What Is Polyradiculoneuropathy?

The etiology of AIDP is unknown, and most scholars support the following two theories: 1. Viral infection said. Reasons: A few days or weeks before the onset of AIDP, symptoms of upper respiratory or gastrointestinal infections, or some viral diseases, such as influenza, chicken pox, shingles, mumps, etc .; Some people found AIDP and other peripheral neuropathies Accompanied by human immunodeficiency virus infection; anti-EB virus and anti-cytomegalovirus antibodies were found in the blood of AIDP patients. In summary, it is suggested that AIDP is related to viral infection, but so far no evidence of direct virus invasion has been found in diseased tissues. Many scholars have used cerebrospinal fluid or neural tissue culture and animal inoculation methods to fail to isolate pathogens. Observe that the patients' infection symptoms are not significant, the disease often does not have fever, the number of cells in the cerebrospinal fluid does not increase, and the pathological tissues have no acute inflammation changes. 2. Autoimmune theory considers that AIDP is an autoimmune disease, which is caused by immune disorders caused by infectious diseases. Reasons) Before the onset of AIDP, infections often occur, and infectious diseases and neurological symptoms appear, with a period of incubation; In peripheral blood lymphoblasts of AIDP patients, the blood lymphocytes of acute AIDP patients can induce the Root ganglion demyelination changes; some AIDP patients' serum can cause demyelination of peripheral nerves after tissue culture or intranerve injection; circulating immune complexes and anti-peripheral nerve myelin antibodies are found in the serum of AIDP patients; The protein of cerebrospinal fluid increased, the IgG, IgM, and IgA in immunoglobulin increased and the oligoclonal TgG appeared in the cerebrospinal fluid 2 weeks after AIDP; Experimental allergic neuritis, which has pathological, electrophysiological, and cerebrospinal fluid changes similar to AIDP. In summary, the disease may be caused by viral infection as the primary cause, and then develop through inflammation or immune disorders. It is an autoimmune disease with delayed allergic reactions.

Polyradiculoneuropathy

Polyradiculoneuropathy is also known as acute infectious polyradiculoneuritis and Guillain-Barre syndrome with acute infectious demyelination. Multiple polyradiculoneuropathy, which mainly affects the spinal nerve root, spinal nerve, and cranial nerve. Clinical features are acute or subacute symmetrical flaccid limb paralysis.

Causes of polyradiculoneuropathy

Western medicine etiology of polyradiculoneuropathy

The etiology of AIDP is unknown, and most scholars support the following two theories: 1. Viral infection said. Reasons: A few days or weeks before the onset of AIDP, symptoms of upper respiratory or gastrointestinal infections, or some viral diseases, such as influenza, chicken pox, shingles, mumps, etc .; Some people found AIDP and other peripheral neuropathies Accompanied by human immunodeficiency virus infection; anti-EB virus and anti-cytomegalovirus antibodies were found in the blood of AIDP patients. In summary, it is suggested that AIDP is related to viral infection, but so far no evidence of direct viral infection has been found in diseased tissues. Many scholars have used cerebrospinal fluid or neural tissue culture and animal inoculation methods to fail to isolate pathogens; from clinical manifestations Observe that the patients' infection symptoms are not significant, the disease often does not have fever, the number of cells in the cerebrospinal fluid does not increase, and the pathological tissues have no acute inflammation changes. 2. Autoimmune theory considers that AIDP is an autoimmune disease, which is caused by immune disorders caused by infectious diseases. Reasons) Before the onset of AIDP, infections often occur, and infectious diseases and neurological symptoms appear, with a period of incubation; In peripheral blood lymphoblasts of AIDP patients, the blood lymphocytes of acute AIDP patients can induce the Root ganglion demyelination changes; some AIDP patients' serum can cause demyelination of peripheral nerves after tissue culture or intranerve injection; circulating immune complexes and anti-peripheral nerve myelin antibodies are found in the serum of AIDP patients; The protein of cerebrospinal fluid increased, the IgG, IgM, and IgA in immunoglobulin increased and the oligoclonal TgG appeared in the cerebrospinal fluid 2 weeks after AIDP; Experimental allergic neuritis, which has pathological, electrophysiological, and cerebrospinal fluid changes similar to AIDP. In summary, the disease may be caused by viral infection as the primary cause, and then develop through inflammation or immune disorders. It is an autoimmune disease with delayed allergic reactions.

