2 English reference tetanus [Xiangya Medical Dictionary]
3. Summarize the injury and spasm as the disease name [1]. Published fifty-two prescriptions for diseases. That is tetanus [1]. Spasm caused by trauma. "Fifty-two Diseases Prescription": "Injury spasm: those who suffer from spasm, injury, wind entering injury, stretching but unable to bend." "The wind hurts, it hurts." We have a correct understanding of spasticity caused by traumatic infection.
Tetanus is the name of this disease. See Secret Recipe of Immortal Healing and Dipsacus. Also known as traumatic spasm [4], traumatic spasm and traumatic stroke spasm [3]. Refers to the acute specific infection caused by tetanus Bacillus [5]. Its clinical characteristics are a history of flesh and blood injury, a certain incubation period, systemic muscle twitching and paroxysmal. During convulsion, the muscles of the whole body are still tense and stiff, accompanied by fever, but they are conscious and often die of complications.
The name tetanus first appeared in Taiping Shenghui Fang in the Song Dynasty. It said, "Stiff body, unable to open mouth, trembling limbs, aching bones and inclined face. These injuries are caused by wind evil, hence the name tetanus. "
Wind poison is widespread, which not only occurs in skin and flesh trauma, but also causes tetanus due to lax disinfection during operation, or neonatal umbilical cord pollution, or improper handling of labor abortion, or bedsore poisoning. Those caused by trauma are called Jin Chuang spasm; Postpartum spasm is called postpartum spasm; If the newborn is caused by umbilical cord rupture, it is called umbilical wind aspiration.
This disease is also called tetanus in western medicine.
4. Etiology and pathogenesis of spasm; Spasm is caused by wind invading the skin, destroying wounds or sores affected by pathogenic factors [3][4]. It is caused by wind and poison attacking collaterals and causing internal wind [4]. Modern medicine has confirmed that this disease is a symptom caused by tetanus invading the human body from the wound and rapidly multiplying in an anoxic environment to produce bacterial toxins [4].
Spastic diseases are caused by broken flesh and blood, and also feel the evil of wind and poison. The evil of wind and poison invades people from the body. Wind is the evil of yang, because it is fickle several times. External wind causes liver wind to move inward, wind poison invades people for a long time, and turns heat into fire, causing visceral imbalance, disharmony between qi and blood, yin damaging yang, and even yin and yang dying.
The symptoms of spasm begin with weakness of limbs, headache, sore cheeks, stiff neck rotation, fever and chills, and then hemifacial spasm, wry smile, gnashing of teeth, strong tongue, salivation, even systemic muscle tension, paroxysmal limb convulsions, varus angulus, frequent attacks, and finally difficulties in language, swallowing and breathing, and even suffocation. Frequent seizures, mild seizures can induce convulsions [4]. If the course of disease progresses rapidly, the prognosis will be poor [4].
6 Diagnosis of Spasm 6. 1 The incubation period is generally about 10 days, the shortest can be 1-2 days, and the elderly can range from half a month to two months. Umbilical cord poisoning usually occurs in 5-7 days, so it is also called seven-day wind. The shorter the incubation period, the more serious the illness and the worse the prognosis.
6.2 The prodromal period is short, only 1-2 days, with fatigue, dizziness, headache, general malaise, weakness in chewing, chills and low fever, irritability, slight tension in the jaw and slight difficulty in opening the mouth. Hyperreflexia. There are more wounds than pus, and the surrounding skin is dark red, which has pain and containment.
6.3 The typical seizure symptoms during the seizure period are muscle tonic spasm and paroxysmal convulsion. Muscle tonic spasm is masticatory muscle at first, followed by facial muscle, neck muscle, abdominal dorsal muscle, limb muscle group, diaphragm muscle and intercostal muscle. The patient began to find it inconvenient to chew and difficult to open his mouth. Then his teeth clenched, his mouth pulled outward, his forehead wrinkled, his eyebrows raised and he smiled bitterly. Then the neck is strong and true, the head leans back, and the spasm extends to the limbs, showing that you can't sit up, your head can't lean forward, and your waist is protruding, which is called angular arch inversion. When the muscles of the limbs contract, because the flexors are more powerful than the extensors, the limbs can bend their knees, elbows and half-clenched fists.
Spasm of diaphragm and intercostal muscle may lead to dyspnea and even asphyxia. Rectum and bladder spasm can cause constipation and urinary retention. Paroxysmal convulsion refers to a person with a serious illness. When muscle tonic spasm occurs, the whole body muscles have paroxysmal convulsions, which are characterized by spontaneous and paroxysmal seizures.
During the spasmodic interval, the patient's muscles are also spasmodic, which is the characteristic of this disease. Strong light, sound, wind blowing, drinking water and touching can all cause convulsions. Each convulsion can last for several minutes to several minutes. The patient's face is pale, his lips are blue, he is sweating profusely, his mouth is watering, he is foaming at the mouth, his teeth are rubbing, and he is short of breath.
