Western medical treatment of acute mastitis.
1, physical therapy is applicable to the early treatment of mastitis to induce the inflammation to subside or confine.
(1) cold compress treatment: cold compress can make the local temperature drop, capillary exudation is reduced, the peripheral nerve conduction impulses slowed, with analgesia, swelling, inhibit the spread of inflammation, reduce the role of milk secretion, hot compress abscess formation faster than cold compress, cold compress incision and drainage rate of 40.42%, lower than the incision rate of hot compress (hot compress incision rate of 82.9%), and the earlier the cold compress the better.
① timing: in the early stage of acute inflammation (within 24h after the onset), within 48h before the inflammation is controlled, and after 48h it can be changed to hot compress.
②Method: After crushing ice, rinse off the corners with cold water, place the ice bag, wrap the ice bag with cotton outside, place it on the hard node local for 3~4h, local skin rewarming can then be cold compress, if the local numbness is not tolerable, change to short time cold compress, cold water compress is available in winter.
③ attention to the problem: in the cold compress at the same time can drink more water, so that the milk becomes thin, reduce stagnation, facilitate the discharge of milk, in order to play the role of drainage and flushing, conducive to inflammation, cold compress fashion must pay attention to prevent local frostbite, such as the disease within 24h with cold compress can not yet be controlled, can give up cold compress and change to hot compress, in order to facilitate the absorption of inflammation.
(2) hot compress treatment: acute mastitis after 3 days, the local lesions show infiltration and exudative changes, at this time hot compress can increase local tissue blood flow, promote leukocyte chemotaxis, improve the phagocytic function of leukocytes, promote the absorption of inflammatory exudates, confinement and liquefaction, with analgesic, anti-inflammatory effect.
①Timing: after 24h or 48h of onset, the inflammation has been confined.
② method: about 50 ℃ warm compress placed on the red swollen local, covered with gauze pad insulation, 20-30min each time, 3-4 times / d, edema is obvious with 25% magnesium sulfate wet heat compress.
(3) infrared, ultraviolet light: the former heat penetration is strong, can reach the deep breast tissue, the effect is better than wet heat compress; the latter through the photochemical effect, has a strong anti-inflammatory, pain-relieving effect.
(4) breast massage: drain the remaining milk with negative pressure suction method, such as breast pump suction or human suction, etc., the negative pressure suction is too large, easy to make the milk ducts temporarily narrow, affecting the effect of breast drainage, breast massage is the use of the role of squeezing, emptying the milk ducts, to promote the dissipation of the silt, the method is suitable for occlusion of the milk ducts, milk stagnation, or the initial stage of lobular inflammation of patients, if the local edema is obvious, accompanied by fever, or abscess has formed, it is prohibited. This method.
①Massage: five fingers together, with the small fish intersection of the two hands, clamping the base of the breast, along the lactiferous ducts, gently massage the nipple for 1 to 2 min, then use the palm of the hand from the outer edge of the sluggish nodes to the nipple direction gradually push and lightly rub the squeeze, repeatedly massage 5 to 10 min, you can gradually push out the sluggish milk, massage, you can use your hand to gently lift the nipple several times, to expand the output tube of the nipple, if massage before the local hot compress, the effect is better.
② comb back massage: the affected part of the breast coated with a small amount of oil (liquid paraffin or castor oil can be) to reduce friction on the skin of the breast stimulation, to avoid skin damage, with a baked hot wooden comb back (to not burn the skin for the degree) from the base of the breast, by the affected part and then to the nipple and pushed, so that the occlusion of the milk ducts from the inside out, from small to large, gradually expanded by the milk, and finally the whole tube open, the milk discharge, the patient can be in a short period of time The patient can be cured in a short period of time.
Massage precautions: A. In order to reduce the spread of inflammation and sepsis caused by massage, massage must be carried out under the premise of systemic application of antibiotics.
B. In order to reduce the pain of massage, massage first in the bruised surrounding tissue injection 0.5% ~ 1% lidocaine 20 ~ 40ml, to be 5min before massage.
C. Breast lobules and surrounding tissues have mild inflammation, can be added to the local anesthetic penicillin 400,000 U, 10min after the injection and then massage.
D. During treatment, the nipples can be lightly washed with warm boric acid solution and coated with penicillin or sulfonamide ointment, and then covered with gauze to protect the nipples.
(5) Breast support: The purpose is to reduce the mobility of the breast and alleviate breast pain, there are 2 types of bra support method and cloth belt or triangle towel belt support method.
2.Antibiotic application
(1) Systemic treatment: Penicillin is preferred, the dosage can be determined according to the symptoms, 800,000 U intramuscular injection each time, 2-3 times/d, also available 8 million U intravenous drip.
(2) Antibiotic local closure.
①Method 1: Local treatment can be closed with 20ml of saline containing 1 million U of penicillin.