TCM etiology of polyradiculoneuropathy

1) External causes feel the evils of the six kinks, such as feeling the heat of dampness or summer heat, the heat is injured, the veins are empty, the veins are lost, and the hands and feet are not used. If the fur is weak and slack, you will also have a pupa "), or in a wet place for a long time, or if you feel wet when you are exposed to the rain, you can get sick if you do nt stay wet (" Su Wen · Xun Luan Pian "" There is gradually getting wet. Water is a matter, if you stay, your residence is extremely wet, your muscles are stained, you are unkind, and your hair is meaty. "

2 due to inadequate endowment, weak body spleen and stomach, prolonged illness, fatigue, excessive strain, liver and kidney injury can also occur. 3, not inside and outside due to dietary insufficiency, fat and thick taste, or addicted to alcohol, eat spicy food, damage the spleen and stomach, Jin liquid qi and blood resources are passive. The acute phase of the disease is mainly evil, and the main causes are summer heat, dampness, and heat. The recovery period is mainly due to insufficient blood and qi, and liver and kidney deficiency. The disease is located in the liver, spleen, and kidneys.

Features of polyradiculoneuropathy

Time: Onset can occur throughout the year, but slightly more frequently in summer and autumn.

Region: The disease occurs in various countries around the world.

Population: Any age can occur, according to the survey found that 4 to 6 years old and the youth group has two peak incidence, more men than women.

Pathogenesis of polyradiculoneuropathy

Polyradiculoneuropathy western medicine

The main pathological changes of AIDP are in the motor and sensory nerve roots. Multiple, segmental demyelination of ganglia, spinal nerves and cranial nerves. It can disintegrate in large pieces, usually without axonal degeneration, but in more severe cases, axonal degeneration, rupture, swelling, distortion and so on. Lymphocytes, monocytes and macrophages infiltrate the peripheral nerve inner membrane. The basic pathological process of AIDP is 3 to 4 days after the onset of nerve fiber edema, demyelination after 4 to 5 days, axon swelling slightly, cell infiltration on the 8th day, macrophages and Schwann on the 12th day. HeLa cells proliferate and myelin regeneration occurs. Demyelination and myelin regeneration can be seen on the same nerve fiber. With the regeneration of the peripheral nerve myelin sheath, approximately 85% of patients can return to action after 6 months. In severe cases, the axon is also damaged, and the recovery is slow and incomplete, leaving a certain degree of neurological dysfunction.

Polyradiculoneuropathy

1. Lung-heat injury and lack of righteousness and feel the damp-heat poisonous evil, high fever does not retreat, or after the illness is not exhausted, low-temperature fever does not understand, the lung heat-heated evil, fluid loss, pulse loss moisturizing, causing hand and foot weakness and weak, and Into a card. "Lung hot leaf coke" means. 2. Damp heat soaks in a wet place for a long time, or feels dampness when it is raining, stays wet, and stagnates heat; or diet is not good, the spleen and stomach are damaged, wet from the endogenous, wet and accumulated heat, damp heat soaks the veins, Qi and blood don't run smoothly, and the muscles of the tendons and veins relax and become unwell. 3. Weak body of spleen and stomach, weak body of spleen and stomach, or loss of spleen and stomach due to illness, lack of sources of qi and blood, and loss of muscle tendons and veins. 4. Insufficient endowment due to liver and kidney deficiency, chronic illness, physical deficiency, kidney essence, liver and blood loss, essence deficiency cannot be irrigated, blood deficiency cannot support tendons, and consequently soft tendons shrink.

Diagnostic criteria for polyradiculoneuropathy

Western medicine standard for polyradiculoneuropathy

Criteria for the diagnosis of acute infectious polyneuritis (Guillain-Barre syndrome) (developed by the National Center for Neurological and Psychiatric-related Diseases and Stroke (NINCDS) in 1978):

First, confirm the symptoms and signs necessary for the clinic

(A) Progressive paralysis of more than one limb, ranging from paresis of the lower limbs to total paralysis of the extremities, affecting the trunk, medullary innervating muscles, facial muscles, and external eye muscles. Mild ataxia.

(2) The deep tendon reflexes disappear, and in principle all reflexes disappear. If other symptoms of the disease exist, the biceps reflex and knee reflex are weakened, and the quadriceps reflex disappears.