Atypical attack, only local muscle rigidity at the broken end appeared, and it did not spread to the whole body.
In the late stage of the disease, patients suffer from long-term muscle rigidity, spasm, convulsion and underexposure, leading to physical exhaustion, pallor, malnutrition, water and electrolyte disorder, acidosis, severe lung infection, or respiratory muscle paralysis leading to suffocation and myocardial paralysis leading to death.
6.4 Auxiliary examination showed that leukocytosis increased during the attack, and tetanus Bacillus grew in wound pus culture.
7 Diseases that need to be differentiated from injuries and spasms 7. 1 The manifestations of purulent meningitis are the same as those of tetanus, such as stiff neck and varus cornus, but purulent meningitis has no paroxysmal convulsions. There are also severe headaches, high fever, jet vomiting, lethargy and coma. Cerebrospinal fluid examination showed a large number of white blood cells.
7.2 Rabies Rabies has a history of being bitten by cats and dogs, but rabies patients are both excited and afraid. When they see or hear underwater sounds, they will have swallowing muscle spasms, which is called "water phobia". It can cause loud vomiting due to diaphragm contraction, such as dog barking.
8 Treatment of spasms The treatment of tetanus should first be based on expelling wind and relieving spasms, taking Yuzhen Powder or Wuhuzhuifeng Powder, or taking Daifan Powder (cicada slough 30g, finely ground) and slightly sweaty clothes with hot yellow wine [3]. External treatment should be debrided, expanded and applied to earthquake dispersion [3]. In the later stage, it is necessary to dispel wind, detoxify and relieve spasm, add and subtract Muyu powder, and cooperate with acupuncture [3]. Or inject tetanus antitoxin [3].
8. 1 Syndrome Differentiation and Treatment 8. 1. 1 Wind-toxin exterior-interior tetanus refers to the common symptoms of wind-toxin exterior-interior tetanus, such as mild dysphagia, clenching teeth, general anxiety, mild convulsions, short spasms and long intervals [5].
8. 1. 1. 1 Symptoms include mild dysphagia, clenched teeth, general anxiety, mild convulsion, short spasm and long interval; The tongue is pale, the coating is thin and white, and the pulse is rapid.
8. 1.65438+ Wind pathogen is on the exterior, and the spasm period is short and the intermission period is long when the pathogen is mild; Light tongue, thin and white fur and rapid pulse are the signs of wind evil in the exterior.
8. 1. 1.3 Treatment of expelling wind and relieving spasm.
8. 1. 1.4 Prescription treatment of Yuzhen powder and Wuhuzhuifeng powder.
8. 1.2 wind-toxic tetanus refers to wind-toxic tetanus, muscle spasm, high fever, cyanosis, shortness of breath, excessive phlegm and saliva, stuffy chest and abdomen, hard abdominal wall, sweating and constipation.
8. 1.2. 1 Symptoms: limb twitching, upturned horn arch, high fever and chills, muscle spasm all over the body, short interval, blue complexion, shortness of breath, excessive phlegm and saliva, stuffy chest and abdomen, sweating, constipation, and urinary obstruction; Red tongue, yellow fur and thready pulse.
8. 1.2.2 Dialectical analysis shows that the entry of evil wind triggers the internal wind, so the limbs twitch, the angular arch is reversed and the muscle spasms; The wind from cremation, Yangming dry and hot, so always sweating, chest and abdomen full of stuffy, constipation knot; When heat is confined to the lungs, shortness of breath and excessive sputum will occur; If the heat is confined in the bladder, the urine will be blocked; Evil people's liver meridian, then the face is blue; When evil forces fight orthogonally, they will have high fever and chills; Red tongue, yellow fur, little body fluid, and thready pulse are the signs of toxic evil.
8. 1.2.3 treatment: calming wind and relieving spasm, clearing away heat and toxic materials.
8. 1.2.4 Muyu powder prescription.
8. 1.3 Type of tetanus with yin deficiency and hyperactivity of pathogenic factors refers to tetanus with the common symptoms of spasticity, dizziness, palpitation, thirst, sallow complexion, occasional sweating, toothache discomfort, occasional spasm or discomfort in flexion and extension, or ant feeling on the skin, red tongue and weak pulse.
8. 1.3. 1 Symptoms: dizziness, pale or sallow complexion, pale lips, palpitation and insomnia, numbness of hands and feet, and unfavorable flexion and extension; Red tongue with little fur and weak pulse.
8. 1.3.2 Dialectical analysis shows that there is a fierce struggle between the positive and the evil, wind and poison are frustrated, healthy qi is also injured, and yin and blood are exhausted. If you can't cash it, you will feel dizzy, pale or yellow, pale lips, yin deficiency and blood deficiency, and your heart will lose support, so palpitation and insomnia; Lack of nourishment of meridians leads to numbness of hands and feet, which is not conducive to flexion and extension; Red tongue with little coating and weak pulse are manifestations of yin-blood deficiency.
