1, Etiology.
The direct etiology is unclear, most patients have symptoms of viral infection such as fever, upper respiratory tract infection, diarrhea or a history of vaccination 1 to 4 weeks before the appearance of spinal symptoms, including influenza, measles, chickenpox, rubella, mumps and EBV, cytomegalovirus, mycoplasma and many other infection factors may be related to the disease, but their cerebrospinal fluid did not detect viral antibodies, and no virus was isolated from the spinal cord and cerebrospinal fluid. It is presumed that it may be related to the autoimmune response after viral infection, not due to direct infection, and is a non-infectious inflammatory myelitis.
2, symptoms.
① can lead to neurological dysfunction below the lesion site, resulting in partial or total loss of sensory, perceptual, and motor functions.
(2) Incontinence or retention of urine and stool.
(3) The dysfunction may lead to a variety of complications (such as pressure sores, pain, infection, muscle contracture, joint stiffness and deformation, osteoporosis, and even fractures).
3.Treatment.
(1) General treatment
Strengthening care and preventing various complications is the prerequisite to ensure functional recovery.
(1) Those with respiratory distress in high cervical segment myelitis should receive oxygen, keep the airway open, use effective antibiotics to control infection, and perform artificially assisted breathing by tracheotomy if necessary.
② Those with urinary disorders should retain sterile catheters and release the drainage tube once every 4 to 6 hours. When the bladder function is restored and the residual urine volume is less than 100ml, no more catheterization will be done to prevent bladder spasm and volume reduction.
③Keep the skin clean, turn, pat the back and aspirate on time, and add air cushions or soft cushions to the easily pressurized parts to prevent pressure sores. The reddened parts of the skin can be lightly rubbed with 10% alcohol or warm water and coated with 3.5% benzoin tincture. Those with ulcer formation should have their medication changed in time and apply pressure sore patches.
(2) Drug treatment
(1) Corticosteroids in the acute stage, high-dose methylprednisolone short-course shock therapy can be used for 3 to 5 days, after which the dosage is gradually reduced to maintain 4 to 6 weeks after discontinuation.
②Immunoglobulin is used for 3 to 5 days as a course of treatment.
③B vitamins help to recover the nerve function. Vitamin B1 and methylcobalamin are commonly used for intramuscular injection.
(3) Rehabilitation exercise
During the acute paralysis period, it is necessary to maintain the functional position, and massage and passive functional exercises for the paralyzed limbs to improve the blood circulation of the patient’s limbs and prevent the contracture and ankylosis of the limbs. When the patient’s limb function gradually recovers, encourage the patient to perform active functional exercises for early recovery.
4.Nursing.
(1) Positioning.
Keep the bed unit flat, clean and dry, keep the joints of their paralyzed limbs in a functional position or against spasticity, and protect the ankle joint to prevent foot drop.
(2) Turning.
Prevent the occurrence of various complications, once every 2h in the acute period and once every 4h in the recovery period; axial turning (keep the spine stable).
(3) Bowel and urine management.
Keep the vulvar skin clean and dry, and do the clean care after urination and defecation.
(1) Urine management: drink water regularly and quantitatively, prevent urinary tract infection, encourage the child to urinate by himself by tapping on the trigger points of the urinary reflex such as above the pubic bone and the root of the inner thigh, encourage regular daily assisted squatting training to urinate, and strictly prohibit squeezing the bladder to urinate.
(2) Stool management: Choose the appropriate method and position according to the level of spinal cord injury and the degree of impairment, encourage regular daily assisted squatting for defecation, use abdominal massage, circular massage in a clockwise direction along the navel, or use fingers containing lubricating fluid to gently massage the perianal area or anal canal to stimulate defecation reflex generation.
(4) Safety management.
①Patients with spinal cord injury mostly have limb sensory impairment and are insensitive to temperature and pain sensation. They need to be alert to trauma, burns and frostbite, and when soaking their feet in warm water, the water temperature should be controlled at 38-40℃.
(2) Restricted movement: choose the correct transfer and movement method to prevent falls.
(5) Respiratory management.
Prevent respiratory infections, turn and pat the back regularly, encourage deep breathing and forceful coughing, and have the patient take a sitting or standing position as much as possible to increase the volume of the chest cavity.
(6) Diet.
Choose a high-fiber, high-protein, low-fat diet (such as fish, lean meat, chicken, vegetables, fruits, etc.) to enhance nutrition, strengthen resistance and facilitate smooth bowel movements.
(7) Fracture prevention.
Osteoporosis can easily cause fracture.
① Pay attention to calcium supplementation (such as oral calcium supplements), and eat more food with high calcium content (such as milk, soy products, etc.).
②Increase standing and exercise time as much as possible.
③Choose the correct method of exercise and activity.
(8) Psychological counselling.
We should take psychological counseling seriously, face the disease or disability correctly, care and encourage the children, talk and communicate with them more often to understand their psychological needs; for children with poor prognosis, do not discriminate and do not abandon them, and develop various functional training programs according to specific situations; carry out home rehabilitation, use braces to assist in increasing the weight-bearing capacity of the limbs if necessary, strengthen residual functional training, and regain confidence to facilitate return to society.