidism. Apathetic hyperthyroidism clinical manifestations: loss of appetite, nausea, chills, dry skin, depression and looked indifferent, indifferent to the surrounding things; the spirit of thinking activity is slow, while answering delay problem, and sometimes difficulty concentrating, lazy action of few words; palpitations those of common, often accompanied by cardiac enlargement, congestive heart failure, atrial fibrillation, eyes sunken, eyes Gao lag atheism, or even the eyelids droop.(6) occult hyperthyroidism. Occult hyperthyroidism is no typical symptoms of hyperthyroidism, the disease to a system for the outstanding performance of a class of hyperthyroidism. Clinical type ① spirit type, for the outstanding performance of mental disorders, the patients showed inattention, distractibility, hallucinations, paranoia, depression, dementia, paranoia, mania, and even suicidal ideation, rage episodes. ② gastrointestinal type, often for the outstanding performance of diarrhea. More common in middle-aged patients stool frequency several times a day to ten several times ranging from a paste or water samples, containing undigested food, and some patients with vomiting or abdominal pain. Gastrointestinal hyperthyroidism vomiting, diarrhea, often accompanied by water and electrolyte disturbance, improper treatment of a serious condition likely to cause thyroid crisis, and life-threatening. ③ myopathy type, gravis and periodic paralysis. The symptoms of hyperthyroidism is not obvious or appeared later. The clinical manifestations of acute and chronic thyrotoxic myopathy, periodic paralysis, myasthenia gravis and ophthalmoplegia.Hyperthyroidism - diagnostic testsHyperthyroidism diagnostic tests rely on the typical clinical manifestations, and sometimes also combined with some special check. Hyperthyroidism commonly used special inspection methods as follows:A. The basal metabolic rate measurement can be calculated according to the pulse pressure and pulse rate, or the determination of basal metabolism string determination. The latter is more reliable, but the former is simple. Commonly calculated as follows: basal metabolic rate = (pulse rate + PP) -111. Determination of basal metabolic rate in a completely quiet, empty stomach. Normal ± l0%; increased to +20% to 30% of mild hyperthyroidism / 30% 60% moderate, 10 to 60 percent or more severe.Two. 131 the amount of thyroid photo of 131I rate determination of normal thyroid uptake within 24 hours for 30% to 40% of the human total. If within two hours thyroid uptake of 131 iodometric more than 25% of the total of the human body, or more than 50% of the total of the human body within 14 hours, and early appearance of the absorption of iodine 131 peak, can be diagnosed hyperthyroidism.3. Serum T3 and T4 levels, the determination of hyperthyroidism, serum T3 may be higher than about 4 times normal, and T4 only the normal two and a half times, T3 determination with high sensitivity to hyperthyroidism attending Jin
Like hyperthyroidism - Surgical treatmentThe hyperthyroidism subtotal thyroidectomy than moderate hyperthyroidism is still the most commonly used and effective therapy, 90% to 95% of the patients get cured, surgical deaths string of less than 1%. The disadvantage of surgical treatment are some complications and about 4% to 5% of patients after recurrence of hyperthyroidism, a small number of patients with postoperative hypothyroidism.Indications for surgical treatment of: ① The secondary hyperthyroidism or high-functioning adenomas; ② moderate primary hyperthyroidism; ③ glands large, with compression symptoms or substernal goiter and other types of hyperthyroidism; ④ antithyroid drugs or 131I therapy for relapse or difficult to adhere to the long-term medication.In addition, in view of hyperthyroidism, pregnancy can cause adverse effects (abortion, premature birth, etc.), but pregnancy may exacerbate hyperthyroidism, therefore, early pregnancy, the medium-term patients with hyperthyroidism who are of the above indications, surgical treatment should be considered. Surgery Contraindications: ① young patients; ② mild persons; the ③ elderly patients or have serious organic disease can not tolerate surgery.Preoperative preparation hyperthyroidism in order to avoid patients with hyperthyroidism in the basal metabolic rate is high-pitched to the risk of surgery, preoperative should be taken fully prepared to ensure the smooth operation and prevent the occurrence of postoperative complications.A. General provisions for psychological tension or insomnia may be appropriate sedation and sleeping pills in order to eliminate the feelings of the patient's fear. Rapid heart rate, oral reserpine O. 25mg or propranolol (Inderal) 10mg, 3 times a day. The occurrence of heart failure, digitalis preparations should be.Two. In addition to the comprehensive physical examination and necessary laboratory tests should also include: ① neck fluoroscopy or radiography preoperative examination, to understand whether compression or displacement of the trachea; (2) detailed examination of the heart whether to expand, murmur, or arrhythmia and for ECG; ③ laryngoscopy to determine the function of the vocal cords; ④ Determination of basal metabolic rate, the degree of hyperthyroidism, select the timing of surgery.3. The drug preparation is an important part of the technique used to reduce the basal metabolic rate. There are two ways: ① The first thiourea drugs, by reducing thyroid hormone synthesis, and inhibition of in vivo lymphocyte to produce its own antibodies to control the symptoms of hyperthyroidism caused by thyroid hormone increased until symptoms of hyperthyroidism are the basic control, namely, change clothes 1-2 weeks of iodine, then surgery.Postoperative protection of hyperthyroidism 1. Anesthesia