8. 1.3.3 Therapeutic methods of nourishing blood, nourishing yin and dredging collaterals.
8. 1.3.4 Prescription treatment of Siwu decoction and Shashen Maidong decoction.
8.2 After tetanus antitoxin 1 hour is used in external treatment, it is feasible to debride and remove necrotic tissue, open the wound, rinse it with hydrogen peroxide first, and then fill it with hydrogen peroxide wet gauze. Wash the dressing with hydrogen peroxide every day and disinfect it strictly after dressing change. When there is residual necrotic tissue on the wound surface, Qisandan can be mixed with cloth; After the wound is cleaned, mix it with a cloth to produce muscle powder.
8.3 Points for attention in acupuncture and moxibustion treatment: both body acupuncture and ear acupuncture can be treated 1 ~ 3 times a day, or the needle can be separated for several hours to 1 ~ 2 days for a long time, but it is necessary to prevent needle sticking and needle folding [4]. After the symptoms are controlled, intradermal needles can be used for several hours to several days [4]. Generally speaking, comprehensive therapy is often used for this disease, and acupuncture can be used as an auxiliary therapy [4].
8.3. 1 body acupuncture 8.3. 1. 1 formula 1 Dazhui, Fengfu, Renzhong, Suo Jing, Fengchi, Taichong, Hegu and Yanglingquan are the main acupoints [4]. Close your teeth and go to Shimonoseki, underground warehouse, cheek car; Corner bow resistance Zhang Jiayao Yangguan, Chengshan and Houxi; Tetraplegia plus Yanglingquan, Taichong and Quchi [4].
8.3. 1.2 Fang Er gritted his teeth and selected points as Xiaguan, Cheek Car, Hegu and Inner Chamber.
The horn bow extends backward to take points such as Fengfu, Dazhui, Changqiang, Chengshan and Kunlun.
Acupoints for limb twitching include Quchi, Waiguan, Hegu, Houxi, Shi Feng, Yanglingquan, Shenmai and Taichong.
8.3.2 Ear acupuncture takes the middle points of brain, pillow, heart, Shenmen and margin, and the middle points are strong.
8.4 Other therapies 8.4. 1 Application of tetanus antitoxin Once the diagnosis is made, tetanus antitoxin should be used as soon as possible. The dose of antitoxin should be increased for the first time, and then reduced according to the condition. For the first injection, 50,000 ~ 654.38+10,000 units should be added to 500 ~ 654.38+0000 ml normal saline or 5% glucose solution for slow intravenous drip. In the future, depending on the condition, you can inject 10000 ~ 20000 units intravenously or intramuscularly every day for 7 days. Allergy test should be done before antitoxin injection to avoid allergic reaction. Those with positive skin test should receive desensitization injection: neonatal tetanus can be blocked by 0.5-65,438+0,000 units of tetanus antitoxin and 30-50,000 units of penicillin, plus 0.5% procaine solution 10 ml.
8.4.2 antispasmodic drugs can stabilize patients and reduce their sensitivity to the outside world, but if patients are in a quiet sleep state for a long time, the possibility of cure is greatly increased. Generally, chloral hydrate 10 15mL or 3040mL *** can be taken orally every time. Barbiturates, such as Lumina 0. 1-0.2g, were injected intramuscularly. Or diazepam 5 5- 10/0mg orally, 3-4 times a day, or10mg intravenously. When convulsion is particularly serious, intramuscular injection or intravenous injection 10% ~ 25% magnesium sulfate solution 10 ml can be used. In case of emergency, 2.5% thiopental sodium, 0.5- 1G each time, can be injected intramuscularly or intravenously and slowly dissolved in 500-1000 ml of 5% glucose solution. Close observation should be made during medication to prevent respiratory depression.
Hibernation therapy: the effect is good. Commonly used hibernating job number (chlorpromazine 50mg, promethazine 50mg, Demerol 100 mg) or hibernating mixture M (acetaminophen replaces chlorpromazine 20mg in job number, otherwise the same), with the dosage of 1/3- 1/2 each time, and intramuscular injection of 65438 every 4-8 hours.
8.4.3 Supportive therapy should give patients a high-calorie and nutritious diet with high carbohydrate and high protein, use a lot of vitamins, especially vitamin B and vitamin C, and enough water and electrolyte, and pay attention to correct acid-base imbalance, and inject new blood or plasma when necessary. If the patient can't eat, nasal feeding or intravenous hypernutrition therapy can be used:
9 prevent spasm 1. The wound should be thoroughly debrided in the early stage and washed repeatedly with hydrogen peroxide, especially for contaminated or deep wounds.
2. Routine use of tetanus antitoxin after injury shall not exceed 24 hours at the latest.
3. The patient isolation monitoring, keep the environment quiet. Avoid light, sound and shock. Pay attention to the care of the mouth and skin, and pay attention to nutrition.
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