Symptoms and signs that strongly support the diagnosis

(A) clinical signs (in order of importance)

1. Progress: Paralysis progressed rapidly, but stopped at about 4 weeks, with 50% of cases reaching a peak in about 2 weeks, 80% of cases in 3 weeks, and more than 90% reaching a peak in 4 weeks.

2. Symmetry of left and right: Symmetry of left and right is not absolute. Generally, one side of the limb is affected, and the other side is affected at the same time.

3. Minor sensory disturbance.

4. Cranial nerve damage: About 50% of those who cause facial muscle paralysis are often bilateral. Other cranial nerves can also be affected, especially the tongue and glossopharyngeal muscles, and sometimes the external eye muscles can also be affected. In a few cases (less than 50%), the sputum sputum starts from the eye muscle or other cranial nerves.

5. Recovery: After progress has stopped, recovery usually begins within 2 to 4 weeks, and there are also those whose recovery is delayed for several months. Most can resume their function.

6. Autonomic dysfunction: frequency and irregular pulses, orthostatic hypotension, hypertension and other causes of vascular motility, such as pulmonary infarction, must be excluded.

7. No fever in patients with neuroinflammatory symptoms.

(II) Irregularities (those who cannot be classified)

1. Fever when symptoms of neuroinflammation occur;

2. Severe pain is gone;

3. The course of disease has reached more than 4 weeks. Symptoms and signs are still progressing or have minor recurrences;

4. Although the course of disease has stopped progressing, it has not recovered, or there are serious persistent sequelae;

5. Usually the sphincter is not involved, but there is a transient bladder palsy, and it is seen in the advanced stage of the disease course;

6. Guillain-Barre syndrome is generally considered to be a peripheral nerve disease. Even if there are signs of central nervous system damage at the same time (such as obvious cerebellar ataxia, dysarthria or Babinski sign positive, less obvious sensory level, etc.), as long as the main signs of the disease are accurate, it is not necessary This disease.

Cerebrospinal fluid changes that strongly support the diagnosis of this disease

(1) Cerebrospinal fluid protein: Although the cerebrospinal fluid protein can be increased one week after the onset of the disease, it is generally seen after several lumbar punctures.

(2) Number of cells: 10 or less monocytes.

Shaped:

1. Protein is not high from 1 to 10 weeks after onset.

2. Some cells have as many as 11-50 monocytes / mm3.

See you at the clinic that strongly supports diagnosis

In about 80% of cases, the rate of nerve conduction is slowed or broken after the onset. Peripheral nerve conduction velocity is generally below 60% of the normal value, but it also varies with the degree of disease, and not all nerves are invaded. Peripheral nerves triple to normal values when latent. Using F waves is often a good way to find that the conduction velocity of the nerve stem and nerve root is slowed down. Nerve conduction velocity is normal in about 20% of cases. Nerve conduction velocity measurements may not be abnormal for several weeks after onset.

V. Suspected disease

(1) Significant and persistent, but asymmetric weakness.

(2) Persistent bladder and rectal dysfunction.

(3) Onset of bladder and rectal dysfunction.

(4) Have a clear sense of the horizontal plane.

Circumstances in which diagnosis must be excluded

(1) Cases of recent abuse of hexavalent carbon, that is, volatile solvents: N-ethane and methyl NJ ketone.

(II) Violet metabolism abnormality: Acute intermittent purpura appears. Urinary excretion of porphyrin cholangiogenin and O-aminolevulinic acid increased.

(3) Patients who have recently suffered from sore throat or trauma. Patients with a history of diphtheria infection and signs of infection, with or without myocarditis.

(4) Those who have a history and signs of lead poisoning neuropathy, or who have signs of lead poisoning.

(5) Only people with pure sensory impairment.

(6) Poliomyelitis, botulism, and toxic neuralgia (such as nitrofurantoin, dapsone [44 'diaminodiphenylsulfone] organophosphorus compounds) are often mistaken for Green-Pale syndrome Therefore, a clear diagnosis should be made.

Domestic standard

1. A few days to weeks before the onset of cold, history of upper respiratory or digestive tract infections.

2. The limbs are acute, symmetrical, and progressively paralyzed with motor neuron paralysis, often beginning in the lower limbs.

3. It can invade the brain nerves at the same time (such as bilateral, glossopharyngeal, and vagus nerves, etc.), and individual patients can only show brain nerve damage.

4. In severe cases, it can invade the intercostal and diaphragm muscles and cause respiratory weakness or sudden arrest.

5. Early numbness, soreness, and other sensory disturbances may be present, physical examination may have muscle tenderness, and only slight condom sensation.