generally available cervical plexus block effects, understand the patient to pronounce avoid recurrent laryngeal nerve injury. Huge retrosternal goiter compression of the trachea, or nervous mental disorders in patients with hyperthyroidism, should still be selected endotracheal anesthesia in order to ensure airway patency and smooth operation.Two. Surgery should be gentle, careful, careful hemostasis, pay attention to the protection of the parathyroid glands and recurrent laryngeal nerve. Should also be noted:(1) fully exposed the thyroid gland. Should be close to the thyroid very ligation, cut off the thyroid artery and vein, to avoid injury to the superior laryngeal nerve; to the inferior thyroid artery ligation, and should leave the glands on the back as far as possible, rely on the common carotid artery ligation its trunk, to avoid the recurrent laryngeal nerve injury .(2) Removal of the gland number, should be determined according to the size of the glands or hyperthyroidism extent. It usually takes 80% to 90% of the Removal of the gland, and removal of the isthmus; each side of the residual glands such as adult thumb tip size appropriate (about 3-4g). Glands removal too easily lead to relapse, too much prone to hypothyroidism (myxedema). Must save both lobes of the gland on the back part, so as not to damage the recurrent laryngeal nerve and parathyroid.(3) strict stop the bleeding. The larger blood vessels (such as the thyroid artery and vein, the thyroid, vein), should be double ligation to prevent slippage bleeding. The surgical field should be routinely place a rubber piece drainage 24-48 hours, and to observe and timely drainage of blood clots within the incision, to prevent blood clots compression of the trachea, causing suffocation.3. Postoperative observation and care after surgery the same day should pay close attention to changes in the patient breathing, body temperature, pulse, blood pressure; the incidence of thyroid crisis prevention. Such as pulse rate too fast, you can use the reserpine intramuscularly. The patient semi-recumbent position to facilitate breathing and drainage incision, blood clots: to help the patient promptly eliminated from the sputum, and to maintain airway patency. In addition, postoperative patients to continue taking the compound potassium iodide solution, 3 times a day. 10 drops each, a total of about one week; or 3 times a day, each 16 drops daily each reduced by a drop.Attention to matters hyperthyroidism disorders iodine's role is to inhibit proteolytic enzymes to reduce the decomposition of thyroglobulin, thus inhibiting the release of thyroid hormone, iodine can reduce the blood flow of the thyroid, the gland congestion reduction, and thus narrow the hardened . Commonly used iodine compound potassium iodide solution, 3 times a day; the first day of each 3 drops, 4 drops of each on the second day, after the daily increments of one drop to each 16 drops so far, and then maintain this dose. However, only iodine inhibit thyroid hormone release rather than inhibit its synthesis, so stop taking the iodine stored in the thyroid follicular thyroglobulin substantial decomposition. The re-emergence of symptoms of hyperthyroidism, even more serious than the original, who is not prepared to implement the surgery, not to take iodine.For routine use iodine or combined with alkali alloxan drugs can not be tolerated or ineffective, advocate with propranolol or together with the iodine for preoperative preparation. Propranolol is an adrenergic β-blockers, can control the symptoms of hyperthyroidism, shorten the time of preoperative preparation, and medication does not cause the gland congestion, surgical operation, effect of thiourea drugs bad or severe reactions could be replaced by this drug. Propranolol can selectively block β receptors on various target organs and tissues sensitivity to catecholamines, and inhibiting the effects of epinephrine to improve the symptoms of hyperthyroidism. Dose of oral administration of 1 every 6 hours, every 20 - 60mg, 4-7 in the future pulse rate dropped to normal levels, can perform an operation. Less than eight hours due to the effective half-life of propranolol in the body, so the last time oral propranolol before surgery l two hours; postoperative oral propranolol 4-7. In addition, before surgery, without atropine, so as not to cause tachycardia.Concurrent symptoms of hyperthyroidism. Postoperative respiratory difficulties and asphyxia occurred within 48 hours after surgery is most critical after complications. The common reasons: the ① incision bleeding compression of the trachea, due to surgery to stop bleeding (glands section hemostasis) imperfect, or vascular ligature slippage caused by the. ② laryngeal edema, mainly caused by surgical trauma. Can also be caused by tracheal intubation. ③ airway collapse. The wall of the airway long-term enlargement thyroid vine oppression, soften, softening of the tracheal wall lost support in most of the removal of the thyroid body. Patients of the latter two cases, due to airway blockage can occur Ming and acute respiratory resistance. The clinical manifestations of progressive shortness of breath, irritability, cyanosis. Or even suffocation. Such as swelling of the neck, the incision oozing blood, mostly incision bleeding caused. Found out that the situation must be immediately bedside rescue, cut sutures in a timely manner, open incision, the speedy removal of the hematoma; so when the patient breathing no improvement should be immediately implemented tracheotomy; the situation improved after sending the operating room for further of gold One, hemostatic, and other treatments. Therefore, patients should be routinely placed in the patient bedside sterile tracheotomy package and gloves to prepare