2020年11月21日星期六

hemorrhoids bleeding treatment,Common TCM diagnosis and treatment methods in anorectal department

    1. Chinese medicine fumigation

    Composition of hemorrhoid lotion:

    Houttuynia cordata 100g Alum 20g Glauber's salt 30g Smilax glabra 30g borneol 2g

    Operation method:

    Add 250ml lotion to 1000ml with boiling water, smoke first and then wash

    Functions and indications:

    Detoxification, dehumidification, swelling and pain relief

    Precautions:

    1. Smoke first, then wash, sit bath, time 10-15 minutes

    2. Avoid use for allergic

    2. Chinese medicine decoction retention enema

    1. Dialectical selection

    (1) Hot and humid betting type: Longdan Xiegan Decoction is used for the prescription.

    (2) Anal heat-toxin type: add or subtract Neishuhuanglian Decoction for prescription.

    (3) Damp and turbid soaking type: Prescription with the addition and subtraction of Yinyue Shenshi Decoction.

    2. Decoct the traditional Chinese medicine twice twice to make a thick decoction of about 200ml, and keep the enema twice in the morning and evening.

    3. Matters needing attention

    1. Pay attention to the temperature of the enema, and insert the anal canal gently.

    2. Try to keep the liquid medicine for more than 1 hour after extubation.

    Three, traditional Chinese medicine Baijiangdan gauze change dressing

    Drug configuration: 0.3-0.5% Baijiangdan gauze

    Method: Configure low-concentration Baijiangdan gauze to change dressing after complicated anal fistula operation, once a day, first take 0.5% gauze and change 0.3% gauze after a week.

    Functions and Indications: Remove decay and grow muscles, used for deep abscess and complex anal fistula surgery.

    Note: People who are allergic to mercury are prohibited.

    four. Dressing

    The application method is to apply Fuhuang ointment to the affected area. When using it, apply the ointment to the affected area. It has the functions of clearing away heat, detoxifying, reducing swelling and relieving pain. Applicable to anal carbuncle in anorectal department.

    Preparation

    Treatment plate, saline cotton ball, medicine, sterile cotton pad or gauze, tissue paper, adhesive cloth or bandage; other medicines used for dressing: golden ointment, anti-inflammatory analgesic ointment, etc.

    Operating procedures

    1. Prepare everything and bring it to the bedside. Make an explanation and get the patient's cooperation.

    2. Assist in taking a proper position, exposing the affected area, keeping warm, and shielding if necessary.

    3. According to the area of ​​application, take tissue paper or thin adhesive paper of appropriate size, and spread the required medicine evenly on the tissue paper with moderate thickness.

    4. If it is a tumor, the area of ​​application should exceed the scope of the swelling potential. One is to prevent the spread of toxins and play a role in entrapment; the other is to restrain the toxins and lift sepsis through the action of drugs.

    5. After applying the medicine, pay attention to the local conditions. If allergies such as rash, itching, blisters, etc. occur, stop using it and deal with it.

    Precautions

    1. People with skin allergies are prohibited.

    2. For tumors at the initial head or purulent stage, leave a space in the middle and wrap around it. It is not advisable to apply it completely.

    5. Yaoshu Point Injection

    1. Selection of drugs:

    1% lidocaine 20~30ml, for longer operation, use 0.25%~0.5% bupivacaine 10~15ml.

    2. Looking for sacral hiatus:

    Find the left and right sacral angles, the depression between the two sacral angles is the sacral hiatus.

    3. Steps:

    Take the lateral position, clear the sacral hiatus, make a mark, and perform routine disinfection. Use a syringe equipped with a 7-gauge needle to draw the liquid medicine. First, inject a skin mound at the mark and infiltrate the needle vertically. When the sacrococcygeal ligament is reached, move the needle toward the umbilicus at an angle of about 45 degrees. When there is a sudden feeling of loss, it will enter the sacral canal, and no blood and cerebrospinal fluid will be sucked. The needle will be slowly injected into the tailbone. 1/5. Observe for 5 minutes. If the patient has no adverse reactions, slowly push in all the anesthetics, pull out the needle, and wait for about 20-25 minutes. The needle can be used to stimulate the anus. If no contraction reaction is seen, it indicates that the anesthesia is successful.

    4. Precautions:

    For sacral hiatus deformity, variation, irregularity, etc., the acupuncture points should be found to prevent injection under the skin.

    Generally no more than 30m.

    six. Moxibustion

    Anorectal moxibustion is mainly used for postoperative urine retention. Utilize the effects of warmth and drugs, conduct through the channels and collaterals, to warm the channels and dredge the collaterals, regulate the qi and blood to achieve the effect of urination.

    method

    Treatment tray, moxa sticks, matches, curved trays, bath towels, screens, etc. as appropriate [Operation procedures]

    1. Prepare the supplies, bring them to the bedside, explain well, and obtain the patient's cooperation.

    2. Assist in taking a proper position, exposing the moxibustion site, and keep warm.

    3. Select acupoints: Sanyinjiao, Qihai, Guanyuan, 5 minutes per acupoint, based on the patient's comfort.

    Precautions

    1. Prevent the moxa ash from falling off, scalding the skin or burning clothes. The extinguished moxa should be put into a small mouth bottle to prevent re-ignition and fire.

    2. After moxibustion, local skin may appear reddish and burning. If small blisters appear after moxibustion, they can be absorbed by themselves without treatment. If the blisters are large, use a sterile syringe to remove the body, cover it with sterile gauze, and keep it dry.

