OVERVIEW
病原微生物侵入血循环并生长繁殖引起的一种全身性感染性疾病
有发热等毒血症状及皮疹、瘀点、瘀斑等
病原微生物感染并侵入到血液内，病原毒素和代谢产物引起疾病
主要为抗感染治疗、支持对症治疗，必要时辅以中医治疗
Definition
Sepsis is a systemic infectious disease caused by the invasion of pathogenic microorganisms into the circulation, their persistence and growth and reproduction, the production of large amounts of toxins, and the induction of multiple inflammatory mediators. When pathogenic microorganisms are present in the blood, but do not cause obvious signs of toxemia, it is called bacteremia.
Sepsis is a serious infectious disease that can progress from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome and multiple organ failure.
Sepsis is now renamed sepsis or septicemia.
Classification
According to the different pathogenic microorganisms infected, sepsis is mainly divided into gram-positive coccus sepsis, gram-negative bacillus sepsis, anaerobic sepsis, fungal sepsis and so on.
Morbidity
Incidence rate
The incidence rate of sepsis in developed countries is increasing dramatically at a rate of 8% to 13% per year, but there is no such data in China for the time being.
Season
It can occur in all seasons of the year.
High-risk groups
Immunocompromised or immunodeficient people, such as those who suffer from malignant tumors, leukemia, bone marrow transplantation, acquired immunodeficiency syndrome (AIDS for short) and other diseases.
Those who use immunosuppressant, glucocorticoid, radiotherapy, broad-spectrum antibiotic treatment for a long time.
People with underlying diseases, such as diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, nephrotic syndrome, uremia, connective tissue disease.
Those with skin and mucous membrane damage, such as extensive burns, skin trauma, needlestick, scratching, mosquito bites, animal bites, etc.
People with major surgery of vital organs, such as liver transplantation, kidney transplantation, etc.
Infants, young children, the elderly.
Susceptibility factors
Skin and mucous membrane breakage: trauma (e.g. intestinal perforation, traumatic brain injury), surgery (e.g. tooth extraction, intestinal resection).
Decrease in body resistance: e.g. pregnancy, childbirth, cold, cold, exertion, alcoholism, etc.
Infection pathway
Invasion of pathogenic microorganisms through broken skin and mucous membrane: e.g. skin and mucous membrane ulceration, burns.
Pathogenic microorganisms invade through the vein: most of them are infected during intravenous infusion and blood transfusion.
Pathogenic microorganisms invade through tubes: e.g. tracheal intubation, urinary catheter, thoracic or abdominal drainage tubes, and intravenous tubes.
Causes
Causes
Sepsis is the result of infection by various pathogenic microorganisms.
Whether or not sepsis is caused by pathogenic microorganisms entering the bloodstream depends on a variety of factors such as the type and number of pathogenic microorganisms and their virulence.
Pathogenic microorganisms
Bacterial infections are predominant.
细菌
Gram-positive cocci
金黄色葡萄球菌：最常见。
肺炎链球菌：可引起免疫缺陷及老年人败血症。
B组溶血性链球菌：可引起婴幼儿败血症。
近年来，耐青霉素肺炎链球菌、肠球菌属（如粪肠球菌、屎肠球菌等）细菌败血症的报道呈逐年增高趋势。
Gram-negative bacilli
埃希菌属：大肠埃希菌所致者约占革兰阴性菌所致败血症的50％。
肠杆菌属：如阴沟肠杆菌、产气肠杆菌等。
其他：如克雷伯菌属（肺炎克雷伯菌、产酸克雷伯菌等）、流感嗜血杆菌、假单胞菌、铜绿假单胞菌、鲍曼不动杆菌等。
Anaerobic bacteria
占细菌败血症的5％～7％。
主要有脆弱类杆菌、梭状芽孢杆菌属、厌氧性消化链球菌、梭状芽孢杆菌属、产气荚膜杆菌等。
Others
分枝杆菌或无毒白喉棒状杆菌：偶可在获得性免疫缺陷综合征（简称艾滋病）或长期使用免疫抑制剂者中发生。
其他还有单核细胞增多性李斯特菌、聚团肠杆菌、沙雷菌、炭疽杆菌、红斑丹毒丝菌等。
真菌
Pseudomonas albicans is predominant, followed by Pseudomonas tropicalis Photorhabdus, Pseudomonas slipperi, and Trichoderma reesei.