for emergency.Two. Recurrent laryngeal nerve injury rate of about 0.5%. Mostly due to the surgical treatment of thyroid pole, accidentally recurrent laryngeal nerve cut, suture or setback folder, traction caused by permanent or temporary injury caused. A few also by hematoma, or scar tissue compression or traction. Closely related to the consequences of injury and the nature of the injury (permanent or temporary) and range (unilateral or bilateral). The recurrent laryngeal nerve containing motor nerve fibers dominated the vocal cords. Side of the recurrent laryngeal nerve damage, mostly caused by hoarseness after surgery, although by the contralateral vocal cord compensatory received to the ipsilateral excessive recovery pronunciation, but laryngoscopy shows ipsilateral vocal cord still not received, and therefore can not be restored the original tone. Full support of the bilateral recurrent laryngeal nerve injury, depending on the injury, before the branch or a different plane and the posterior branch, can lead to aphonia or severe breathing difficulties, or asphyxia, requiring immediate tracheotomy. Surgical cut, suture fell folder, traction and direct the recurrent laryngeal nerve injury, intraoperative immediate symptoms. Caused by hematoma compression, scar tissue pulling may be a few days after surgery before the onset of symptoms. Cut the suture caused a permanent injury setback folder, stretch, due to hematoma compression is more timely processing of the temporary manager spa, the general may be in three to six months, gradually restored.3. Laryngeal nerve injury occurred to the handling of the thyroid pole, too far away from the glands, separated carefully and the nerve and surrounding tissue with a large bunch of ligation caused. Laryngeal nerve, since the beginning of (feeling) and outside (movement) two. If the damage to the external branch makes the cricothyroid muscle paralysis, causing the vocal cords relaxation, lower tone. The internal branch of injury, throat mucosal sensory loss, eating especially drinking, it is easy swallowing choking. General manager after the treatment can restore itself.4. Tetany due to involvement due to accidental injury during surgery and parathyroid glands or their blood supply, the serum calcium concentration decreased to below 2.0mmol / L, severe cases can be reduced to 1.0-1.5mmol / L (normal 2.25-2.75mmol / L) neuromuscular stress was significantly higher, more than three days of the postoperative l tetany. The majority of patients, only the face, lip or hand and foot acupuncture-like numbness or a sense of rigidity, after 2-3 weeks, intact parathyroid hyperplasia hypertrophy play a compensatory role, the symptoms can disappear. In severe cases, there may be persistent spasm, facial and hand, foot pain associated with feeling daily seizure overcharged. Each lasting 10 to 20 minutes or longer, severe cases can occur in the larynx and diaphragm spasm, causing suffocation and death. The Thyroidectomy care to preserve the integrity of the glands on the back part of the. Thyroid specimens cut double-check the back of the parathyroid correct cut, found that when trying to transplant to the sternocleidomastoid medium, are the key to avoid this complication occurred.Occurrence of tetany, meat, dairy and eggs and other foods should be limited (due to higher phosphorus, affect the absorption of calcium). Seizure, immediate intravenous injection of 10% calcium gluconate or calcium chloride 10 to 20ml. Mild symptoms of oral calcium gluconate or calcium lactate 2-4g, 3 times a day; severe symptoms or long-term recovery, plus vitamin D3, and 5 in case of 100 000 U a day to promote the calcium in the intestine absorption. Oral oxygen speed sterol (dihydrotestosterone rapid change steroids) (DT10) oil can significantly improve the content of calcium in the blood, reducing the stress of the neuromuscular Can also be used with blood vessels of the thyroid - parathyroid transplantation of allogeneic5 Thyroid storm is a serious complication of hyperthyroidism. Clinical observations: crisis occurred with the preoperative preparation is not enough, the symptoms of hyperthyroidism is not well controlled and surgical stress. Crisis patients mainly as follows: fever (> 39 ° C), pulse (120 beats / min) concomitant nervous, circulatory and digestive systems, severe functional disorders such as irritability, delirium, sweating, vomiting, watery diarrhea reflects The disease is caused due to thyroid hormone excess release of the fulminant adrenaline excitement phenomenon. Without timely treatment, the rapid development of coma, collapse, shock and even death, the mortality rate is about 20% to 30%.Treatment includes: (1) adrenergic blockers: the choice of reserpine 1-2mg intramuscularly, or guanethidine 10 ~ 20mg oral. 4-8 hours after the former drug crisis can be eased; the latter in 12 hours onset of action. Can also be used propranolol 5mg plus 100ml intravenous infusion of 5% a 10% glucose solution to reduce the response to adrenaline of the surrounding tissue. (2) potassium iodide solution of iodine: oral compound, for the first time 3-5ml, 500ml of 10% glucose solution by adding 10% sodium iodide-10m1 emergency intravenous drip to reduce the level of thyroxine in the blood. (3) hydrocortisone: daily 200-400mg, graded intravenous infusion to antagonize too much thyroid hormone response. (4) sedative: Common phenobarbital sodium 100mg, or the lytic cocktail n half the amount, intramuscular injection of 6-8 hours (5) cooling: antipyretic, hibernation drugs and physical cooling methods, to maintain body temperature at 37 ℃. (6) of intravenous glucose solution to replenish their energy and oxygen, in order to reduce tissue hypoxia. (7) have heart failure, the addition of digitalis preparations..