6. Cerebrospinal fluid often has "protein-cell separation" phenomenon and corresponding immune function abnormalities.

7. Electromyographic examination showed signs of motor neuron damage and slowed motor conduction.

Attachment 1:

(A) diagnostic criteria: The new diagnostic criteria revised by Asbury (1990) are simplified as follows:

1. Necessary conditions (1) Weak progressive force over one limb; (2) Loss of reflection;

2. Supporting conditions clinically: (1) the peak of progression to the disease is shorter than 4 weeks; (2) the relative symmetry of weak force; (3) the signs of sensory damage are relatively light; (4) the cranial nerve can be affected, Facial nerves are more common; (5) autonomic dysfunction; (6) without fever when symptoms occur; (7) recovery generally begins 2 to 4 weeks after stopping the progress and recovers well.

Cerebrospinal fluid examination:

(1) The protein increases after the first week, or has been increased after several inspections;

(2) The number of cells is close to normal;

(3) The nerve conduction speed slows down;

Appendix 2: The editorial board of the Chinese Journal of Neuropsychiatry held a seminar on Guillain-Barre Syndrome in Huangshan City in October 1993 and October to formulate diagnostic criteria:

Basic diagnostic criteria:

1. The progressive limbs are weak, basically symmetrical, and a few may be asymmetric, ranging from weakness of the lower limbs to quadriplegia, including physical paralysis, bulbar paralysis, facial muscles and extraocular muscle paralysis. The most severe is respiratory muscle paralysis;

2. The tendon reflexes weaken or disappear, especially at the distal end;

3 The onset of the disease rapidly progressed progressively, often reaching a peak within a few days to 1 or 2 weeks, stopping development in 4 weeks, and entering the recovery period steadily;

4 There are many complaints of sensory disorders, and the objective examination is relatively light. It may be gloves or socks-like abnormalities or no obvious sensory disturbances. A few have sensory allergies and neuralgia.

5. The cranial nerves are more common in the glossopharyngeal, vagus, and facial nerves. Other cranial nerves can also be damaged, but the optic and auditory nerves are hardly affected;

6. Can be combined with autonomic dysfunction, such as tachycardia, hypertension, hypotension, vascular dyskinesia, excessive sweating, temporary dysuria, etc .;

7. About half of the patients had respiratory and intestinal infections from 1 to 3 weeks before the illness, fever of unknown cause, chickenpox, shingles, mumps, mycoplasma, malaria, cold rain, fatigue, trauma, surgery, etc .;

8. The recovery period is 2 to 4 weeks after the onset, but it can also be postponed to several months before the recovery begins;

9. Cerebrospinal fluid examination: Leukocytes are often less than 10 × 106 / L, and protein elevation occurs within 1 to 2 weeks, and protein cells are separated. If the cells are more than 10 × 106 / L, multi-nucleus-based, other diseases need to be excluded. Cytological classification is lymph Monocytes are predominant, and a large number of phagocytes can appear;

10. Electrophysiological examination, the nerve conduction velocity may decrease significantly after the disease, and the F-wave response slows the nerve conduction velocity at the proximal end.

(Two) clinical typing

The Chinese Journal of Neuropsychiatry edited the clinical classification in October 1993 (according to the severity of the clinical condition to facilitate treatment):

Light: Extremity muscle strength above 3 degrees, can walk independently;

Medium: Extremities muscle strength below 3 degrees, can not walk;

Severe: , and other cranial nerves are paralyzed and cannot be swallowed. At the same time, the limbs are weak and paralyzed, and there is mild dyspnea during movement, but no tracheostomy artificial breath is required;

Extremely heavy: In several hours to 2 days, it develops to paralysis of the limbs, inability to swallow, and paralysis of the respiratory muscles. It is necessary to immediately open the tracheostomy for artificial respiration, with severe cardiovascular dysfunction or irritability being incorporated into this type;

Re-style: It can be repeated many times in a few months (4 ~ 6) to more than 10 years. The severity of the symptoms mentioned above should be paid more attention. It is often heavier than the first episode, and can be mild to extremely severe.

Chronic or chronic inflammatory demyelinating polyneuropathy: slowly onset from February to several months or even years, unhealed, less cranial nerve damage, obvious muscle atrophy in the limbs, and continuous increase in cerebrospinal fluid protein;

Variants: pure motor GBS; sensory GBS; multicranial nerve GBS; pure total autonomic nerve dysfunction GBS; others include Fisher syndrome; a few GBS with transient pyramidal sign and GBS with cerebellar ataxia Disorders.

