Note: Spinal cord injury is a very serious disease with a very large number of complications, some occurring mainly in the acute phase and others mainly in the mid to late phase. We provide a brief introduction by body system classification. We will try to use non-medical terms in the introduction. We hope that patients can have a simple understanding.
1.Pulmonary infections
Respiratory tract infections, especially bacterial infections of the lower respiratory tract, are often a prominent problem for patients and physicians. Respiratory infections are also a major cause of death in the acute phase of spinal cord injury. Clinical manifestations, laboratory tests and X-ray examinations and diagnostic and therapeutic principles are the same as those for the diagnosis and treatment of general pulmonary infections. Nursing care should be timely removal of airway secretions, strengthening turning and back patting, and encouraging patients to cough and sputum. If the patient is unable to cough up the sputum, he should be diligently attracted to the secretions in the airway.
2. Pulmonary atelectasis
Due to paralysis of respiratory muscles, the patient is unable to cough or cough up sputum, and at the same time, secretions are stored in the trachea of the low lung segment due to the difficulty of bed rest and position change, resulting in pulmonary atelectasis. Early treatment after spinal cord injury with dehydrating agents or diuretics and increased sputum viscosity are also causative factors. The clinical diagnosis and treatment of post-spinal cord injury pulmonary atelectasis is basically the same as that of general pulmonary atelectasis
Digestive system complications
1.Stress ulcer
Patients with spinal cord injury can develop acute gastric mucosal lesions and stress ulcers and bleeding of the stomach. Due to the loss of sensation below the level of injury after spinal cord injury, the diagnosis of stress ulcers, hemorrhage and even perforation is difficult and can easily be missed. Stress ulcers are suggested by bloating, nausea, especially vomiting or gastrointestinal decompression with coffee-colored gastric contents, or black stools.
The main stress ulcer treatments are
Internal treatment
1.Continuous decompression with an indwelling gastric tube can prevent gastric dilatation Remove gastric acid and blood accumulation Understand bleeding
2.Ice saline or vasoconstrictor gastric lavage can make mucosal vasoconstriction to achieve hemostasis
3.Intravenous vasoconstrictors (norepinephrine, posterior pituitary pressor, etc.)
4.Antacid drugs to inhibit gastric acid.
Surgical treatment
Only 10% of patients with bleeding stress ulcers require surgical treatment There are strict indications for surgery.
2.Gastrointestinal tract dysfunction
Gastrointestinal dysfunction is very common in patients with spinal cord injury. It is mainly due to vegetative nerve dysfunction, which leads to the weakening of intestinal peristalsis or disturbance of peristaltic rhythm. General performance of abdominal discomfort and fullness, nausea and other symptoms, generally less serious. In the acute phase, severe gastrointestinal problems can occur, such as intestinal paralysis, resulting in severe flatulence, abdominal distention, and even affecting the movement of the muscle diaphragm. Active management is required. Several principles are noted in the management.
1.Fastening
2, gastrointestinal decompression
3, intravenous nutrition
4, semi-sitting position can reduce intra-abdominal organ compression on the diaphragm and improve breathing
5.Watch out for stress ulcers.
3.Abnormal stool function
Patients with spinal cord injury all have abnormal stool function. Early spinal cord injury manifests as fecal incontinence, followed by constipation. Severe constipation in paraplegic patients is mainly due to lack of gastrocolic reflex, slowed peristalsis of the colon (mainly in the left hemicocele) and excessive absorption of water due to loss of the rectal defecation reflex. Treatment of constipation.
1.Promote intestinal peristalsis: You can promote intestinal peristalsis by abdominal massage, especially in the left hemicolectomy.
2, training defecation reflex: as far as possible every day the patient sitting, increase abdominal pressure, and give appropriate stimulation or finger stimulation, such as pressure on the anus and lower abdomen. At the same time, schedule regular bowel movements according to the patient’s pre-injury bowel habits.
3.Adjust the dietary habits and increase fiber-containing food.
4.Laxative drugs: glycerin enema, etc.
