catalogue
1 Symptoms and signs
2 drug therapy
3 diet health care
4 preventive health care
5 pathological causes
6 disease diagnosis
7 inspection method
Fold and edit the symptoms and signs of this paragraph.
In patients with superficial phlebitis, the local swelling and pain of the affected limb are aggravated when walking, and painful strips or beaded nodules can be felt. Patients with deep phlebitis have sudden onset, swollen limbs, dark red skin, extensive varicose veins and telangiectasia; There are malnutrition changes in the later stage, accompanied by stasis dermatitis, pigmentation or superficial ulcers. The circumference of femur and tibia is more than 65,438 0 cm thicker than that of healthy limbs. The swelling and pain increased when walking, and eased after lying still. Venography showed that the deep vein of the affected limb was narrow or blocked. Wandering thrombophlebitis is a kind of superficial phlebitis with uncertain occurrence, which is a special kind of superficial phlebitis in human body. It refers to the common disease of venous thrombosis in chest wall, breast, costal margin and upper abdomen accompanied by inflammatory lesions, also known as Mond's disease.
Classification of phlebitis
1, mechanical phlebitis:
1) Improper fixation method: the puncture site is not firmly fixed, causing the needle tube to slide.
2) The diameter of the selected catheter is too thick, which stimulates the blood vessel wall.
3) The puncture site is too close to the joint, and the needle tube and the blood vessel wall are constantly rubbed due to joint activity, resulting in inflammatory reaction.
2. Chemical phlebitis: insufficient drug dilution, infusion acid, high alkalinity, high solute concentration and different materials of indwelling needle are all causes of chemical phlebitis.
3. Bacterial phlebitis: It is usually related to incorrect disinfection method, poor puncture technique, destruction of sterile state of infusion cannula and long indwelling time of catheter.
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Workers who stand for a long time or are exposed to cold and humid environment, such as freight forwarders, ticket sellers, textile workers, teachers, etc., are prone to this disease; Some patients are stimulated by intravenous infusion; Patients who are injected with sclerosing agent and arsenic and stay in bed for a long time after operation, pregnancy and postpartum are also prone to this disease. The disease is developing rapidly. If treated in time, the prognosis will be better. Otherwise, if it is not treated properly, it may recur and persist.
Treatment of phlebitis with traditional Chinese medicine
treatment according to syndrome differentiation
(1) thrombotic superficial phlebitis:
① Damp-heat in veins: Treatment: clearing away heat and promoting diuresis, removing blood stasis and dredging collaterals.
Prescription: Wushen Decoction. Medicinal Flos Lonicerae, Herba Violae, Poria, Semen Plantaginis, Saviae Miltiorrhizae Radix, Semen Persicae, Carthami Flos, and Achyranthis Radix. The prescription uses honeysuckle and viola yedoensis to clear away heat and toxic materials, tuckahoe and plantain seed to clear away damp heat, salvia miltiorrhiza, peach kernel and safflower to promote blood circulation and remove blood stasis, Achyranthes bidentata to break blood and dredge channels, and the medicine goes down. For patients with severe red heat, Gongying, Fructus Forsythiae and Cortex Phellodendri are added to strengthen the power of clearing away heat and toxic materials; Atractylodes rhizome and Alisma orientalis are added to those with severe swelling to promote diuresis and reduce swelling; For those with severe pain, add frankincense and myrrh to promote blood circulation and relieve pain.
② Blood stasis blocking collaterals: Treatment: promoting blood circulation to remove blood stasis, dredging collaterals and relieving pain.
Prescription: Taohong Siwu Decoction. Medicinal peach kernel, safflower, angelica, white peony root, chuanxiong rhizome, salvia miltiorrhiza, corydalis tuber, spatholobus stem and leech.
The prescription uses peach kernel, safflower, angelica, white peony root, Ligusticum Chuanxiong, Salvia miltiorrhiza, Rhizoma Corydalis, Spatholobus Spatholobus and Hirudo, which can achieve the effects of removing blood stasis, dredging collaterals and relieving pain. Achyranthes bidentata can be added to patients with lower limbs, and mulberry branches can be added to patients with upper limbs; Talcum and Ramulus Cinnamomi are added to patients with swelling to help yang and diuresis; Gongying and Diding are added to the patients with redness and swelling to clear away heat and toxic materials; Add cimicifugae Rhizoma and Radix Astragali for edema in the morning and evening.