Western medicine diagnosis based on 1. There are symptoms of upper respiratory or gastrointestinal infections before the disease; 2. Acute or subacute disease; 3. Weak limbs or lower limbs, symmetrical flaccid paralysis; There are no objective sensory disturbances, and some are mild; 5. May be accompanied by cranial nerve damage, such as facial paralysis, bulbar palsy, etc., and severe respiratory muscle paralysis; Electrogram F wave is abnormal, or motion conduction block, or slowed down.

TCM Standards for Polyradiculoneuropathy

1. Injury: Syndrome: fever at the beginning of the disease, thirst, sore throat, cough, dry throat, paralysis of the limbs, short red urine, dry stool, red tongue, little Jin, yellow fur, and pulse count. Syndrome analysis: the invasion of the hot and humid evil, heat and injury, lack of fluid, so we are sore, sore throat, cough, pharyngeal and dry throat; lack of fluid, loss of tendon and veins, so limb paralysis, soft and soft; red tongue Shaojin, Dry stool, short red urine, pulse count, etc. are all signs of Yin injury.

2. Damp-heat infiltration: Syndromes: heavy limbs, low body heat, weak limbs, numbness, swollen thirst, unwilling to drink thirsty, chest fullness, short urine, red tongue, yellow greasy tongue, slippery pulses. Syndrome analysis: Damp heat soaks the skin, so the limbs are heavy: Damp heat soaks and steams, so you see body heat; Damp heat soaks tendons, qi and blood block, loss of tendons and veins makes limbs weak or numb, and numbness; resistance to damp heat The chest is full of stuffiness; betting is hot and humid, so the urine is short and red; the tongue is red and greasy, and the number of slippery pulses is a sign of dampness and heat.

3. Weakness of spleen and stomach: Syndrome: limbs are weak and weak, food is lacking, appetite is thin, stools are pale, or the surface is floating, fatigue is weak, tongue coating is thin and white, and pulse is thin. Syndrome analysis: The spleen is the foundation of the acquired spleen. If the spleen and stomach are weak, the source of qi and blood will be insufficient. If the qi and blood are weak, the muscles and veins will lose their honor. Therefore, the limbs will be weak. Therefore, the food is less appetite, the stool is thin, and the surface is floating; the source of qi and blood is insufficient to maintain the skin, so the complexion is gloomy and the pulse is fine.

4. Liver and kidney yin deficiency: Syndromes: due to a long illness, weak lower limbs, weak lumbar spine, accompanied by dizziness, tinnitus, dry mouth, irritability, nocturnal emission or enuresis, red tongue, less moss, and pulse count. Syndrome analysis: Deficiency of liver and kidney, insufficient blood, can not support the tendons and veins gradually become emaciated; the kidney is the kidney, the main bone of the kidney, the raw marrow, the lack of essence, the lumbar kidney is sour. The essence and blood are deficient and cannot be carried on, so dizziness, tinnitus, dry mouth, etc. In the appearance of the kidney and bladder, kidney deficiency and bladder will not cause enuresis; kidney deficiency cannot hide sperm, so see nocturnal emission; red tongue, less moss, pulse count, etc., are signs of yin deficiency and internal heat.