Hyperthyroidism, also known as Graves' disease or diffuse toxic goiter.Hyperthyroidism is an autoimmune disease, clinical manifestations are not limited to the thyroid, but a multi-system syndrome, including: the group of high metabolic disease, diffuse goiter, eye symptoms, skin lesions and thyroid extremitiesdiseases. The majority of patients also have high metabolic disease and goiter. Thyroid other than the performance of invasive endocrine exophthalmos can stand alone and not accompanied by a high metabolic disease.
Hyperthyroidism - disease descriptionFemale endocrine disorders can also cause hyperthyroidism typical cases the diagnosis is generally not difficult. In patients with mild cases of elderly and children, clinical manifestations of less rather than the typical diagnosis often be through laboratory tests.(A) The diagnostic significance of clinical manifestations and special attention to heat intolerance, sweating, agitation, satisfied Kang associated with weight loss, resting heart rate too fast, special eye sign, and goiter. Found in the thyroid vascular murmur, tremor, even with diagnostic significance.
(B) Under normal circumstances, the thyroid function tests in patients with hyperthyroidism T3, rT3 and and T4 increased blood concentrations of elevated T3 than T4, obviously. TSH below normal only seen in the more sensitive immunoradiometric assay.
The etiology of this disease is unknown, it is therefore not a cause of treatment and control of high metabolic disease group. Net of mental stress and other negative factors of the disease. The beginning of treatment, be proper rest and a variety of supportive therapy, and add enough calories and nutrients such as sugar, protein and various vitamins to correct the disease caused by consumption. Control hyperthyroidism disease group: ① anti-thyroid drugs; ② radioisotope iodine; ③ surgery.
Hyperthyroidism from all causes loss of feedback control mechanism of the normal thyroid secretion, caused by the abnormal increase of the main features of the disease a general term systemic hypermetabolism circulating thyroid hormone.
Hyperthyroidism - symptoms and signsThe clinical manifestations of the the exophthalmos therapy of hyperthyroidism hyperthyroidism include goiter, brash, easily agitated, insomnia, his hands trembling, heat intolerance, sweating, skin moist but weight loss, appetite, hyperactivity, weight loss, heart palpitations, rapid pulse, strong (regular pulse rate above 100 beats per minute, rest and sleep is still faster), increased pulse pressure (mainly due to elevated systolic blood pressure), endocrine disorders (such as menstrual disorders), as well as weakness, fatigue, and limb-side muscle atrophy and so on. Pulse rate and pulse pressure is particularly important, and often can be used as an important symbol to determine severity and treatment effects.
Hyperthyroidism is a common endocrine disease caused by excessive secretion of thyroid hormone caused by a variety of factors. The main clinical manifestations of food, weight loss, fear of heat, sweating, palpitations, agitation high excitability of the metabolic syndrome, nerves and blood vessels to enhance, as well as varying degrees of goiter and exophthalmos, and other characteristics. The disease is more common and women into a few years the incidence of childhood hyperthyroidism upward trend. Slow onset, more than six months to one year after the onset of treatment. Typical cases are often the following performance: a high metabolic syndrome; 2, goiter; 3, exophthalmos;, nervous system symptoms; symptoms of the cardiovascular system; 6, the symptoms of the endocrine system; 7 digestive symptoms; 8, symptoms of blood and hematopoietic system; reproductive system symptoms; 10 motor system symptoms; 11, symptoms of the skin and extremities. Integrative Medicine, what method of treatment, according to medical advice. Must not casually buy drugs to cope with, be sure to doctors under the guidance system, the entire full amount of treatment. Avoid not treated early, inappropriate, not change card profusion. Western medicine is convenient, safe, usually does not cause irreversible thyroid damage, but its long course of treatment, recurrence rate, remission rate was 40% -60%, and Integrative Medicine and low recurrence rate, remission rate
Hyperthyroidism - Diseases etiologyThe hyperthyroidism characterization can be divided into: primary, secondary and high-functioning adenomas into three categories according to the cause of the hyperthyroidism.(1) primary hyperthyroidism is the most common symptoms of hyperthyroidism in a goiter at the same time. Patient age in between 20 to 40 years. Swollen glands, diffuse, bilaterally symmetrical, often accompanied by exophthalmos, it is also known as Graves' disease.② secondary hyperthyroidism is less common, such as secondary hyperthyroidism in nodular goiter; the patient is first nodular goiter for many years, appeared after the symptoms of hyperthyroidism. The age of onset more than 40 years. Glands showed a nodular swelling on both sides more than asymmetric, no eye, and prone to myocardial damage.