A patient; the patient had advanced breast cancer, and the presence of intracranial metastases was unknown because no cranial MRI was performed. The patient presented with fever, hypothermia in the extremities and high temperature in the trunk, rising above 40 degrees, which was consistent with central hyperthermia, and any antipyretic drugs were ineffective, so physical cooling was given as the main treatment.
Treatment of central hyperthermia.
Central fever: It is caused by damage to the thermoregulatory center of the lower thalamus, i.e., damage to the anterior and posterior lateral parts of the lower thalamus, caused by dysfunction of the heat dissipation, heat production, and heat preservation centers, and the body temperature can change easily with the environmental temperature, resulting in thermoregulatory disorders. Clinically, the patient’s body temperature can be as high as 41-42℃, but the skin is dry and less sweaty, the skin temperature is unevenly distributed, the extremities are lower than the trunk, and some patients can have a difference of more than 0.5℃ between the two sides of the body temperature, and there is an obvious phenomenon of incomplete symmetry, but the patient has no signs of infection, no obvious symptoms of intoxication, no chills, no heart rate change corresponding to the change in body temperature, and the use of antipyretic drugs is ineffective.
The body temperature fluctuates easily with changes in the external environment, so it is often slightly low during the day and high at night, and there is the phenomenon of temperature inversion. Some are not serious can show hypothermia, generally not more than 38.5 ℃, but can last for a long time,. And there is no inflammation and toxic manifestations, and antipyretic agents are also ineffective. Sometimes hypothermia, or hypothermia after high fever, if the physical warming is also ineffective, the prognosis is very poor.
Persistent hyperthermia and hyperthermia can rapidly increase brain oxygen consumption, aggravate brain hypoxia, brain edema and brain pathological damage, seriously affect the recovery of brain cell function, and increase the incidence of disability, mortality and complications. Recent studies have shown that lowering brain temperature by 2℃ can significantly reduce post-ischemic neurological damage in neurologically vulnerable areas of the brain . Therefore, rapid cooling is one of the key measures of clinical treatment. Physical cooling plus hormone therapy is commonly used in Western medicine and has certain efficacy. Ling Jianghong, Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangxi Medical University
Treatment of fever reduction: physical cooling is the main treatment, including
1, alcohol rubbing bath, alcohol rubbing bath general alcohol concentration of about 30%, rubbing bath can be first upper limbs after the lower limbs, one side of the rubbing for the other side, and finally rub the waist back. But in the process of bathing should pay attention to observe the changes in the patient, such as a drop in body temperature, chills, pale, blue lips and other signs, should immediately stop bathing, and should be covered with a quilt to keep warm.
2.Warm water rubbing bath.
3, ice pad ice cap cooling: ice bag or ice cap cooling, ice in a plastic bag, tighten the mouth, placed in the large blood vessels, that is, both sides of the armpit, the root of the thigh, the neck and head, 1 hour to replace 1 time. Ice caps on the head can also be used for cooling treatment. And in the application of ice bags or ice caps for treatment, attention should be paid to protecting the ears with gauze to prevent frostbite.
4.Ice water enema, etc.
5.Ice water intravenous infusion: method:0.9% sodium chloride injection, 5% glucose injection, etc. placed in the refrigerator, cooled to 0 ~ 10 ℃ when the liquid is removed with a cotton sleeve insulation. The “intravenous infusion method” was used to infuse cryogenic fluid into the patients, 40-60 gtt/min, with a volume of 500-1,500 ml. intensive care and bedside T, P, R, BP and ECG, CBA (cerebral hemodynamics) monitoring were performed at the beginning of the infusion. In the control group, 1000ml of 0-4℃ fluid was infused at 60gtt/min for those aged 35-55 years; 500ml of 5-10℃ fluid at 40gtt/min for those aged 56-75 years. effect: body temperature started to drop in 28 cases 30min after the infusion of cryogenic fluid, and in 1 case 15min and 1 case 2h later. In all cases, it dropped to below 37.5℃ after 6h. However, the maintenance time was not long. 1 case started to rise again after 15h of normal body temperature; 27 cases maintained normal body temperature for more than 24h; 2 cases did not rise again after normal body temperature until recovery. Complications of intravenous cryogenic fluids.
①Local pain: 1 case in the observation group complained of pain at the venipuncture site, which was relieved after changing the puncture site; no such symptoms in the control group.
②Sudden drop in body temperature or non-increase in body temperature: 1 case in the observation group had a sudden drop in body temperature, which was controlled in the normal range after slowing down the drip rate; the control group did not have this symptom. It is suggested that when infusing cryogenic fluid, the temperature change should be closely observed and the drip rate and infusion volume should be controlled according to the degree of temperature drop.
6.Chinese medicine treatment.
① Angong Niuhuang pills 1 pill, with warm boiled water about 50ml finely grinded after infusion or from the gastric tube injection, 1 to 2 times a day, for 2 to 3 days until the fever subsides and the spirit is clear;
Cold Chinese medicine preparation enema: (enema 1): 30g of rhubarb, 10g of Huanglian, 20g of cypress, 30g of gardenia, 40g of honeysuckle, 30g of gypsum, 20g of Zhi Mu, 30g of japonica rice, 30g of maitong, 10g of licorice. decocted in water to 800ml, put it in the refrigerator to lower the temperature to 12-15℃, 500ml of one-time enema, 300ml of reserved enema for 30min. Repeat 1 time for 3h.
Chinese medicine theory: Although this disease is mainly characterized by high fever, it belongs to the category of “stroke and internal organs” in Chinese medicine; the pathogenesis is that liver yang turns into wind, Qi and blood reverses, and phlegm and fire block the orifice; the treatment is to clear liver and calm wind, resolve phlegm and clear heat, and awaken the brain and open the orifice. The medicine of Angong Niuhuang Pill contains Niuhuang, Rhinoceros Horn, Musk, Yujin, Scutellaria, Huanglian, Pearl, Xionghuang, etc. It has the function of clearing heat and detoxifying, opening the orifice with phlegm, which is very suitable for the pathogenesis and treatment of this disease. “Enema No. 1” formula of honeysuckle, cypress, scutellaria, gardenia, rhubarb has the effect of clearing heat and detoxifying, dipping fire and drying dampness, pharmacological research has confirmed that it has a strong inhibitory effect on bacteria such as Staphylococcus aureus, hemolytic streptococcus, dysentery bacillus and typhoid bacillus.
It is also used to reduce intracranial pressure, reduce cerebral edema, remove endotoxins and pyrogenic sources, and reduce the production of pyrogenic factors; gypsum, Zhi Mu, licorice, and japonica rice, that is, the Chinese medicine Bai Hu Tang, can clear heat and produce fluid, with a significant effect on reducing fever; heat can easily injure yin, so add maitong to nourish yin and produce fluid. 12-15 ℃ cold Chinese medicine preparation enema, but also directly take away the rich rectal and colonic The heat in the blood vessels .
Caution
Artificial hibernation therapy should be applied with precautions
(1) Strictly grasp the indications and contraindications.
(2) During the hibernation process, a person should be responsible for closely observing the condition and recording blood pressure, pulse, respiration, body temperature and urine volume on time. If the patient is agitated, the drip rate should be accelerated. For pain relief, the patient can be put in semi-hibernation as long as the patient does not reach pain.
(3) If the patient is allowed to eat, let the patient awake once every 6-8 hours; those who cannot eat should be given nasal feeding and intravenous nutrient solution.
(4) Strengthen the nursing work, appropriate turning and massage to avoid bedsores.
(5) Hibernation can only be used as a kind of hypnosis and auxiliary therapy, and effective basic treatment should not be neglected.