Pathogenic microorganism virulence
Exotoxin
主要由金黄色葡萄球菌、链球菌等革兰阳性菌产生，痢疾志贺菌、肠产毒型大肠埃希菌、铜绿假单胞菌等少数革兰阴性细菌也可产生。
外毒素可诱生多种炎症因子参与败血症的发生与发展，引起病理改变。
Endotoxin
主要由革兰阴性杆菌、螺旋体、立克次体等产生，主要活性成分是脂多糖，是病原微生物崩解后的细胞壁成分。
内毒素可促发人体免疫，产生炎症反应。
Metabolites: Metabolites of pathogenic microorganisms and metabolites produced in the inflammatory response can exacerbate tissue damage and further amplify the inflammatory response under the action of a variety of inflammatory factors, such as interleukin-6, tumor necrosis factor, and interferon.
Symptoms
Sepsis caused by different pathogenic microorganisms has common and different manifestations.
Common manifestations
Toxemia symptoms
Chills, high fever, mostly flaccid or intermittent fever type, a few of which are arrested fever, irregular fever or bimodal fever.
Headache, muscle and joint pain, weakness, general malaise, rapid pulse and respiration.
30% of patients have gastrointestinal symptoms such as nausea, vomiting, abdominal distension, abdominal pain, diarrhea.
Body temperature does not rise and extremities are clammy and cold.
Severe patients have central nervous function changes such as disorientation or personality changes, irritability, and confusion.
Skin damage
Skin damage is diverse.
Petechiae, ecchymosis
多分布于躯干、四肢、口腔黏膜及眼结膜等处，数量较少。
见于脑膜炎奈瑟菌败血症。
Skin rash
荨麻疹、猩红热样皮疹，见于金黄色葡萄球菌败血症。
脓疱疹、烫伤样皮疹，多见于金黄色葡萄球菌和A群链球菌败血症。
中心坏死性皮疹，见于铜绿假单胞菌败血症。
Joint lesions
Most often seen with gram-positive cocci and alkali-producing bacilli sepsis.
Large joints, such as the knee, are red, swollen, painful, and have limited movement, and in a few cases, there is fluid or pus accumulation in the joint cavity.
Primary site of infection
The primary site of infection shows corresponding symptoms such as redness, swelling, heat and pain.
Common primary foci are folliculitis, carbuncle or abscess, etc., skin burns, pressure sores, respiratory, urinary, biliary, digestive and reproductive infections, and open trauma infections.
A few patients do not have a clear primary focus of infection.
Migratory foci
Bacteria spread with the bloodstream to re-cause infection in other parts of the body.
Gram-positive cocci sepsis and anaerobic sepsis are common, and metastatic abscesses often begin to appear in the 2nd week.
Common metastatic lesions include subcutaneous abscesses, lung abscesses, liver abscesses, osteomyelitis, septic arthritis, and pericarditis.
Acute or subacute infective endocarditis, metastatic myocardial abscess, and meningitis may occur in a few cases.
Septicemia caused by different pathogenic microorganisms
Gram-positive cocci sepsis
Staphylococcus aureus septicemia
多见于皮肤严重感染者。
发病急、寒战、高热，呈弛张热或稽留热型。
常见迁徙性感染病灶，出现多发脓肿；有心脏瓣膜病或基础病的老年人易并发感染性心内膜炎。
Staphylococcus epidermidis septicemia: mostly hospital-acquired infections after installation of prosthetic valves, artificial joints, catheters and pacemakers, with severe drug resistance.