③ high-functioning adenomas, rare, single, autonomous high-functioning nodules, nodules surrounding thyroid tissue in the thyroid gland showed atrophy changes. Patients had no exophthalmos.Hyperthyroidism - pathophysiologyGestational hyperthyroidism primary hyperthyroidism cause has not yet completely clear. TSH concentration in the blood of patients is not high, and some lower than normal; even applications of TSH promote shock wrapped also failed to stimulate the TSH concentration in the blood of these patients later found in the blood of patients with two types stimulate the thyroid gland autoantibodies, primary hyperthyroidism - kind of autoimmune disease.Types of antibodies, one is to stimulate thyroid function with TSH, but the substance of the role of time lasting than that of TSH (TSH half-life of only 30 minutes and the substance for 25 days) so called "long-acting thyroid hormone; another thyroid stimulating immunoglobulin, two types of substances belong to the class G immunoglobulin, derived from lymphocytes, can inhibit TSH and TSH receptor binding, and thus strengthen the thyroid cell function, secretion of a large number of T3 and T4 .As for the cause of secondary hyperthyroidism and high-functioning adenomas, but also not entirely clear. Patient straight in the long-acting thyroid stimulating hormone, such as the concentration is not high, perhaps with nodular itself autonomous secretion disorder.Hyperthyroidism - hyperthyroidism typeThere are many types of hyperthyroidism, one of the most common diffuse toxic goiter, Graves' disease. Diffuse toxic goiter incidence and genetic and autoimmune factors, but whether the symptoms of hyperthyroidism and a number of predisposing factors (environmental Kang Su). If you avoid these triggers may not be the symptoms of hyperthyroidism, or delay the symptoms of hyperthyroidism, or alleviate the symptoms of hyperthyroidism.In addition to the typical hyperthyroidism on clinical common:(1) T3 hyperthyroidism. T3 hyperthyroidism is the clinical manifestation of hyperthyroidism, serum TT4 and FT4 is normal or even low, only T3 increased a class of hyperthyroidism.(2) T4 in hyperthyroidism, also known as thyroxine hyperthyroidism by serum of TT4 and FT4 increased, TT3, FT3 normal type of hyperthyroidism. In 1975, Turner First report the name of the T4 hyperthyroidism, its clinical manifestations and typical of hyperthyroidism, can occur in Graves' disease, toxic nodular goiter, subacute thyroiditis, more common in middle-aged general poor, such as severe infection, surgery, malnutrition and other patients. Of TT3 and FT3, normal laboratory tests of serum TT4 and FT4 increased. Thyroid photo 131I rate was significantly higher thyroid tablets or T3 suppression test abnormalities.The needs of this disease and acute stress-induced hyperthyroidism (false T4 hyperthyroidism) identification. Stress in patients with hyperthyroidism is suffering from various acute or chronic systemic disease, because of the relationship of these diseases, the serum TT4, FT4 increased, TT3, FT3 normal or reduced, with the exception of a small number of patients with goiter outside other no hyperthyroidism evidence, when the primary disease is cured, the above-mentioned laboratory parameters in the near future return to normal.(3) children with hyperthyroidism. The incidence gradually increased to 3 years of age the highest incidence rate of 11-16-year-old girls than boys, a few call all children have a diffuse goiter and typical metabolic syndrome, exophthalmos is more common.(4) age-related hyperthyroidism. Due to physiological changes in the elderly, the function of body organs have varying degrees of loss, fibrosis and atrophy of the thyroid tissue to a certain degree of reduction in thyroid hormone secretion and peripheral tissue responses to thyroid hormone changes, senile hyperthyroidism clinical features: often not enlarged thyroid, or mild swelling, many accompanied by nodules; sudden eye or no obvious exophthalmos, high metabolic syndrome is not obvious, lack of appetite, hyperactivity, heat intolerance, sweating and irritability symptoms; often associated with other heart disease such as angina or myocardial infarction, and prone to arrhythmias and heart failure, more common in persistent AF; patients showed apathy was no desire like severe cases, lethargy, or was stupor, coma.(5) Apathetic hyperthyroidism. The type is a the hyperthyroidism special performance type. Contrary to the symptoms associated with typical symptoms of hyperthyroidism, manifested as a kind of nervous depression hyperthyroidism. Apathetic hyperthyroidism clinical manifestations: loss of appetite, nausea, chills, dry skin, depression and looked indifferent, indifferent to the surrounding things; the spirit of thinking activity is slow, while answering delay problem, and sometimes difficulty concentrating, lazy action of few words; palpitations those of common, often accompanied by cardiac enlargement, congestive heart failure, atrial fibrillation, eyes sunken, eyes Gao lag atheism, or even the eyelids droop.