Treatment of polyradiculoneuropathy

Polyradiculoneuropathy western medicine

The cause is not clear, so there is no specific treatment at present. In the acute phase of AIDP, bed rest should be performed. Paralyzed limbs should be massaged and passively exercised as soon as possible. Pay attention to maintaining functional positions. Both hands should sag. Splints or braces should be used to prevent limb contracture. Severely paralyzed people should turn over regularly, pat their backs often, sucking sputum when having sputum difficulty, pay attention to oral care, and keep the airway open. Nasal feeding tubes should be inserted as soon as possible for swallowing difficulties to enhance nutrition. 1. Hormonal treatment of AIDP with hormones is currently inconsistent. Most scholars believe that the use of hormonal therapy in the acute phase is ineffective, cannot shorten the course and improve the prognosis, and even delay the recovery of the disease and increase the relapse rate. Some people have found that the concentration of cortisol in patients' serum increases with the worsening of AIDP, and that severe and extremely heavy AIDP show a significant increase. This may explain why AIDP is not effective or worsened after treatment with hormones; some scholars have suggested that Hormones. Those who do not have contraindications should use hormones in sufficient quantity early. Adults of hydrocortisone 300-500mg / day, or dexamethasone 10-30mg / day, intravenous drip with glucose solution, once a day for 7-14 days. It is a course of treatment. After the condition improves, the oral prednisone 60 100mg is changed and taken daily in the morning. After the condition is stable, it is reduced by 5mg every 1 to 2 weeks according to the specific patient. For patients with severe symptoms, 500 to 2000 mg of methylprednisolone can be used, plus glucose drip intravenous drip therapy (MPPT), once a day, for 3 to 5 days, and then to oral prednisone. Methylprednisolone impact therapy has a short course of treatment and rapid curative effect. It can quickly prevent the progression of the disease in patients with severe AIDP. It has a rapid effect on respiratory muscles and swallowing vagal palsy. It is believed that methylprednisolone impact therapy is of great value for severe AIDP. . Common side effects of MPPT include an increase in mean arterial pressure of 1.7 to 3.6 kPa; rapid intravenous drip may cause arrhythmia; psychiatric symptoms such as increased speech and euphoria; upper gastrointestinal bleeding; facial flushing, and ankle Edema and metallic taste in the mouth.

2.Immune enhancer

(1) Intravenous high-dose immunoglobulin (IVIG): Use human immunoglobulin preparations at a daily dose of 0.4 g / kg, starting at 40 ml / hour, and then gradually increasing to 100 ml / hour. Intravenous infusion is continued for 5 days as a course . Mechanism of action: Activate the activity of the complement system; Enhance phagocytic cell function and Fc-mediated adhesion, enhance cell biochemical effects during phagocytosis; Increase serum neutralizing antibody levels; Increase serum and lower respiratory tract Ig levels It can resist the adhesion of bacteria and help to eliminate bacteria. It can regulate the immune deficiency state caused by virus and bacterial infection, and can make human Th / Ts return to normal quickly. Side effects: chills and high fever caused by pyrogen reaction; headache, myalgia, nausea, vomiting; tachycardia, hypotension, allergies, etc.

(2) Transfer Factor (TF): Generally, it is subcutaneously injected into the inner side of the upper arm or the lower end of the groin, one at a time, once or twice a week, and once every two weeks after one month.

3. Anti-infection Severe AIDP patients with respiratory infections, or when using large doses of hormones, should prevent infection, and must apply a sufficient amount of effective antibiotics in a timely manner.

4. Application of neurotrophic agents According to the condition, vitamin B1, B12, citicoline, adenosine triphosphate, coenzyme A, and cytochrome C can be used to promote nerve function recovery.

(Two) non-drug therapy

1. Plasma exchange Plasma exchange (PE) is a newly developed therapy for patients with AIDP in recent years. The clinical report is effective and can shorten the time from recovery to independent walking. It can shorten the time for patients to use assisted breathing and significantly reduce the mortality of patients with AIDP. Plasma exchange therapy can remove toxic myelin antibodies, antigen-immunoglobulin immune complexes, inflammatory chemical mediator complements, fibrinogen and antibodies, thereby reducing and avoiding toxic damage to the myelin sheath and promoting Repair and regeneration of exfoliated myelin sheath, improve and relieve clinical symptoms. The amount of plasma exchanged each time was 40-50ml / kg, replaced with 5% protein saline, 5-8 times as a course of treatment, side effects include arrhythmia, hypoarsenic acid caused hypocalcemia, decreased blood volume, myocardial infarction, and thrombosis. , Infection, bleeding, allergic reactions, puncture local hematoma, etc. This therapy is difficult to be widely used due to its high price.

2. Artificial respiratory palsy is the main cause of death in AIDP. When patients have shallow breathing, fast frequency, fast heart rate, irritability, mild cyanosis at the extremities of limbs, etc., it indicates hypoxia and carbon dioxide retention. Use artificial respirator as early as possible to assist breathing.

3 When a tracheotomy patient has a weak cough and it is difficult to discharge respiratory secretions, a tracheotomy should be performed in time to keep the airway open.

4 Intensive care Intensive care should be given to AIDP patients. Special attention should be paid to oral care to remove oral secretions in a timely manner. Breath monitoring should be performed at the bedside every 2 hours to measure the breathing volume. When the tidal volume is <1 000ml, or the patient should continuously read the number not exceeding 4. At the time, intubation and assisted breathing should be timely; pay attention to decubitus and second-aid nursing, regular pressure on the abdomen when the urine is retained. 5. Medical sports can carry out medical physical exercises during the recovery period of the disease.