② method 2: with 0.25% procaine 60 ~ 80ml, plus penicillin 800,000 ~ 1.6 million U, in the inflammatory area above about 3cm of healthy subcutaneous tissue for the horizontal “a” shape closed, the range should be more than the diameter of the inflammatory area, closed once a day or every other day, or injected into the loose tissue after the breast, this treatment both anti-inflammatory This treatment is both anti-inflammatory, swelling, pain relief, and also can make the breast tissue in a relaxed state, which is conducive to the discharge of milk, when the injection must pay attention to leave the inflammatory area, so as to avoid the spread of inflammation due to the injection, local pressure increase.
3.Surgical treatment
(1) Laser perforation: After determining the location of abscess, perforate the most obvious part of abscess fluctuation and suck out the pus, then push antibiotics into the abscess cavity, this method is less traumatic and easy for patients to accept, and also free from the pain of changing medicine.
(2) Abscess incision and drainage: After abscess formation, the abscess should be incised and drained in time, but several points need to be noted.
(1) Anesthesia: local anesthesia is mostly used for superficial abscesses, while intravenous anesthesia is appropriate for deep abscesses or post-breast abscesses.
Method: A long-needle syringe is used to stab the posterior breast from the upper, lower and lateral sides of the basal edge of the breast; 0.5% procaine is used for fan infiltration; then subcutaneous infiltration is performed around the basal edge of the breast, totaling about 100 ml, and the needle should be parallel to the chest wall during puncture to avoid puncturing the pleura; if anesthesia is not complete at the incision site, intracutaneous and subcutaneous infiltration can be performed along the incision, and if the abscess is small in scope, it can also be If the scope of abscess is small, rhombic infiltration anesthesia and intradermal and subcutaneous infiltration along the incision line can be performed in the normal tissue around the inflammation.
②Purulent puncture: Before incision, the pus cavity should be punctured, especially for deep abscesses, and the puncture point should be chosen at the place with the most obvious edema and the most painful pressure, and a small amount of pus should be extracted for smear or bacterial culture, and after the pus is extracted, the needle should not be removed for the time being, and the abscess should be incised with the needle as a guide.
③ Incision of abscess.
A. Incision size selection: incision in different directions should be taken according to the abscess in different parts, but the length of the incision should be basically the same as the size of the abscess cavity base, such as small skin incision, which affects drainage; and too large skin incision, which will cause delayed healing.
B. Incision direction: choose different incision directions according to the abscess site, for abscesses located in the interglandular lobe of the breast, the incision should be made in the direction of the milk duct in a radial pattern and not in the areola, interglandular lobe abscesses are mostly spaced and composed of several abscesses, so after cutting the skin and subcutaneous tissue, the abscess is propped up by inserting a vascular clamp into the abscess cavity, then the abscess is probed with the index finger and the abscess cavity is spaced apart to make it a pus cavity for drainage, and also to understand the extent and size of the abscess, and to feasibly drain the counterpart if necessary.
For abscesses located under the areola, in order to prevent damage to the sebaceous glands under the areola, an arc-shaped incision should be made along the edge of the areola, subcutaneous, and the abscess cavity should be inserted and propped open with vascular forceps and not too deep so as not to cut off the milk ducts and cause breast fistula.
For abscesses located behind the breast or abscesses around the breast, an arc-shaped incision can be made around the breast (i.e. at the breast breast crease at the base of the breast) to drain through the posterior gap of the breast, so as not to damage the milk ducts and cause milk leakage, and to facilitate drainage.
④ Drainage of pus: cut the skin layer by layer, subcutaneous tissue, ligate the bleeding point, deep tissue, use medium curved forceps along the needle to bluntly separate into the pus cavity, see the pus can pull out the needle, and then insert the finger into the pus cavity to detect the size of the pus cavity and open each interval of the pus cavity for drainage.
In some abscesses with larger pus cavities, sometimes the drainage is still poor after incision, and when exploring the pus cavity, an additional incision can be made at the lowest position of the pus cavity to bluntly separate the breast tissue, so that the two incisions can communicate with each other, i.e., counter-oral drainage, and the counter-oral incision should pay attention to the fact that the deep incision should be similar in size to the skin incision to prevent the skin incision from being large and the deep incision from being small, which makes it difficult to drain adequately.
⑤ Placement of pus cavity drains: after incision, the pus in the pus cavity is removed by dry gauze or attractor, which can also be rinsed with saline, and then dry gauze is folded into the pus cavity from the bottom of the pus cavity to the incision, which should be slightly tight, and dry gauze drains, which is beneficial to stopping bleeding and sucking out pus and expanding the trauma, and is superior to petroleum jelly gauze or saline gauze.
(6) drug change: 2 to 3 days after the incision and drainage of the first drug change, drug change can be used to wet the gauze drainage strip with saline, and then gently and slowly pulled out, with saline cotton balls or saline gauze will be wiped dry secretions, with saline gauze drainage, one is easy to drain, the other is easy to granulation newborn, conducive to adsorption of pus moss and necrotic tissue, less irritation to the wound surface, better than petroleum jelly gauze, the placement of drainage strips to be slightly loose, too tight will affect the drainage effect and necrotic tissue, superior to petroleum jelly gauze. Too tight will affect the drainage effect and the growth of granulation. The drainage strip should be placed at the bottom of the pus cavity to prevent residual abscesses, and the number of drainage strips placed should be recorded and carefully checked when removed to avoid leaving behind and affecting the healing of the trauma.