    Seven. Thread

    The traditional treatment method of TCM anorectal department is suitable for the treatment of anal fistula and extends to the treatment of pubic rectus hypertrophy.

    operating:

    After anesthesia, the probe is gently inserted from the outer opening of the anal fistula, the subcutaneous tissue of the skin is cut, the rubber band is brought in, and the 7th thread is tightened and ligated.

    Precautions:

    1. Instruct patients not to drag the rubber band left outside the anal canal, so as not to cause pain and breakage.

    2. Check whether the ligation rubber band (thread) is loose. Generally, it will fall off within 8-11 days. If it is loose, tighten the thread once.

    3. Observe whether there is adhesion on the wound with thread hanging. If the skin adheres prematurely, it should be separated or filled with gauze.

    4. Encourage patients to move appropriately to speed up the opening of the fistula.

    Eight. Buried seeds in ear points

    purpose

    In the anorectal department, auricular acupoint embedding (kidney, bladder, endocrine) is to use Wangbuliuxing seeds (or rapeseed) to stimulate the acupuncture points or reaction points on the auricle, and to achieve the purpose of preventing and curing diseases through the channels and collaterals. It is suitable for pain syndrome, urine storage, etc.

    Preparation

    Treatment plate, probe, cotton swab, 0.5% iodophor, tweezers, Wang Buliu xing seeds, tape, scissors, etc.

    Operating procedures

    1. Prepare the supplies, bring them to the bedside, explain well, and obtain the patient's cooperation.

    2. The patient takes a side lying or sitting position.

    3. The surgeon holds the upper back of the helix with one hand, and the other holds the probe from top to bottom to find sensitive points in the selected area, and routinely disinfect.

    4. Buried seeds: Stick the Wangbuliuxing seeds in the middle of the 7 mm × 7 mm tape, paste them on the selected acupoints, and press them with the index finger.

    5. While pressing, ask the patient whether there is any "deqi" sensation such as soreness, swelling, and pain.

    6. Teach the patient or family members how to press, and keep seeds for 2 to 3 days as needed.

    7. Remove seeds: remove the tape and Wangbuliu seeds, observe whether the local skin is red, swollen or damaged, and deal with it in time.

    8. After the operation is completed, clean up the supplies and return them to the original place.

    Precautions

    1. It is contraindicated for pregnant women who have inflammation, frostbite or a history of habitual abortion.

    2. The movement is light and the pressure is moderate, so that the patient has the feeling of "getting qi".

    nine. ligation

    The ligation therapy of hemorrhoids is a traditional method, as recorded in the "Fifty-two Recipes" unearthed from the Han Tomb of Mawangdui, Changsha. Summarizing the experience of the predecessors, the ligation method is now summarized as simple ligation method, segmented ligation method and so on.

    (1) Simple ligation: suitable for hemorrhoids in stage II and III.

    Ligation steps: the patient takes the lithotomy position or lateral position. Routine disinfection, spread towels. Local infiltration anesthesia, after the anesthesia takes effect, disinfect the anus and lower rectum. Perform preoperative inspection with anoscope, design a comprehensive ligation site, pull the internal hemorrhoids from the anus with tissue clamps, fully expose the ligation part, clamp the base of the hemorrhoids with curved vascular clamps, and cut the skin and mucous membranes at the dent line area. Make a small mouth, ligate under the hemostatic forceps with No. 7 or No. 10 thread, or use a needle and tape thread through the center of the base twice to make a figure-eight suture ligation, tighten the ligation line, and slowly loosen the hemostatic forceps and withdraw. The other hemorrhoids are ligated at the same time. After the operation, put chlorhexidine suppository and oil gauze strips in the rectum, arrange the tower-shaped gauze at the anus, and apply pressure bandaging.

    (2) Segmented ligation: suitable for circular mixed hemorrhoids and mixed hemorrhoids.

    Steps of segmented ligation: routine disinfection, drape, and local anesthesia; divide the ring hemorrhoids into 3 to 4 areas, preferably in the mother hemorrhoid area, make a radial fan or prismatic incision, and cut into the anus direction from the skin to the hemorrhoid , And cut to the base of the internal hemorrhoids one by one, and use the 7th thread to make a figure-eight suture. Cut off the separated excess tissue from the distance 12.5px from the ligation line. After the inspection, there is no active bleeding, and the tissue stump is reset to Intestines to reduce postoperative anal edema and pain. The rest is the same as simple ligation.

    Precautions:

    First, the circular hemorrhoid incision should be peeled off at the corresponding part of the female hemorrhoid, and the continuous damage of the anal canal and anal skin should not exceed 1/2.

    Secondly, each ligation point cannot be level and at the same height to prevent postoperative scar contracture in the anus.

    10. Suppository

    Suppository method is a common method of hemorrhoid treatment. When used, the drug is made into a suppository and stuffed into the anus. After the drug suppository is dissolved, the drug acts on the local lesion to treat it. Because the direct local administration directly acts on the local area, the effect is fast. At the same time, the drug is absorbed through the rectum. Can directly enter the NPC circulation without detoxification through the liver.

    Commonly used suppositories

    Hemorrhoids analgesic suppository, hemorrhoids hemorrhoid suppository, bear bile hemorrhoid suppository, Ma Yinglong hemorrhoid suppository, Kangtai suppository, etc.

    Function: clearing away heat and swelling, relieving pain and bleeding, converging and solidifying.

    Indications: It has hemostatic, analgesic, astringent, and anti-inflammatory effects on internal hemorrhoids, and has a therapeutic effect on systemic symptoms and proctitis.

    usage

    Wash the anus every day after defecation, and put 1 suppository into the anus

    note

    The drug suppository should be above the tooth line, if it is lower or in the tooth line area, it will feel uncomfortable or want to defecate.

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