Enterococcus septicemia: mostly opportunistic infections, mainly seen in patients with low resistance, gastrointestinal tract tumors, abdominal cavity infections, common invasion pathways for the urinary tract, reproductive tract, easy to complicate endocarditis, resistant to a variety of drugs such as cephalosporins.
Methicillin-resistant Staphylococcus aureus septicemia: seen in immune dysfunction, the condition is more serious.
Gram-negative bacillus sepsis
Patients tend to have serious underlying diseases (e.g., diabetes mellitus, cirrhosis, malignant tumors), or long-term use of immunosuppressive drugs.
Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae are common causative agents.
Primary foci of infection are commonly found in the lungs, urinary tract, peritoneum and biliary tract.
Toxemia symptoms are obvious, and infectious shock is easy to occur. It often starts with chills, and the fever type is variable, which may be intermittent or high and persistent, or the temperature may not rise or may be below normal.
Anaerobic septicemia
Fusobacterium fragilis septicemia is predominant, accounting for more than 80% of cases. Followed by anaerobic streptococci, Pseudomonas aeruginosa and so on.
The main invasion route is the gastrointestinal tract and female genital tract, followed by pressure ulcers and gangrenous limbs.
It is often characterized by fever, with body temperature higher than 38℃.
Disseminated intravascular coagulation or infectious shock may occur in some patients, and jaundice, infectious thrombophlebitis, and metastatic septic infection in the chest and abdominal cavity, heart, lungs and other places may also occur; local secretions often have a special rotten odor.
There is often gas formation in the lesion, which is obvious with P. aeruginosa, which is an important feature of P. aeruginosa infection.
Fungal sepsis
Mostly opportunistic infection.
Seen in elderly and frail patients with severely reduced immune function.
Pseudomonas albicans and Pseudomonas tropicalis are the main pathogenic fungi.
Commonly found in infected areas such as lungs, spleen and endocardium.
The disease is serious, there may be chills, fever, sweating, liver and spleen enlargement. Treatment is difficult, and the mortality rate can reach 20%～40%.
Special Septicemia
Neonatal sepsis
The infection is easy to spread.
Mostly caused by the spread of infection through the birth canal, inhalation of amniotic fluid, umbilical cord or skin infection.
Escherichia coli and group B hemolytic streptococcus are the main pathogens.
The manifestations are refusal to eat, vomiting, abdominal distension, poor spirit, respiratory distress, irritability, convulsions, deepening jaundice.
Easily complicate central nervous system infection.
Septicemia in the Elderly
Localized infection is easy to spread and sepsis occurs.
Common in lung infection and skin pressure sore infection.
Gram-negative bacilli such as Escherichia coli and Klebsiella pneumoniae are the main causative organisms, followed by anaerobes and Pseudomonas albicans.
There may be high fever or body temperature does not rise (body temperature <36℃).
Easily complicated by infective endocarditis.
There are often heart, lung, brain, kidney and other important organs dysfunction, high mortality rate.
Burn sepsis
Septicemia often occurs after extensive burns.
In the early stage, there is mostly a single bacterial infection, and in the late stage, there is mostly a mixed infection. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis are the common pathogenic bacteria.
Mostly occur within 2 weeks after burns, and the chance of sepsis is reduced after the formation of traumatic granuloma.
High fever or body temperature does not rise.
Can be complicated with toxic myocarditis, toxic hepatitis, paralytic intestinal obstruction.
Immunocompromised sepsis
Drug-resistant staphylococcus, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Enterococcus, Pseudomonas aeruginosa, Aeromonas hydrophila, and Pseudomona albicans are the common causative agents.
Clinical manifestations are atypical. Fever is often the main manifestation, sometimes the only manifestation, or can be hypothermic.
Hypotensive shock, multiple organ dysfunction syndrome or multiple organ failure may occur.
Complications
Toxic myocarditis: palpitations and chest tightness can be seen; in severe cases, heart failure occurs, with shortness of breath, dyspnea, pallor, cyanosis and irritability.
Toxic hepatitis: jaundice can be seen, manifested as yellow staining of skin and mucous membrane, and pressure pain in liver area.