(6) occult hyperthyroidism. Occult hyperthyroidism is no typical symptoms of hyperthyroidism, the disease to a system for the outstanding performance of a class of hyperthyroidism. Clinical type ① spirit type, for the outstanding performance of mental disorders, the patients showed inattention, distractibility, hallucinations, paranoia, depression, dementia, paranoia, mania, and even suicidal ideation, rage episodes. ② gastrointestinal type, often for the outstanding performance of diarrhea. More common in middle-aged patients stool frequency several times a day to ten several times ranging from a paste or water samples, containing undigested food, and some patients with vomiting or abdominal pain. Gastrointestinal hyperthyroidism vomiting, diarrhea, often accompanied by water and electrolyte disturbance, improper treatment of a serious condition likely to cause thyroid crisis, and life-threatening. ③ myopathy type, gravis and periodic paralysis. The symptoms of hyperthyroidism is not obvious or appeared later. The clinical manifestations of acute and chronic thyrotoxic myopathy, periodic paralysis, myasthenia gravis and ophthalmoplegia.Hyperthyroidism - diagnostic testsHyperthyroidism diagnostic tests rely on the typical clinical manifestations, and sometimes also combined with some special check. Hyperthyroidism commonly used special inspection methods as follows:A. The basal metabolic rate measurement can be calculated according to the pulse pressure and pulse rate, or the determination of basal metabolism string determination. The latter is more reliable, but the former is simple. Commonly calculated as follows: basal metabolic rate = (pulse rate + PP) -111. Determination of basal metabolic rate in a completely quiet, empty stomach. Normal ± l0%; increased to +20% to 30% of mild hyperthyroidism / 30% 60% moderate, 10 to 60 percent or more severe.Two. 131 the amount of thyroid photo of 131I rate determination of normal thyroid uptake within 24 hours for 30% to 40% of the human total. If within two hours thyroid uptake of 131 iodometric more than 25% of the total of the human body, or more than 50% of the total of the human body within 14 hours, and early appearance of the absorption of iodine 131 peak, can be diagnosed hyperthyroidism.3. Serum T3 and T4 levels, the determination of hyperthyroidism, serum T3 may be higher than about 4 times normal, and T4 only the normal two and a half times, T3 determination with high sensitivity to hyperthyroidism attending Jin
Like hyperthyroidism - Surgical treatmentThe hyperthyroidism subtotal thyroidectomy than moderate hyperthyroidism is still the most commonly used and effective therapy, 90% to 95% of the patients get cured, surgical deaths string of less than 1%. The disadvantage of surgical treatment are some complications and about 4% to 5% of patients after recurrence of hyperthyroidism, a small number of patients with postoperative hypothyroidism.Indications for surgical treatment of: ① The secondary hyperthyroidism or high-functioning adenomas; ② moderate primary hyperthyroidism; ③ glands large, with compression symptoms or substernal goiter and other types of hyperthyroidism; ④ antithyroid drugs or 131I therapy for relapse or difficult to adhere to the long-term medication.In addition, in view of hyperthyroidism, pregnancy can cause adverse effects (abortion, premature birth, etc.), but pregnancy may exacerbate hyperthyroidism, therefore, early pregnancy, the medium-term patients with hyperthyroidism who are of the above indications, surgical treatment should be considered. Surgery Contraindications: ① young patients; ② mild persons; the ③ elderly patients or have serious organic disease can not tolerate surgery.Preoperative preparation hyperthyroidism in order to avoid patients with hyperthyroidism in the basal metabolic rate is high-pitched to the risk of surgery, preoperative should be taken fully prepared to ensure the smooth operation and prevent the occurrence of postoperative complications.A. General provisions for psychological tension or insomnia may be appropriate sedation and sleeping pills in order to eliminate the feelings of the patient's fear. Rapid heart rate, oral reserpine O. 25mg or propranolol (Inderal) 10mg, 3 times a day. The occurrence of heart failure, digitalis preparations should be.Two. In addition to the comprehensive physical examination and necessary laboratory tests should also include: ① neck fluoroscopy or radiography preoperative examination, to understand whether compression or displacement of the trachea; (2) detailed examination of the heart whether to expand, murmur, or arrhythmia and for ECG; ③ laryngoscopy to determine the function of the vocal cords; ④ Determination of basal metabolic rate, the degree of hyperthyroidism, select the timing of surgery.3. The drug preparation is an important part of the technique used to reduce the basal metabolic rate. There are two ways: ① The first thiourea drugs, by reducing thyroid hormone synthesis, and inhibition of in vivo lymphocyte to produce its own antibodies to control the symptoms of hyperthyroidism caused by thyroid hormone increased until symptoms of hyperthyroidism are the basic control, namely, change clothes 1-2 weeks of iodine, then surgery.Postoperative protection of hyperthyroidism 1. Anesthesia generally available cervical plexus block effects, understand the patient to pronounce avoid recurrent laryngeal nerve injury. Huge retrosternal goiter compression of the trachea, or nervous mental disorders in patients with hyperthyroidism, should still be selected endotracheal anesthesia in order to ensure airway patency and smooth operation.Two. Surgery should be gentle, careful, careful hemostasis, pay attention to the protection of the parathyroid glands and recurrent laryngeal nerve. Should also be noted:(1) fully exposed the thyroid gland. Should be close to the thyroid very ligation, cut off the thyroid artery and vein, to avoid injury to the superior laryngeal nerve; to the inferior thyroid artery ligation, and should leave the glands on the back as far as possible, rely on the common carotid artery ligation its trunk, to avoid the recurrent laryngeal nerve injury .