Vasculitis
Introduction
Introduction to vasculitis The full name of vasculitis is "thrombotic occlusive vasculitis", which is an allergic inflammation that occurs in blood vessels, leading to segmental stenosis and occlusion of small and medium arteries, loss of nutrition in the extremities, ulceration and necrosis, and is a more stubborn blood vessel. The disease, which is an inflammatory manifestation of the blood vessel wall itself, has nothing to do with bacterial infection. The high-risk groups suffering from vasculitis are smokers (especially young men), nervous men, unbalanced nutrition, residents in cold and humid areas, and family genetic factors. The vast majority of men occur in men between the ages of 20 and 40, and women are rare. Vasculitis is an inflammatory manifestation of the blood vessel wall itself and has nothing to do with bacterial infection. Normal blood vessels are divided into inner, middle and outer layers. The inner layer is very smooth, with blood flowing inside; the middle layer is the muscle layer, which keeps the elasticity of the blood vessels; the outer layer is a very smooth structure separated from other tissues. The vascular wall of vasculitis is involved in the lesion from the inner and outer layers. The inflammatory changes in the inner layer cause vascular stenosis. The middle layer changes the muscles and the elasticity is poor. The nerves, the outer membrane and the muscles around the blood vessels also participate in the inflammation. Sexual changes produce a range of symptoms. basic knowledge The proportion of illness: 0.004%-0.007%, (more common in patients with frequent infusion) Susceptible people: young adults Mode of infection: non-infectious Complications: muscle atrophy
Cause
Cause of vasculitis
Western medicine believes that the etiology of vasculitis
Mold infection (20%):
Mold infection, in addition, after many years of clinical observation, many patients have had a history of trauma before the onset of illness, some have been injured a few years ago, or even more than 10 years ago. Therefore, it is believed that traumatic blood stasis and chronic persistent infection are also one of the causes. These factors are not directly caused by small and medium arteriovenous fistula, non-suppurative inflammation, and increased blood viscosity, leading to thrombosis, even occlusion of blood flow, limb blood supply disorders, is the main pathogenesis of vasculitis.
Smoking (20%):
Nicotine causes vasoconstriction. A large number of studies have shown that smoking can cause vasoconstriction, but only for capillaries, almost no effect on small and medium arteries, and vasculitis is mainly small and medium arterial disease, so smoking is only an external factor after small and medium arterial lesions.
Low temperature stimulation (20%):
Cold stimuli cause vasospasm.
Hormone level disorder (10%):
Disorders of hormone levels, autonomic cerebral palsy, can cause vasomotor dysfunction.
Chinese medicine believes that the etiology of vasculitis
(1) cold and wet invasion, stagnation veins.
(2) Traumatic blood stasis, block the veins.
(3) emotional disorders, qi stagnation and blood stasis. The above factors block the meridians, make the blood and blood run poorly, can not reach the extremities, the limbs lose the warmth of blood and blood, and cause pain, ulceration, and even necrosis are the main pathogenesis of dislocation.
Prevention
Vasculitis prevention
(1) Avoiding trauma
Patients should avoid trauma, especially the affected limb. Due to poor blood circulation and poor disease resistance in patients with vasculitis, the wound is easily infected after trauma, and the wound is not easy to heal. Therefore, patients must protect the ischemic limbs. Patients must wear wide and comfortable shoes and socks to avoid scratches caused by local friction. Toenails should be trimmed in time to avoid excessive tearing and flesh, and should not be damaged during trimming. Peel; armor, corns, sputum and other foot diseases should not be damaged by internal tissues and blood vessels during treatment. Do not arbitrarily apply irritating drugs after injury to prevent chemical damage. Because these strong chemicals (such as iodine) can not only not receive the expected results, but will cause greater damage to local tissues.
(2) Do not smoke
(three) limb training
Functional exercise not only prevents muscle atrophy, but also increases blood flow to the limbs, promoting the opening of the vascular branch and maintaining the limb's ability to move. However, the exercise of the affected limb cannot be performed too quickly, and the amount of activity should be appropriate. Because the affected limb itself is in an ischemic state, symptoms may be aggravated when excessive activity occurs. The activities mentioned here are appropriate, so as not to cause physical pain.
(4) Pay attention to diet and nursed back to health
Diet should be light, nutritious food, eat more fruits and vegetables, drink more water, eat more black fungus, eat less or not eat sticky food, such as glutinous rice noodles, rice cake, sesame sugar, etc., these foods can make blood viscosity Increased, blood flow slows, causing thrombosis, completely occluded the already narrow artery. A small dose of aspirin can be taken under the guidance of a doctor. Stay in a good mood, live, study and work with full of passion and energy. Patients with initial symptoms should be diagnosed in time and actively treated to achieve early detection and early treatment.
(5) Other matters needing attention
1, adhere to the treatment on time, according to the treatment, do not arbitrarily interrupt.
2. Maintain adequate sleep (8-12 hours) every day during treatment.
3, need to avoid alcohol and spicy stimulating items in the medication.