Infective endocarditis: prolonged fever, palpitation, and cyanosis of the skin are seen.
Septic meningitis: headache, nausea, vomiting, and impaired consciousness are seen.
Migratory abscesses: can occur all over the body, superficial ones can be palpated with masses and tenderness.
Disseminated intravascular coagulation: seen with clammy cold extremities, florid skin, and decreased blood pressure.
Infectious shock: a drop in blood pressure, oliguria or anuria, and increased pulse rate can be seen.
Multi-organ failure: intestinal paralysis, liver failure, renal failure, respiratory failure, circulatory failure can be seen.
Consultation
Department
Emergency Department
When there are emergencies such as high fever, convulsions, consciousness disorder, etc., it is recommended to go to the emergency department immediately.
General Surgery
If there is an obvious skin abscess or open trauma, you may consult the General Surgery Department.
Infection Department
After diagnosis, further treatment can be received in the Infection Department.
Preparation for medical treatment
Preparing for your visit: registering, preparing your documents, FAQs
Tips for your visit to the doctor
During the consultation, abdominal ultrasound and chest CT are often needed, so you should wear loose-fitting clothes and avoid wearing clothes made of metal, and inform your doctor in advance if you are pregnant or planning to become pregnant.
For patients with high fever, physical cooling can be done first, such as applying cold compresses to the forehead and wiping the hands, feet and armpits with warm water.
Preparation checklist for medical consultation
症状清单
Pay special attention to the time of onset of symptoms, special manifestations, etc.
Is there fever? What is the highest degree?
Is there a decrease in urine output and what is the approximate 24-hour urine output?
病史清单
Was there any previous trauma or skin lesions?
Is there any systemic or localized infection? Such as a UTI, pneumonia, abscess, etc.?
Are there any immunodeficiency diseases, such as AIDS?
Are there any chronic diseases, such as diabetes, kidney disease, cancer, etc.?
检查清单
Test results in the last six months, which can be carried for medical consultation
Laboratory tests: blood test, C-reactive protein, blood biochemistry, urine test
Imaging tests: abdominal ultrasound, urinary system ultrasound, chest CT examination
用药清单
Medication for the past 3 months, if available, bring the box or package with you to the doctor.
Antibiotics: meropenem, imipenem
Antipyretics: ibuprofen, acetaminophen
Diagnosis
Diagnosis is based on
Medical history
There are underlying diseases such as diabetes mellitus, cirrhosis, uremia, etc.
History of trauma and surgery.
Long-term treatment with immunosuppressants.
There is immunodeficiency, such as AIDS.
Clinical manifestations
症状
Fever, chills, cough, sputum, chest tightness, chest pain.
Or fever, headache, nausea, vomiting, abdominal pain, diarrhea.
Or wet and cold limbs, body temperature does not rise.
Or fever, unconsciousness, convulsion.
Or fever, skin petechiae, ecchymosis.
体格检查
Enlarged liver and spleen.
Decreased blood pressure, increased pulse rate.
Laboratory Tests
一般检查
Blood routine
大多数患者白细胞增高，多为（10～30）×109/L，中性粒细胞比例增高，可有明显核左移及细胞内中毒颗粒。
少数白细胞数可正常或降低，但中性粒细胞数增高。
检查时无需空腹。
Urine routine
可见尿蛋白、管型和白细胞。
需取清洁中段尿送检。
Stool routine
肠道感染时可见脓血便，有白细胞、脓细胞、红细胞。
检查前排空尿液，避免尿液污染粪便标本；排便后，取少许粪便中间部分送检。
炎症相关指标检测
Serum tumor necrosis factor-alpha (TNF-α), C-reactive protein: used to determine the intensity of inflammatory response in the body.
Calcitoninogen: can be used to identify bacterial infection and viral infection.
Interleukin-10, cortisone concentration: to reflect the body’s compensatory anti-infection status.
Small intestinal fatty acid binding protein: can reflect the degree of damage to the intestinal mucosa, with specificity.