(7) Remediation of breast duct injury: Once the milk duct is mistakenly cut off during the operation (milk flow is visible on the trauma during lactation), suture ligation is feasible to prevent the occurrence of breast fistula.
4, pus cavity flushing: puncture the pus cavity, pump out the pus, then inject sterile saline or antibiotic diluted saline – pump out and discard – inject saline again, and so on repeatedly, so that the pus and necrotic tissue is flushed out, promoting the growth of pus cavity buds, reducing the absorption of toxins and promoting the early healing of the pus cavity, and the patient’s pain is small, less damage to breast tissue, and does not affect the function of milk secretion, but also to avoid the formation of scarring due to incision It also avoids scar formation and even breast deformation due to pus drainage, and can be accompanied by internal administration of traditional Chinese medicine while flushing the pus cavity.
(1) Indications: ①Limited inflammation, abscess formation, systemic toxic symptoms are not obvious.
(2) Those whose inflammation has turned into chronic process.
(3) Single abscess with no pus interval.
④Patients who are allergic to anesthetics or who cannot undergo general anesthesia.
(2) Tools: one 20ml syringe, two No. 6 needles, one No. 16 blood collection needle, 1% or 0.5% procaine injection, and 0.9% sterilized saline, etc.
(3) Operation: Perform routine disinfection in the center of the abscess cavity, use 0.5% procaine as local anesthesia, and then puncture in the thicker part of the abscess cavity wall (puncture in the abscess cavity wall is too thin, the eye of the needle is not easy to heal).
After puncture, generally inject sterile saline, but if the inflammatory infiltration around the pus cavity is obvious, penicillin 800,000 ~ 1.2 million U can be diluted with saline 10 ~ 20 ml, then add 1% procaine (nufcaine) liquid 1 ~ 2 ml, injected into the flushed pus cavity (with penicillin must be skin test), after daily flushing, inject penicillin once, the whole body can no longer use antibiotics.
Acute mastitis TCM treatment.
The Chinese medicine called acute mastitis as “canker sore”, which is caused by “liver qi stagnation and internal heat congestion”, and should be treated by “draining liver qi, clearing heat and detoxifying”.
(1) Local treatment
①Ruyi Jinhuang San is made into a paste with vinegar or white wine and applied to the lesion locally.
② fresh dandelion, white onion, pounded into a paste, applied to the affected area, tied with a bandage or triangular towel, change the medicine once a day.
③Triple yellow ointment applied externally: triple yellow ointment, i.e. cypress, rhubarb, scutellaria each equal parts, grinded into fine surface, mixed with cool boiled water, honey or equal amount of petroleum jelly into a paste.
④ Hibiscus paste applied externally: Hibiscus paste has the function of clearing heat and detoxifying, activating blood circulation, resolving blood stasis and eliminating swelling.
Recipe 1: Hibiscus leaves are grinded into a fine surface and mixed with sesame oil or tea water, or an equal amount of petroleum jelly can be added to make a paste.
Recipe 2: Hibiscus leaves, rhubarb, cypress, zelenium leaves, ice chips, finely ground together, mixed with yellow wine or blended with petroleum jelly as ointment for external application.
(2) Soup treatment.
(1) Fresh dandelion, decoction in water.
(2) Whole herb of fine leaf of Farmer’s Mantle, decoction in water.
(3) Deer horn powder, taken with boiling water.
④Dandelion, wild chrysanthemum, decoction in water, 1 payment per day.
⑤Brachium burdock soup: cooked burdock, raw gardenia, honeysuckle, forsythia, whole brachium (broken), dandelion, orange peel, orange leaf, bupleurum, yellow ling, decoction in water, 1 payment per day.
(6) Five Flavors Disinfectant Drink: honeysuckle, dandelion, daidin, forsythia, wild chrysanthemum, panax quinquefolium, red peony, decoction in water, 1 payment per day, this formula mainly has the effect of clearing heat and detoxifying, eliminating swelling and dispersion, invigorating blood and dispelling silt, which is an effective formula to control the symptoms of systemic poisoning.
(7) Sore and ulcer drink: samphire pearl, soapberry, angelica tail, smallpox powder, chenpi, frankincense, myrrh, honeysuckle, red peony, dandelion, decoction in water, 1 payment per day, this formula has the function of activating blood circulation and removing blood stasis, clearing heat and detoxifying, and reducing swelling and softening.
(8) Jin Yin Hua, Dandelion, Brahmi, Chai Hu, Scutellaria, Wang Bu Liu Xing, Qing Pi, Soapberry, Red Peony, Silphium, taken with water decoction, 1 dose daily.
⑨ Whole sphagnum is decocted in water and the residue is applied to the affected area while it is hot.
⑩ burdock leaves decoction in water and drink as tea, 1 payment per day, for the period of lactation stagnation.