4, do not use drugs, especially anesthetics, anti-inflammatory drugs, the more serious the disease, the consequences are very dangerous.
(6) Avoid cold stimulation
Keep warm during the cold season. The cold will cause the blood vessels to contract, the blood flow to be reduced, and the symptoms caused by ischemia become more serious. This shows the importance of warmth of the limbs. The physiotherapeutic measures for patients with vasculitis are:
1. The patient's clothes should be wide and warm, not too small or too tight, affecting blood running, and not letting the affected limbs get cold.
2, winter patients should prepare special cotton, cotton socks, cotton shoes to protect the affected limbs, these cold clothing is easy to put on and off, warmth is the principle.
3. In addition to local necrosis of the affected limb, the affected limb should be washed once a day with warm water. It is better to use a symptomatic drug.
4, local hot water bottle or Chinese medicine.
Complication
Vasculitis complications Complications muscle atrophy
If vasculitis is not treated in time, there may be ischemic pathological changes in tissues such as nerves, muscles, and bones. If there is a local infection, there may be symptoms of systemic toxic blood such as fever, chills, and irritability. Limb tissue ischemia is more severe, causing ulcers or gangrene. Mostly dry gangrene, if secondary infection, it is wet gangrene. The symptoms of systemic poisoning caused by the toxins or other toxins produced by bacteria entering the blood circulation are called toxemia.
Symptom
Symptoms of vascular inflammation Common symptoms Skin dry and cold skin dry refers to (toe) numb foot and posterior tibial artery... Skin temperature reduces lower limb skin nutrition changes distal numbness of limbs, ... Partial skin of the limbs...
There are many symptoms of vasculitis, because the onset of vasculitis is insidious, slow progress, and periodic episodes, usually after 2 to 3 years to be discovered.
The symptoms of specific vasculitis are:
1. Pain: Early patients walk a certain distance at a certain speed and feel that the calf or foot is sore and painful, and they are forced to rest or slow to relieve. Sudden pain in the later stage, especially at night, forms a resting pain, often causing the patient to sit on his knees.
2. Cool and abnormal feeling: The affected limb is cold and cold, and it is very sensitive to cold, especially the finger (toe) end. Because the nerve endings are slightly affected by ischemia, the affected limb may have abnormal feelings such as pain, acupuncture, numbness, burning sensation.
3. Changes in skin color: The skin color is abnormally pale due to arterial ischemia. Because the superficial vein tension is reduced, the skin will also appear flushed or cyanotic on the basis of paleness, and the limbs are more obvious when drooping.
4. Arterial pulsation weakened or disappeared: As the disease progressed, the pulsation of the dorsal and posterior tibial arteries disappeared or weakened, while the skin was dry and ruptured, sweat stopped, no sweat, and the nails were thickened and deformed to form a sulcus. Nutritional disorders such as inflammation.
5. Gangrene and ulcers: If the treatment is not timely in the later stage of vasculitis, combined with mistreatment, trauma, hot compress, etc., it is easy to form ulcers and dry necrosis.
6, migratory thrombophlebitis (red nodules): about 50% of patients before and during the onset of the disease, the calf or superficial veins of the foot repeatedly migratory thrombophlebitis, red The nodules are nodular, accompanied by mild pain. After 2-3 weeks of acute onset, the symptoms subsided, and after the regression, there was pigmentation, one self-healing, and another.
Clinical features of vasculitis
(1) The limbs, especially the toes, are cold, chills, numbness and paresthesia are common early symptoms.
(2) Pain is the main symptom of this disease, which is expressed as:
1 Intermittent claudication: When the patient walks for a long distance, the calf or foot muscles develop numbness, soreness, pain, convulsions, weakness and other symptoms. If you continue walking, the symptoms will be aggravated, and finally you will be forced to stop. After standing and resting for a while, The pain is relieved quickly and can continue to walk, but the above symptoms reappear after walking. This symptom is called intermittent claudication and is a typical manifestation of insufficient blood supply to the lower extremity arteries.
2 Resting pain: When the arterial ischemia is severe, the pain of the affected limb is severe and sustained. The pain is still not enough at rest, and it is difficult to sleep at night. Even the toe rupture and infection, the pain is more severe.
(3) Limb dystrophy: manifested as thickening and deforming of the toenail, dry skin, hair loss, atrophy of the calf or foot muscles, etc. When the disease progresses, the ischemic dryness and necrosis of the toe end occur.
Examine
Vasculitis examination
After obtaining detailed information on the patient's symptoms and medical history, we will conduct a physical examination of the patient. The purpose of the examination is to clarify the blood supply of the limb arteries of the patient, including examination of the skin color, temperature, nutritional status and arterial pulsation of the limbs of the patient. When checking the body, you should pay attention to the correct and comprehensive application method, and do not miss the item. The main points are:
1. Regardless of whether the symptoms are single or both limbs, both limbs should be examined at the same time. When the affected limb is a unilateral limb, the normal contralateral side can be used as a control; when both limbs are sick, the proximal side of the ipsilateral limb is used as a control.