Horseshoe crab test: a positive test suggests the presence of endotoxemia, a gram-negative bacterial infection.
器官功能评价指标检测
Liver function
丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、胆红素等检测有助于评价肝脏损伤程度。
检查时需空腹。
Renal function: urea nitrogen, creatinine, cystatin C test helps to evaluate the degree of renal injury.
Cardiac enzymes: lactate dehydrogenase, creatine kinase and its isoenzymes, and alpha-hydroxybutyrate dehydrogenase tests help evaluate the degree of myocardial injury.
Coagulation tests: prothrombin time, activated partial thromboplastin time, prothrombin time, and fibrinogen tests help evaluate the presence of disseminated intravascular coagulation.
Arterial blood gas analysis: helps to evaluate lung function and hypoxia status of the body.
病原学检查
Bacterial Culture
包括血培养、骨髓培养、各种体液（脓液、胸水、腹水、脑脊液）培养；瘀点挤液涂片或培养。
细菌培养应在使用抗菌药物前完成。
细菌培养阳性应做药敏试验，以指导临床用药。
Nucleic acid test: It is the most advanced diagnostic technique for pathogenicity and is characterized by rapidity and sensitivity.
Immunological examination: targeted antigen or antibody detection can assist in clinical pathogenetic diagnosis.
Imaging
Imaging tests are helpful in finding infected lesions.
Examination methods include magnetic resonance imaging (MRI), CT, X-rays, ultrasound and so on.
Precautions
X线片检查：有一定的放射性，孕妇、婴幼儿等特殊人群慎用。
CT：腹部CT平扫、增强CT需禁食4小时；如有碘对比剂过敏史，需提前告知医生。
MRI：腹部检查者，需禁食4小时；颈部检查时，请不要做吞咽动作；体内有金属或磁性物植入史者，如有心脏起搏器、人工心脏金属瓣膜等，不能进行检查。
Other tests
Electrocardiography, GI endoscopy, etc.
Differential Diagnosis
Malignant blood diseases
Malignant blood diseases, such as leukemia, lymphoma, and malignant histiocytosis, are easily confused with sepsis, but bone marrow examination and lymph node biopsy help to differentiate.
Typhoid paratyphoid fever
It may present with fever and splenomegaly, but the white blood cell count is not high, and the patient is unresponsive, apathetic, and has eosinophilia.
Positive blood fattening test helps diagnosis, and positive culture of typhoid bacillus can confirm the diagnosis.
Blood-borne tuberculosis
There is often a history of tuberculosis or a family history of tuberculosis, and the toxemia symptoms are not severe, with irregular high fever, night sweats, hot flashes, and cough. Chest X-ray shows evenly distributed cornified lesions in the lungs.
Adult Steele’s disease
Clinical manifestations are very similar to sepsis, but treatment with antimicrobial drugs is ineffective, and symptoms can be relieved with glucocorticoids or nonsteroidal anti-inflammatory drugs such as indomethacin.
Systemic lupus erythematosus
Prolonged fever, multi-organ damage, effective with antipyretic and analgesic drugs, but ineffective with anti-infective treatment, autoantibody testing can help to differentiate.
Shock
When sepsis is combined with shock, care should be taken to distinguish it from allergic shock, neurogenic shock, and cardiogenic shock.
In allergic shock, the patient has a clear allergen (sensitizer).
In neurogenic shock, the patient has central nervous system disease.
In cardiogenic shock, the patient has underlying cardiac disease.
Treatment
The principle of treatment is active infection control, supportive therapy and symptomatic treatment; Chinese medicine can be supplemented when needed.
Infection control
Antibacterial drugs
应用原则
Empirical medication: before the results of bacterial culture come out, empirical medication is often carried out to buy time.