(2) Deep vein thrombosis
① Damp-heat in veins: treatment: clearing heat and promoting diuresis, activating blood circulation and dredging collaterals.
Prescription: Qingre Tongluo Decoction. Medicinal Flos Lonicerae, Herba Taraxaci, Herba Violae, Poria, Semen Plantaginis, Coicis Semen, Herba Hedyotidis Diffusae, Radix Salviae Miltiorrhizae and Squama Manis.
The prescription uses honeysuckle, dandelion, viola yedoensis, plantain seed, coix seed, tuckahoe and oldenlandia diffusa to clear away heat, promote diuresis and detoxify. Saviae Miltiorrhizae Radix, Carapax et Plastrum Testudinis, promoting blood circulation, resolving hard mass, and reducing swelling; and Rhizoma Smilacis Glabrae and Alismatis Rhizoma can be added for those with obvious swelling and bright skin color; If the pain is obvious, add frankincense and myrrh; Radix Codonopsis and Radix Astragali are added for patients with qi deficiency.
② Pulse dampness and blood stasis: Treatment: promoting blood circulation and removing blood stasis, promoting diuresis and dredging collaterals.
Prescription: Huoxue Tongmai Decoction. Medicinal Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Flos Lonicerae, Rhizoma Smilacis Glabrae, Semen Phaseoli, and Coicis Semen. Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, Radix Angelicae Sinensis and Rhizoma Chuanxiong were used to promote blood circulation and remove blood stasis. Flos Lonicerae, Rhizoma Smilacis Glabrae, Semen Phaseoli and Coicis Semen have the functions of clearing heat, promoting diuresis and dredging collaterals. If the pain is severe, turtle shell, frankincense and myrrh can be added to promote blood circulation and relieve pain; For those with cold limbs due to yang deficiency, honeysuckle is removed, and cassia twig, Asari and aconite root are added to warm the yang; Radix Codonopsis and Radix Astragali are added for qi deficiency.
③ Spleen deficiency and dampness resistance: Treatment: invigorating spleen and eliminating dampness, promoting blood circulation and removing blood stasis.
Prescription: Jianpi Tongluo Decoction. Medicinal Radix Astragali, Radix Codonopsis, Coicis Semen, Poria Peel, Semen Plantaginis, Rhizoma Zingiberis Recens, Lentils, Atractylodis Rhizoma, Caulis Spatholobi, Saviae Miltiorrhizae Radix, and Radix Cyathulae. The prescription consists of Radix Astragali, Radix Codonopsis, Coicis Semen, Poria, Semen Plantaginis, Rhizoma Zingiberis Recens, Lentils and Atractylodis Rhizoma. Spatholobus suberectus, Saviae Miltiorrhizae Radix and Radix Cyathulae promote blood circulation and remove blood stasis.
Addition and subtraction can refer to the above two.
Treatment of phlebitis with western medicine
For thrombophlebitis, it is necessary to stay in bed in the acute stage, raise the affected limb, reduce the inflammation and edema of the affected limb during chemotherapy, and adopt unique physical therapy for local treatment. Antibiotics should be used when there is secondary bacterial infection.
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Dialectical dietotherapy of traditional Chinese medicine
1. Patients with deficiency of both qi and blood (emaciation and fatigue, muscle atrophy of affected limbs, skin wrinkling and desquamation, and prolonged wound healing time) should eat nutritious and digestible foods, such as lean meat, eggs and milk. Edible beef stew with Radix Codonopsis, Radix Astragali, Rhizoma Atractylodis Macrocephalae and Fructus Jujubae.
2. Patients with phlebitis caused by blood stasis blocking collaterals (warm and cold, pale toe skin, persistent swelling and pain, no ulcer) can eat ginger mutton soup, duck meat, deer blood, hawthorn, cassia twig and longan meat; Avoid catching cold.
3. Patients with phlebitis caused by collateral damage caused by heat toxin (toe may have recurrent superficial thrombophlebitis, gangrene and ulcer) should eat easily digestible food, such as mung beans, red beans, tea, pears, watermelons and horse teeth. You can drink chrysanthemum tea, honeysuckle dew or use lotus leaves, bamboo leaves and fresh plantain soup instead of water.
Principles of nutritious diet
1. The diet should be light and juicy, easy to digest and nutritious. Don't eat spicy and greasy things, such as pepper, pepper, garlic, pepper, etc.