(2) Removal of the gland number, should be determined according to the size of the glands or hyperthyroidism extent. It usually takes 80% to 90% of the Removal of the gland, and removal of the isthmus; each side of the residual glands such as adult thumb tip size appropriate (about 3-4g). Glands removal too easily lead to relapse, too much prone to hypothyroidism (myxedema). Must save both lobes of the gland on the back part, so as not to damage the recurrent laryngeal nerve and parathyroid.(3) strict stop the bleeding. The larger blood vessels (such as the thyroid artery and vein, the thyroid, vein), should be double ligation to prevent slippage bleeding. The surgical field should be routinely place a rubber piece drainage 24-48 hours, and to observe and timely drainage of blood clots within the incision, to prevent blood clots compression of the trachea, causing suffocation.3. Postoperative observation and care after surgery the same day should pay close attention to changes in the patient breathing, body temperature, pulse, blood pressure; the incidence of thyroid crisis prevention. Such as pulse rate too fast, you can use the reserpine intramuscularly. The patient semi-recumbent position to facilitate breathing and drainage incision, blood clots: to help the patient promptly eliminated from the sputum, and to maintain airway patency. In addition, postoperative patients to continue taking the compound potassium iodide solution, 3 times a day. 10 drops each, a total of about one week; or 3 times a day, each 16 drops daily each reduced by a drop.Attention to matters hyperthyroidism disorders iodine's role is to inhibit proteolytic enzymes to reduce the decomposition of thyroglobulin, thus inhibiting the release of thyroid hormone, iodine can reduce the blood flow of the thyroid, the gland congestion reduction, and thus narrow the hardened . Commonly used iodine compound potassium iodide solution, 3 times a day; the first day of each 3 drops, 4 drops of each on the second day, after the daily increments of one drop to each 16 drops so far, and then maintain this dose. However, only iodine inhibit thyroid hormone release rather than inhibit its synthesis, so stop taking the iodine stored in the thyroid follicular thyroglobulin substantial decomposition. The re-emergence of symptoms of hyperthyroidism, even more serious than the original, who is not prepared to implement the surgery, not to take iodine.For routine use iodine or combined with alkali alloxan drugs can not be tolerated or ineffective, advocate with propranolol or together with the iodine for preoperative preparation. Propranolol is an adrenergic β-blockers, can control the symptoms of hyperthyroidism, shorten the time of preoperative preparation, and medication does not cause the gland congestion, surgical operation, effect of thiourea drugs bad or severe reactions could be replaced by this drug. Propranolol can selectively block β receptors on various target organs and tissues sensitivity to catecholamines, and inhibiting the effects of epinephrine to improve the symptoms of hyperthyroidism. Dose of oral administration of 1 every 6 hours, every 20 - 60mg, 4-7 in the future pulse rate dropped to normal levels, can perform an operation. Less than eight hours due to the effective half-life of propranolol in the body, so the last time oral propranolol before surgery l two hours; postoperative oral propranolol 4-7. In addition, before surgery, without atropine, so as not to cause tachycardia.Concurrent symptoms of hyperthyroidism. Postoperative respiratory difficulties and asphyxia occurred within 48 hours after surgery is most critical after complications. The common reasons: the ① incision bleeding compression of the trachea, due to surgery to stop bleeding (glands section hemostasis) imperfect, or vascular ligature slippage caused by the. ② laryngeal edema, mainly caused by surgical trauma. Can also be caused by tracheal intubation. ③ airway collapse. The wall of the airway long-term enlargement thyroid vine oppression, soften, softening of the tracheal wall lost support in most of the removal of the thyroid body. Patients of the latter two cases, due to airway blockage can occur Ming and acute respiratory resistance. The clinical manifestations of progressive shortness of breath, irritability, cyanosis. Or even suffocation. Such as swelling of the neck, the incision oozing blood, mostly incision bleeding caused. Found out that the situation must be immediately bedside rescue, cut sutures in a timely manner, open incision, the speedy removal of the hematoma; so when the patient breathing no improvement should be immediately implemented tracheotomy; the situation improved after sending the operating room for further of gold One, hemostatic, and other treatments. Therefore, patients should be routinely placed in the patient bedside sterile tracheotomy package and gloves to prepare for emergency.Two. Recurrent laryngeal nerve injury rate of about 0.5%. Mostly due to the surgical treatment of thyroid pole, accidentally recurrent laryngeal nerve cut, suture or setback folder, traction caused by permanent or temporary injury caused. A few also by hematoma, or scar tissue compression or traction. Closely related to the consequences of injury and the nature of the injury (permanent or temporary) and