肺部感染：多为肺炎链球菌或流感杆菌等所致，可选用青霉素、氨苄青霉素或环丙沙星等。
腹腔感染：多为革兰阴性细菌所致，可选用头孢噻肟、头孢哌酮、头孢曲松、庆大霉素等。
免疫力低下或存在严重基础疾病者：多为革兰阴性细菌所致，可选用头孢噻肟、头孢哌酮、头孢曲松、庆大霉素等。
考虑真菌感染时，可用氟康唑、伊曲康唑治疗。
According to the bacterial culture and drug sensitivity test: when the bacterial culture and drug sensitivity test reports come out, the drug should be adjusted according to the test results.
Precautions
重症感染多需两种以上的抗菌药物联合应用。
治疗中应兼顾到厌氧菌感染，加用甲硝唑或替硝唑抗感染。
常见感染的抗菌药物选择
Community-acquired pneumonia
无合并症或MRSA/铜绿假单胞菌感染风险:阿莫西林或多西环素。
有合并症:可选用喹诺酮类抗菌药物，但18岁以下禁用。
住院患者:β-内酰胺类+(阿奇霉素/克拉霉素或呼吸喹诺酮类)。
Cholecystitis or biliary tract infection
首选方案:哌拉西林-他唑巴坦或氨苄西林-舒巴坦,如病情危重,选择亚胺培南或美罗培南。
备选方案:注射用三代头孢菌素+甲硝唑或氨曲南+甲硝唑。对于严重病例，仅是胆管充分引流的补充。
Gastrointestinal tract infection
喹诺酮类或三代头孢菌素等。
注意监测肝肾功能。
Urinary tract infection
环丙沙星或左氧氟沙星,磷霉素可作为备选方案。
喹诺酮类药物18岁以下禁用。
Bacterial meningitis
<1月龄:氨苄西林+头孢噻肟。
1月龄至50岁:头孢曲松(儿童:美罗培南)。
>50岁或有严重基础疾病:青霉素类或三代头孢菌素或美罗培南。
Surgical removal of lesions
Surgical removal of the lesion is required when there is a limited focus of infection and medications are not effective, such as incision and drainage of abscesses, skin debridement, and excision of the infected lesion.
Supportive treatment
Oxygen therapy is needed when there is hypoxia such as low blood pressure, chest tightness, wet and cold extremities.
Intravenous fluids, blood transfusion, albumin infusion: control hypotension to ensure good blood supply to all organs.
Correct acidosis, correct electrolyte disorders, and supplement vitamins.
For patients who cannot eat, intravenous nutritional therapy can be carried out, and fat milk and amino acid can be infused.
Symptomatic treatment
The use of any drug should follow the doctor’s instructions, patients should not be unauthorized use of drugs.
Antipyretic: When the body temperature is below 38.5℃, cold compresses on the forehead and alcohol baths can be used to physically lower the temperature; when the body temperature is more than 38.5℃, ibuprofen, acetaminophen and other antipyretic treatments can be given.
Antiemetic: metoclopramide or domperidone.
Cough and phlegm: Ambroxol, compound licorice tablets, loquat lozenges syrup, etc.
Sedation: when the patient is irritable, drugs such as benzodiazepines can be given.
Traditional Chinese Medicine (TCM)
When needed, it can be supplemented with Chinese herbal medicine and treated by regular Chinese medicine practitioners to identify the symptoms.
Toxic heat syndrome
Clinically used Chinese medicines for clearing heat and removing toxins, such as Heat-Toxin-Ning Injection, Qingkailing Injection, Wake-Brain-Jing Injection, and Angong Niuhuang Pill.
Visceral Qi Blockage
Representative formula is Da Cheng Qi Tang.
Blood stasis
Safflower, red peony, chuanxiong, angelica, danshen and other Chinese medicines that activate blood circulation and eliminate blood stasis, as well as blood circulation and blood stasis soup and other prescriptions are often used for treatment.
Proprietary Chinese medicines can be used, such as Compound Danshen Injection and Haibijin Injection.
Acute deficiency syndrome
Clinically, Shengmai Injection or Shenmai Injection are commonly used.
Rehabilitation
Patients with sequelae of the neuromotor system need to undergo rehabilitation therapy, and the training activities should be gradual and according to the strength of the patient.