2. Always eat a lot of fresh fruits, vegetables, raw nuts, plant seeds, bean products and whole grain foods to meet the body's demand for various nutrients.
Eating more ginger can promote blood circulation, purify blood vessels and stabilize blood pressure.
4. Drinking ginkgo tea can improve microcirculation and brain function, and has antioxidant effect.
5. It is forbidden to eat any dairy products, fried foods, pickled foods and processed foods.
6. Don't eat cold things, such as popsicles, soft drinks and cold drinks.
Treatment prescription:
Steamed Chinese Bass
Ingredients: 65438+ 0 bass, 3 slices of ham (square), 3 mushrooms and 6 grams of ginger. Material A: 1 tbsp wine, 2g salt, 4 onions.
manufacture
1. Wash the perch, cut it from the lower part of the abdomen, cut it three times diagonally on each side, and coat it with material A for later use.
2. Soak the mushrooms and remove the pedicles, and cut them in half; Cut the ham into 3 mm thick slices, and then cut into triangles.
3. Put the chopped mushrooms and ham into the meat seam of the fish knife, put the fish on a plate, wrap the tail with aluminum foil, pour wine around the fish, cover it, steam for 8 minutes on high fire, and remove the aluminum foil.
The efficacy is rich in nutrition, warming cold and benefiting qi.
Tree frog meat pie
Ingredients: tree frog 150g (tree frog with spotted legs), 50g lean pork, 6 slices of ginger, 5g mushrooms, a small amount of starch, soy sauce, refined salt and monosodium glutamate.
manufacture
1. Cut open the tree frog, take out its internal organs, wash it, and cut off its beak and claws. Wash and drain lean meat. Peel ginger. Wet the mushrooms and cut off the stems. Chop the four raw materials together into minced meat.
2. Put the minced meat into a large bowl, add soy sauce, starch, monosodium glutamate and refined salt, stir well, marinate and taste, then inject a proper amount of water and steam in the pot.
Efficacy: anti-inflammatory, analgesic and blood circulation promoting.
The information is for reference only. Please consult a doctor for details.
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The diagnosis and treatment of vascular diseases of limbs certainly play a decisive role, but without the close cooperation of nursing, the expected purpose can not be achieved. As the saying goes, "three-point treatment and seven-point nutrition", through reasonable nursing, can alleviate the pain of patients, shorten the course of treatment and recover as soon as possible. Therefore, nursing plays a very important role in the treatment of vascular diseases of limbs.
Nursing characteristics:
1. Nursing is both * * * and personalized: whether the lesion is located in artery or vein, the peripheral circulation is damaged, and the tissue blood perfusion is reduced. When the blood flow decreases to the point where it can't meet the oxygen and nutrition required by tissue metabolism, tissue ischemia and hypoxia will occur, which will show many similar symptoms in clinic, such as chills in the affected limbs. With the development of the disease, acromegaly, infection, gangrene and other malnutrition changes gradually appear, so the nursing of arteriovenous diseases has certain characteristics. At the same time, the etiology, severity, scope and development of each disease are different, and patients' working and living habits are different, so are their clinical manifestations. Therefore, the formulation of nursing measures should also be treated according to people, illness and illness.
2. Education and guidance for patients is the guarantee for the effective implementation of nursing plan: many methods of treatment and nursing for vascular diseases have their particularity and strict indications. For example, the arterial blood supply is insufficient, and the affected limb should be below the heart level, so that the symptoms can be alleviated, while venous diseases are just the opposite. Elastic bandage can promote venous return, protect and support venous diseases, but if used improperly, it will aggravate blood stasis. It is very important for patients with venous diseases to choose the correct rest posture. Therefore, the nursing measures to maintain the tissue integrity of the affected limb are meticulous and trivial, which runs through the daily work and life of patients. Patients must also be guided and educated by professionals in order to cooperate with the implementation of various nursing programs and learn to carry out long-term self-health training.
3. Psychological care: The pain caused by tissue ischemia and hypoxia caused by vascular diseases is chronic and long-term, which reduces the patient's activity ability, affects sleep, makes his mood easily excited or inhibited, and makes him depressed and suicidal. The condition is aggravated, there are long-term unhealed ulcers, tissue gangrene needs amputation, hospitalization for many times, medical expenses increase, and the unit and family are in trouble; Or the abnormal appearance caused by lymphedema will cause different degrees of psychological impact. Therefore, psychological nursing is an important part of patients' holistic nursing.
First, some problems and solutions in the care of vascular diseases.