Neurological complications
1.Vegetational hyperreflexia
Vegetative hyperreflexia occurs after the end of spinal shock and is seen in patients with spinal cord injury above T6, but individual cases of spinal cord injury below T6 cannot be excluded. This is a serious complication that requires emergency treatment and may lead to cerebral hemorrhage and death. Phytohyperreflexia is caused by an imbalance in the sympathetic and parasympathetic balance of the vegetative nervous system after spinal cord injury and is caused by the sudden release of sympathoadrenergic mediators caused by stimuli below the level of spinal cord injury. Clinical symptoms: The main symptom is headache, sometimes with severe throbbing pain, and the patient may experience blurred vision, nausea, chest pain and dyspnea. The main sign is sudden hypertension, followed by a slow or rapid pulse, accompanied by facial flushing, excessive sweating, and sometimes a rash. Triggers of vegetative hyperreflexia: Abnormal stimulation of the paralyzed area below the plane of spinal cord injury is a trigger for vegetative hyperreflexia, and urinary retention and constipation are the main common clinical triggers. Other triggers such as bed sores, bladder stones, urinary tract infections, acute abdomen, sexual intercourse and childbirth, and even tight clothing or ingrown toenails may also be triggers. Treatment of vegetative hyperreflexia.
1. Immediately elevate the head of the bed or adopt a sitting position to reduce intracranial pressure.
2. In severe cases, take 10mg of sublingual cardiac painkillers and repeat after 10-20 minutes if necessary.
3.Monitor blood pressure and pulse.
4.Eliminate triggers: such as catheterization or rectal evacuation.
5.For those with frequent vegetative overreflexes, make the patient and family understand the treatment.
6.If serious complications occur, seek medical attention immediately.
2.Spasm
Generally, spastic paralysis is manifested in cervical and thoracic medullary injuries, while lumbar and sacral medullary injuries are mostly manifested as flaccid paralysis. Spastic paralysis can be seen in complete paralysis, but also in incomplete paralysis, which is more common in incomplete paralysis. The most important sign of spasticity is stiffness of the limbs, involuntary jerking or clonus of the limbs, which can be triggered especially by external stimulation. Severe spasticity can make the patient unable to sleep at night, difficult to sit or lie down, and tightly clenched thighs during urination and defecation, leading to difficulties in cleaning and care; there are many factors that aggravate spasticity, such as.
1, pressure sores and their foci of infection ;
2, urinary tract infection, urinary tract stones and other complications;
3, fractures, dislocations and other traumatic injuries and heterotopic ossification, etc.;
4, joint contracture;
5, hemorrhoids and other anal disorders;
6, bladder, rectal filling;
7, tight and crowded clothes and shoes;
8, rapid changes in climate and temperature;
9, mental anxiety, excessive tension in the condition of spasm aggravated.
The main principles of treatment of spasticity are
1.Eliminate the cause
2.Medication
3.Physical therapy
4.Surgical treatment
Since spasticity is very common in patients with spinal cord injury. We introduce it separately.
3.Pain (paraplegic neuralgia)
It is common and difficult to manage. Patients with spinal cord injury often complain of pain at the site where the connection with the brain should have been completely blocked. This kind of pain contains emotional, external and internal factors. Happiness can reduce pain, having distractions and psychological problems can aggravate pain, and it has been observed that weather, fatigue, infection, cramps, swelling sensation of urine, smoking, alcohol consumption, pressure sores, constipation, etc. all affect pain. Paraplegic neuralgia can be divided into five types.
1, myofascial pain at the spinal cord injury.
2.cardiogenic pain.
3. visceral pain.
4. nerve root pain.
5, spinal cord injury distal diffuse abnormal sensory pain.
The principles of treatment for paraplegic neuralgia are.
1.Elimination of causative factors
2.Medication
3.Physical therapy
4.Surgical treatment
5.Mind treatment
Since pain is very common in patients with spinal cord injury. We introduce it separately.
Complications of genitourinary system
1.Urinary system infection
Urinary tract infection should be considered if routine urine pus cell count is found to be greater than 10 per high magnification field, and bacterial count is greater than or equal to 100000/ml. In patients with spinal cord injury urinary tract infection, there may be fever and chills, but most do not have obvious urinary frequency, painful urination. Treatment principles include.
1, according to the results of bacterial culture and drug sensitivity test results to select sensitive antimicrobial agents
2.Keep urination unobstructed, if necessary, leave a urinary catheter in place; drink more water on the basis of unobstructed urination, the effect of bladder flushing is not certain.
3, prevention of urinary tract infection is very important.
2, hydronephrosis
The impact of spinal cord injury on the urinary system is mainly urinary disorders, such as improper treatment can cause vesicoureteral reflux, hydronephrosis, urinary tract infection and renal hypofunction or failure. When hydronephrosis occurs, the principle of treatment is to leave the catheter in place and open first, and always seek medical attention.