I. Thinking and practice of diagnosis and treatment in the acute progressive stage
(A) the acute progressive phase of clinical often encountered problems
1, patients with interstitial lung disease, especially the acute progression of severe disease, patients suffocating wheezing, dyspnea, often feel is no effective treatment can make it relief.
2, fever, often irregular high fever, clinical control is very difficult.
3, diagnostic difficulties – this is when the lung inflammation progresses, but co-infection? Dysbiosis? Or is it progression of interstitial pneumonia itself?
Case 1, Yang Hongying, Tong County, Beijing, due to recurrent fever, dyspnea, and poor outcome by treatment for more than two months. She was admitted to the hospital on June 4, 2003, with rapid progression of her disease, progressive worsening of dyspnea, and inflammation of both lungs on chest CT. (Picture data)
Through the analysis of this patient’s disease progression, we can often get the right treatment, this type of patient is actually not difficult to treat and diagnose, but, why do we often face – the patient’s condition progresses rapidly, and the treatment is really ineffective?
(B) Acute progression of the diagnosis and treatment of the problem often over-treatment
1, often over-treatment. For patients with acute onset, can we also consider the patient’s physical status?
such as malnutrition ? cardiac insufficiency? Drug fever?
2.Sensitivity to drugs – often neglected in acute and critical resuscitation?
3, even if the patient’s physique can afford, can we try to choose the right medication?
4, can we add Chinese medicine treatment, reduce hormone shock, multiple antibiotics use?
Example 2 The patient is a 19-year-old female, May 7, 2009, with sudden high fever, T:39.C paroxysmal cough severe, cough even waist pain heavy. Amoxicillin, Archie, and now Meperidine drops, but the body temperature did not drop. Took 2 pills of Chinese medicine. After the above treatment for 10 days, the high fever still does not subside and the inflammation in the lungs does not subside. Blood sedimentation 110 CRP 112, CT:inflammation of right lower lung. (May 17)
On 5-18 Chai Hu 15 Pueraria Mirifica 24 Su Ye 12 Scutellariae 12 Radix Scutellariae 30 Jinyin Hua 30 Forsythia 15 Patchouli 15 Panax notoginseng 30 Citrus aurantium 12 Ginseng 24 Qing Xian Xia 12 Paeoniae 15 Yam 24 Qiang Wu 12 Rutabaga 30 Peppermint 12 Licorice 6 Take 2 doses, add three slices of ginger and five jujubes, decoct twice with water, 20 minutes after each boiling, (cover the pot with low heat) pour together and take in 4-5 times. Also, methylprednisolone 120mg, Danhong 30ml and cardiac amide 90mg were given intravenously. 3 days later, the cough was not so frequent and the body temperature dropped, around 37C, with itchy throat and cough in paroxysms. After taking the above herbs, the temperature dropped (37.5-38C).
On May 19, her temperature was 37.2-37.7, and on May 20, it was about 36.5. She was in better spirits than before and wanted to eat.
On May 26, “my daughter’s illness is basically better now”. Chest X-ray “bronchitis, lung shadow basically disappeared.” . .
Through this case analysis, interstitial lung disease must first be diagnosed clearly, and the acute exacerbation, often because of the cold, the following do focus on the analysis.
(C) determine whether the patient’s cold causes an acute exacerbation of the disease points, in addition to the common symptoms of the cold, fever, sore throat, head and body pain, there are any of the following, all suggest that the patient is an exacerbation of the disease.
1. The patient suddenly feels short of breath and difficulty in breathing when moving.
2.Faster breathing rate at rest.
3.Vigorous cough, especially a violent cough that is constantly associated with day and night.
4.High fever, chest pain, general joint pain with dyspnea. This is an acute exacerbation of the disease and must be treated as early and aggressively as possible.
(D) Common treatments for acute progression of interstitial pneumonia and for patients with advanced colds.
1, commonly used proprietary Chinese medicine: (if the patient is mild, no fever and respiratory distress, only the following drugs can be used)
Sanjiu cold and flu spirit: 1-2 generations, 2-3 times a day, depending on the patient’s physical condition and weight.
Qingkailing soft capsule: 2 capsules, 3 times a day
Lung Power Cough Capsules: 4 capsules, 3 times a day
2.Chinese herbal decoction: (if only common symptoms of cold and fever, no respiratory distress, only decoction can be used)
Radix Bupleurum 15 Radix Puerariae 24 Radix Scutellariae 12 Radix Scutellariae 12 Radix Gastrodiae 24
Jin Yin Hua 30 Forsythia 15 Panax notoginseng 24 Yuan Shen 24
Qingxia 12 Chrysanthemum 12 Radix Platycodon 15 Zhebeijian 12 Peppermint 12
Bamboo leaf 12 rhizome 30 licorice 6 Take 2-3 doses.
Add three slices of ginger and five jujubes, decoct twice with water, 20 minutes after each pot is opened (cover the pot with a low flame), pour together and take in 2-3 times with warmth.
3, intravenous medication (cold symptoms, fever, dyspnea, chest film inflammation recently progressed)
Maiqing (bitter ginseng base) injection 100ml, once a day;
Danhong injection 30ml add 250ml saline once a day;
4,, antibiotics, can be used according to the patient’s cold time judgment, 1-3 days, no need to use. 3 days or more, according to the lung auscultation to determine. 5-7 days course of treatment.
5, Ginseng Astragalus injection 250ml, once a day; No need to use antibiotics and antibiotics after stopping.