In view of the common characteristics of vascular diseases, such as tissue ischemia caused by damaged circulation, the primary purpose of nursing is to promote circulation, reduce tissue ischemia or prevent its further development, followed by alleviating the pain caused by ischemia and preventing tissue integrity damage such as ulcer and gangrene that may be caused by tissue malnutrition. Education and guidance on patients' disease knowledge and nursing techniques can ensure that all nursing measures can be implemented smoothly and correctly, and better achieve the purpose of controlling illness and preventing complications.
(a) insufficient tissue perfusion
Nursing goal: to increase tissue perfusion and relieve clinical symptoms. In order to increase tissue perfusion and provide enough oxygen and nutrients for tissue metabolism, nursing measures mainly start with promoting the establishment of collateral circulation, avoiding vasospasm and protecting the affected limb.
1. Promote the establishment of collateral circulation: For patients with chronic arterial insufficiency, the insufficiency of collateral circulation directly affects tissue perfusion, and ischemic pain in the affected limb will limit the patient's activities and is not conducive to the establishment of collateral circulation. The muscles of the affected limb will atrophy due to insufficient blood supply and disuse. Exercise in a planned and step-by-step manner. Increasing activities can promote the establishment of collateral circulation and increase the perfusion of peripheral tissues. Walking and Buerger exercise are often used.
2. Quit smoking and adjust your mentality: Nicotine, alcohol and mood swings will excite sympathetic nerves and cause vasospasm. Patients should be helped to quit smoking and drink less or no caffeinated drinks in their diet. Traumatic patients should adhere to a low-fat and low-sugar diet because they eat little or no irritating food. Patients with arteriosclerosis or diabetes should adhere to a low-fat and low-sugar diet.
3. Avoid oppressing the affected limb: too tight clothes, sitting cross-legged or crossing your legs on your knees, and putting things down in the popliteal fossa can compress blood vessels and affect arterial blood supply, which should be avoided as much as possible.
4. Keep warm: Contact with cold air and direct contact with cold objects will cause arterial contraction or spasm. Keep the indoor temperature and humidity appropriate and avoid direct contact with cold water. Pay attention to keep warm when going out in cold season. Normal people keep warm half a month or a month in advance to avoid exposing their limbs. Clothes, pants, shoes and socks should be loose and soft.
5. Protect the affected limb from injury: The affected limb with insufficient arterial blood supply may have a lasting ulcer under slight stimulation. Therefore, scratching and forcibly scrubbing the affected limb should be avoided. Those with blisters, ulcers or gangrene should keep local cleanliness and actively adopt correct treatment methods. Patients with severe blood supply should avoid taking a bath with hot water, so as not to increase tissue metabolism, aggravate tissue hypoxia, make the disease develop faster and aggravate symptoms.
(b) venous reflux disorder
Nursing goal: to reduce edema of the affected limb. In order to achieve the purpose of reducing venous stasis, promoting venous return and reducing edema of affected limbs, nursing measures mainly start from the following aspects.
1. posture: the affected limb should be higher than the heart level under the action of gravity. Patients should avoid keeping the same posture for a long time. When they have to stand, they should constantly bend and stretch the affected limb to promote venous return through the action of muscle pump.
2. Exercise: For venous diseases of lower limbs, proper ground walking exercise can be carried out to promote the establishment of collateral circulation and improve venous return.
3. Others: Patients who often work standing or sitting should wear elastic bandages or elastic socks.
(3) improving pain symptoms
Nursing goal: relieving or alleviating pain. The main nursing measures: promoting peripheral circulation, increasing tissue perfusion and promoting venous reflux are the fundamental measures to solve pain. Appropriate nursing measures can effectively relieve or alleviate pain. In addition, the pain often appears or worsens after the activity, so it is often manifested as a decrease in exercise and poor sleep, which makes the patient fidgety, irritable or depressed and unable to actively participate in and cooperate with the nursing staff to implement the exercise plan. Therefore, it is necessary to give it in time.
(d) Nursing care of potential tissue integrity damage
Nursing objectives: skin or tissue injury, vascular disease, decreased tissue perfusion, malnutrition, etc. It will not happen or worsen because of improper care. The outermost skin tissue of the limb is the most easily damaged part, which is easily injured by minor injuries. Once damaged, it will easily evolve into a long-term unhealed ulcer. Therefore, it should play a role in the initial stage of tissue perfusion reduction. Careful preventive skin care, especially the care of lower limbs and feet, combined with vitamin B 1 C and high protein diet, can strengthen nutrition and be beneficial to wound healing. If the disease develops rapidly and ulcer or gangrene appears in the tissue, it should be found in time and corresponding nursing measures should be taken.