Rehabilitation training should be carried out under the guidance of professional rehabilitation doctors.
Those who can get out of bed can do simple fitness activities on the balcony, living room and other spacious places.
For those with mobility problems, they can do limb activities in sitting or lying position.
Prognosis
Cure
Most patients can be cured with aggressive anti-infective treatment, but there is still a high case fatality rate (30% to 40%).
The morbidity and mortality rates are high in infants and the elderly, and in patients with severe underlying diseases (e.g., diabetes mellitus, cirrhosis, uremia).
Fungal sepsis and complex sepsis are more difficult to control and have high morbidity and mortality rates.
Those with multi-drug resistance have a high morbidity and mortality rate.
Once sepsis occurs in patients with AIDS, the infection is difficult to control and the morbidity and mortality rate is high.
Patients with serious complications have a high morbidity and mortality rate. Complicated with renal failure, the morbidity and mortality rate is 61.5%, and the morbidity and mortality rate is 35%~50% when complicated with shock.
Hazard
Sepsis is life-threatening with a high morbidity and mortality rate.
Multiple serious complications often occur in sepsis, affecting the function of vital organs.
Infections that affect the nervous system and motor system can leave sequelae and have a certain degree of disability.
Daily
Daily Management
Dietary management
Eat rice and noodles as the main food, and eat more vegetables and fruits, soft fruits are best, such as bananas, kiwis, oranges.
Gradually increase protein diet, one egg, one bag of milk and moderate amount of lean meat daily.
Do not eat spicy and irritating foods, such as ginger, garlic, chili peppers.
Patients with underlying diseases should follow the relevant dietary requirements.
糖尿病患者：低糖饮食。
高血压患者：低盐、低脂饮食。
高尿酸患者：应控制海鲜、豆制品、蘑菇类食物的摄入。
肝硬化患者：禁食粗糙、坚硬的食物，以防消化道出血。
Smaller meals can be eaten at first, 6 to 8 meals per day, gradually transitioning to a normal diet of 3 meals.
Lifestyle management
Those with smoking and alcohol addiction need to quit smoking and alcohol.
Brush teeth daily after waking up and before going to bed to maintain oral hygiene.
Regular work and rest. Daily sleep time: children and adolescents should have no less than 10 hours; young adults 7 to 8 hours; elderly people should have no less than 6 hours of sleep at night, and it is recommended to increase the time of lunch break.
Maintain a good state of mind, can engage in their own hobbies of recreational activities, such as watching television, listening to music.
Home care
Open windows and ventilate the living room to keep the air fresh.
Reduce visits from friends and relatives, especially those with symptoms of respiratory infections such as coughing, phlegm and sneezing.
Individuals should pay attention to maintaining oral hygiene and perineal hygiene, especially women during menstruation should pay attention to local washing.
Pay attention to the skin care of the intravenous injection site, you can use a towel to apply hot compresses or apply Hilotropin.
When the skin is broken or infected, make sure to clean and sterilize the bandage in time.
For long-term bedridden patients, should help turn over regularly, once every 2 hours, to prevent pressure sores.
Cough up sputum in a timely manner, and when coughing up sputum is difficult, relatives should help change the position and gently pat the back to assist in coughing up the sputum.
Relatives should pay attention to observe the patient’s psychological changes, and timely appeasement when there are problems.
Prevention
Active treatment of underlying diseases, such as diabetes mellitus, cirrhosis of the liver, chronic obstructive pulmonary disease.
Vaccination: e.g. pneumococcal vaccination, influenza vaccination.
Even mild infections (e.g. gingivitis, tonsillitis) should be taken seriously and treated promptly as a precaution.
Do not squeeze boils on the face, especially in the danger triangle.
Pay attention to sexual hygiene and do not take the liberty or over-do vaginal douching, as this may destroy the normal flora of the vagina.
Do not abuse antibacterial drugs.
Strengthen exercise to enhance physical fitness.
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