2. The color of our Chinese people is slightly yellow. When checking the color of the skin, pay attention to the check of the limbs. If one side is pale or yellow on the opposite side, the arterial blood supply may be considered insufficient; if there is intermittent claudication, and the skin color is normal during the examination, further limb height test is required. The method is to raise the bilateral lower limbs at a 70? angle for 60 seconds. If the skin color is pale, it still indicates arterial stenosis or occlusion.
3. When using the percussion method to check the skin temperature of the limbs, it should be noted that the examiner uses the symmetrical part of the back of the three fingers on the ulnar side to touch the limb. If it is significantly lower than the contralateral side, it indicates that the limb is insufficiently supplied with blood. . The skin temperature at the distal extremities and joints of the same limb is slightly lower than that of the proximal heart and muscles. However, if the skin temperature of the distal limb is significantly lower than that of the proximal limb, the blood supply to the distal limb is also insufficient.
4. Skin nutrition check contents include: skin texture, elasticity, hair, claws and muscles. Nutritional disorders caused by severe chronic ischemia are characterized by thin skin, dryness, desquamation, loss of elasticity, slow growth of toenail, thickening, sparse or complete hair loss, muscle atrophy; late ulcers or gangrene at the end of the limb.
5. When doing peripheral pulsation examination, also pay attention to touching the limb arterial pulsation at the same time, such as one side weakened or disappeared, the other side normalized to weaken the side limb artery stenosis or occlusion, such as bilateral arteries are weak or inaccessible, Be considered for reasons other than obesity, edema or congenital variation.
Diagnosis
Diagnosis and diagnosis of vasculitis
Self-diagnosis
1. Check whether the dorsal artery of the foot is normal or not. If there is normal pulsation, vasculitis can be ruled out. This is the simplest screening test. If the dorsal artery of the foot is palpated without pulsation or only weak pulsation, further examination is needed, and the internationally accepted non-invasive vascular examination / index is used as an objective standard for diagnosing vasculitis. Whether the middle and small arteries are ischemic, and according to their numerical values can objectively reflect the degree of arterial ischemia of the lower extremities. The results of angiography in patients with vasculitis must be consistent with the results of the / index measurement.
2, it must be emphasized that the course of vasculitis is long, the condition is serious, and the treatment of 10,000 is not too urgent. It cannot be changed yesterday, and the duration of treatment should be more than 3 months.
3. For patients with vasculitis with obvious blood vessel obstruction or ulceration, such as ischemia and gangrene, the course of disease is prolonged. Therefore, when there is abnormal change in the foot, it should be treated early and miss the best treatment time. So as not to delay the disease.
Vasculitis should be distinguished from the following diseases:
(a) Raynaud syndrome
The clinical tension of the acromion caused by vascular nerve outcome disorder is that when the cold or emotional impulse, the skin color of the finger (toe) suddenly turns pale, then purple, and then turns into flushing, then Normal recovery, a small number of patients with vasculitis, the early manifestations of Raynaud's syndrome, and therefore must be distinguished. The characteristics of Raynaud's syndrome are as follows:
1 mostly young women;
2 The location of the disease is mostly finger, and often is a symmetric disease;
3 The arterial pulse of the affected limb is normal, and even if the disease course is long, the genital tract is rarely produced.
(two) occlusive atherosclerosis
Both vasculitis and occlusive atherosclerosis are chronic occlusive venous lesions, which are similar in terms of symptoms, signs, and course of disease, but occlusive atherosclerosis has the following characteristics:
1 patients are older, mostly over 50 years old, not sure of smoking hobbies;
2 often accompanied by high blood pressure, high blood lipids, coronary heart disease, arteriosclerosis or diabetes;
3 lesions of the arteries are often large, medium-sized arteries, such as the abdominal aorta bifurcation, radial artery, femoral artery or radial artery, rarely the upper extremity artery;
4X-ray film can show irregular calcification shadows in the arteries;
5 no manifestation of no migratory thrombophlebitis.
(three) multiple arteritis
More common in young women; lesions often involve multiple aorta; active low fever, increased erythrocyte sedimentation rate; angiographic manifestations of aortic tension branch cramps or sputum closure.
(four) nodular arteritis
In this disease, the small and dynamic limbs of the disease can have ischemic symptoms similar to vasculitis, and its characteristics are:
1 lesions often involve the kidney, heart, liver, gastrointestinal tract and other arteries;
2 subcutaneous, nodules, purple spots, ischemia or bad death;
3 often have fever, fatigue, increased erythrocyte sedimentation rate and hyperglobulinemia;
4 diagnosis is often required to check the living structure.
(5) Diabetic gangrene
When vasculitis produces gangrene of the extremities, it needs to be distinguished from diabetic gangrene. Diabetes patients have a history of thirst, hunger and polyuria. Urine sugar is positive and blood sugar is increased.