(5) Nursing care of self-care defects
Patients with vascular diseases of limbs are completely or partially affected by severe pain, ulcer, gangrene or swelling of limbs, or their activities are limited due to treatment needs. In the early stage of bed rest, nurses should take the initiative to implement bedside care, including assisting in eating, drinking, defecating, cleaning, entertainment, etc., to meet patients' basic needs, eliminate patients' sense of helplessness, and comprehensively evaluate patients' self-care ability, self-care potential, learning desire and stress ability. Work out a training plan together with patients and their families, and advise their families to provide necessary material conditions and environment for patients, encourage patients to study consciously, fully mobilize their self-care potential, reduce their dependence on others, and gradually overcome the psychological barriers of self-care defects. In the process of implementing the training plan, we should actively assist patients to complete the therapeutic self-care needs, make up for the lack of patients' self-care ability, and provide help and guidance for patients to establish a new self-care model. Due to malnutrition, the limbs of patients with vascular diseases of limbs are prone to complex and refractory complications such as ulcer, cellulitis or gangrene. These complications are all due to insufficient arterial blood supply or venous reflux disorder, or lack of active preventive and nursing measures and protective support measures for distal tissues from the early stage of the disease, or failure to adhere to them for a long time. Ischemic malnutrition, the distal tissues of the affected limbs, especially the outermost skin tissues of the human body, will gradually become thin and dry. Lack of elasticity, easy to be chapped or broken due to trauma, thinning hair, thickening, brittle or deformed toenails, etc. In particular, long-term malnutrition makes it difficult to trim toenails, and abnormal feelings of tissue ischemia, such as numbness, tingling, itching and ant walking, occur due to peripheral nerve involvement. , so that the ischemic site loses its normal judgment of hot and cold.
(1) cleanliness
Wash your feet with warm water and mild and less irritating soap every day, and dry them thoroughly with a towel, especially between your toes, so as not to scratch your skin and cause ulcers.
(2) Moisturize the skin
In order to avoid wet feet as much as possible, wear cotton socks with good moisture absorption and shoes with good air permeability, and change them every day. Avoid wearing canvas shoes or rubber shoes that make your feet sweat easily to prevent dry skin. Don't expose your feet to the sun. When your feet are too dry, you can apply a thin layer of lanolin or water-containing lubricant and gently wipe your skin. Avoid using emulsion containing alcohol or perfume.
(3) Safety
We should try our best to avoid the trauma and oppression of peripheral tissues, and insist on practicing walking on the flat ground without obstacles; Don't go through the crowded crowd; Wear loose and comfortable shoes, don't wear high heels, and don't squeeze your toes. Before wearing shoes, check whether there are foreign objects in them, don't walk barefoot, and wear protective socks at night. To prevent mosquito bites and itchy skin in summer, you can use antipruritic agents instead of scratching them with your hands; To trim your nails, first soak your toenails in warm water and cut them flat with a nail knife when the light is good. Patients with abnormal thickening or diabetes should be pruned more carefully. It is advisable to wash your feet with warm water (about 32℃) to prevent burns, and you can't use hot water bags or electric mattresses to directly contact the affected parts of the affected limbs; Keep warm, don't expose the focus to cold air, and don't wash hands, feet or swim in cold water.
(4) Practice
Body position and foot exercise can promote blood circulation and establish collateral circulation. For patients with insufficient blood supply to the lower limbs, Allen—Buerger exercise should be done regularly in order to relieve the pain of the affected limbs, increase the collateral circulation of the affected limbs and improve the blood supply deficiency of the lower limbs. The method is: the patient lies on the bed, raises his lower limbs above 45 degrees, and persists until the skin of the foot turns white, so that the blood in the lower limbs is evacuated, and the time for raising the affected limb is 30 minutes. Then the patient sat up with his lower limbs hanging under the bed. At the same time, his feet do adduction, abduction or flexion and extension of the ankle joint. When exercising, the amplitude should not be too large or too fast until the skin of the affected limb is red or purple, and the suspension time is generally 2 ~ 3 minutes. Finally, the patient lay on his back for 65,438+0 ~ 3 minutes and repeated the above actions.