range (unilateral or bilateral). The recurrent laryngeal nerve containing motor nerve fibers dominated the vocal cords. Side of the recurrent laryngeal nerve damage, mostly caused by hoarseness after surgery, although by the contralateral vocal cord compensatory received to the ipsilateral excessive recovery pronunciation, but laryngoscopy shows ipsilateral vocal cord still not received, and therefore can not be restored the original tone. Full support of the bilateral recurrent laryngeal nerve injury, depending on the injury, before the branch or a different plane and the posterior branch, can lead to aphonia or severe breathing difficulties, or asphyxia, requiring immediate tracheotomy. Surgical cut, suture fell folder, traction and direct the recurrent laryngeal nerve injury, intraoperative immediate symptoms. Caused by hematoma compression, scar tissue pulling may be a few days after surgery before the onset of symptoms. Cut the suture caused a permanent injury setback folder, stretch, due to hematoma compression is more timely processing of the temporary manager spa, the general may be in three to six months, gradually restored.3. Laryngeal nerve injury occurred to the handling of the thyroid pole, too far away from the glands, separated carefully and the nerve and surrounding tissue with a large bunch of ligation caused. Laryngeal nerve, since the beginning of (feeling) and outside (movement) two. If the damage to the external branch makes the cricothyroid muscle paralysis, causing the vocal cords relaxation, lower tone. The internal branch of injury, throat mucosal sensory loss, eating especially drinking, it is easy swallowing choking. General manager after the treatment can restore itself.4. Tetany due to involvement due to accidental injury during surgery and parathyroid glands or their blood supply, the serum calcium concentration decreased to below 2.0mmol / L, severe cases can be reduced to 1.0-1.5mmol / L (normal 2.25-2.75mmol / L) neuromuscular stress was significantly higher, more than three days of the postoperative l tetany. The majority of patients, only the face, lip or hand and foot acupuncture-like numbness or a sense of rigidity, after 2-3 weeks, intact parathyroid hyperplasia hypertrophy play a compensatory role, the symptoms can disappear. In severe cases, there may be persistent spasm, facial and hand, foot pain associated with feeling daily seizure overcharged. Each lasting 10 to 20 minutes or longer, severe cases can occur in the larynx and diaphragm spasm, causing suffocation and death. The Thyroidectomy care to preserve the integrity of the glands on the back part of the. Thyroid specimens cut double-check the back of the parathyroid correct cut, found that when trying to transplant to the sternocleidomastoid medium, are the key to avoid this complication occurred.Occurrence of tetany, meat, dairy and eggs and other foods should be limited (due to higher phosphorus, affect the absorption of calcium). Seizure, immediate intravenous injection of 10% calcium gluconate or calcium chloride 10 to 20ml. Mild symptoms of oral calcium gluconate or calcium lactate 2-4g, 3 times a day; severe symptoms or long-term recovery, plus vitamin D3, and 5 in case of 100 000 U a day to promote the calcium in the intestine absorption. Oral oxygen speed sterol (dihydrotestosterone rapid change steroids) (DT10) oil can significantly improve the content of calcium in the blood, reducing the stress of the neuromuscular Can also be used with blood vessels of the thyroid - parathyroid transplantation of allogeneic5 Thyroid storm is a serious complication of hyperthyroidism. Clinical observations: crisis occurred with the preoperative preparation is not enough, the symptoms of hyperthyroidism is not well controlled and surgical stress. Crisis patients mainly as follows: fever (> 39 ° C), pulse (120 beats / min) concomitant nervous, circulatory and digestive systems, severe functional disorders such as irritability, delirium, sweating, vomiting, watery diarrhea reflects The disease is caused due to thyroid hormone excess release of the fulminant adrenaline excitement phenomenon. Without timely treatment, the rapid development of coma, collapse, shock and even death, the mortality rate is about 20% to 30%.Treatment includes: (1) adrenergic blockers: the choice of reserpine 1-2mg intramuscularly, or guanethidine 10 ~ 20mg oral. 4-8 hours after the former drug crisis can be eased; the latter in 12 hours onset of action. Can also be used propranolol 5mg plus 100ml intravenous infusion of 5% a 10% glucose solution to reduce the response to adrenaline of the surrounding tissue. (2) potassium iodide solution of iodine: oral compound, for the first time 3-5ml, 500ml of 10% glucose solution by adding 10% sodium iodide-10m1 emergency intravenous drip to reduce the level of thyroxine in the blood. (3) hydrocortisone: daily 200-400mg, graded intravenous infusion to antagonize too much thyroid hormone response. (4) sedative: Common phenobarbital sodium 100mg, or the lytic cocktail n half the amount, intramuscular injection of 6-8 hours (5) cooling: antipyretic, hibernation drugs and physical cooling methods, to maintain body temperature at 37 ℃. (6) of intravenous glucose solution to replenish their energy and oxygen, in order to reduce tissue hypoxia. (7) have heart failure, the addition of digitalis preparations..
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