(1) Combination of passive and active: paralyzed limb movement inability, limb muscular dystrophy, muscle atrophy, limb twinning, deformity, joint rigidity, and dyskinesia are more obvious. Therefore, passive movement should be carried out as soon as possible after the condition is stable. Joints facet joints, from proximal to distal, passive movement followed by active exercise exercises. Patients' subjective ideas of lifting limbs or moving limbs can accelerate the recovery of autonomous movement.

(2) Combination of bed and under-bed: Patients can only rest in bed after paralysis of the limbs. In this way, the muscles of the paralyzed limbs will relax and atrophy over time. Begin functional exercises early in the early stages of the disease. Bedriding exercises such as lifting heads, turning over, and lifting limbs; after upper limb function is restored, use your upper limbs to support the bed and slowly sit up; gradually move to the side of the bed with your legs drooping, raising your legs, and lifting After the lower limb muscle strength reaches level 3, you can sit down on a chair or stand to practice both lower limbs. Both lower limbs have the ability to carry weight. When one leg can support the whole body, you can slowly practice walking, step up, etc., and gradually increase the amount of exercise. , Exercise time gradually increased.

Polyradiculoneuropathy

1, heat Shengjujin:

Governing Law: heat and dryness, nourishing yin.

Recipes: mulberry leaves, raw gypsum, clearing and dehydrating lungs; almonds, loquat leaves, and removing lungs and lowering air; Ejiao, Ophiopogon, flax kernels, ginseng, and licorice for yin and Shengjin; heat and add Zhimu, Yinhua, and even wings to clear away heat; The sputum is not easy to get rid of the guagua.

2. Damp heat soaking:

Governing Law: clearing away heat and dampness.

Recipes: Cork, Atractylodes for clearing heat and dampness; Achyranthes bidentata, anti-self-inducing dampness and heat from urination; Coix seed, papaya, dampness and collaterals; wet and thicken Pak, Poria, Alisma and Qi; dampness of physical activity; Achyranthes; crooked eyes and white aconite, white silkworm, whole scorpion and so on.

3. Weak spleen and stomach:

Governing Law: Spleen, Stomach and Nourishing Qi.

Recipes: Codonopsis, Atractylodes, Yam, White Lentils, and Lotus Seed Meat all strengthen the spleen and invigorate qi, Poria and Coix spleen invigorate the spleen and soak up the moisture; Amomum villosum, Chenpi, and Weiqi. If the limbs are cold, add aconite and dried ginger to warm the spleen and yang; If the chronic illness is weak, those with qi and blood deficiency should reuse Codonopsis, yam, atractylodes, astragalus and angelica.

4, liver and kidney yin deficiency:

Governing Law: Tonify liver and kidney, nourish yin and clear heat.

Recipes: Tiger bone, Achyranthes bidentata strong muscles and bones; Cynomorium can warm kidney and replenish essence: Angelica sinensis, Paeonia lactiflora to nourish blood and soften liver; Cork radix motherland, Shudi, Turtle board nourish yin and clear heat. Yin deficiency and heat Sheng to Cynomorium and Dried Ginger; Qi deficiency and heart palpitations, add Astragalus and Codonopsis; if the lesions are obvious, go to Zhimu and Cork, add Antler gum, Psoralen, Fairy spleen, Morinda citrifolia, Aconite, cinnamon and so on.

Acupuncture

(1) Body acupuncture: paralysis of the upper limbs includes scapula, Quchi, Shousanli, Waiguan, Hegu, etc .; paralysis of the lower limbs includes ring jump, Fengshi, Zusanli, hanging bell, etc. For lung injury, add ruler, Feishu, and use diarrhea; damp heat infusion plus Yanglingquan; liver and kidney deficiency plus hanging bell, Yanglingquan, Shenshu; spleen and stomach weakness plus Pishu, Weishu.

(2) Electro-acupuncture: The pulse electro-acupuncture is used, and the acupuncture point can be selected from the acupuncture point, 30 minutes each time, once a day, and 10 times is a course of treatment.

(3) Water injection: vitamin B1, B12, galantamine, angelica injection, etc. are selected for the drug. Each time, 2 to 3 points are selected, 0.5 ml is injected in each point, once every other day, and 10 times is a course of treatment.

(4) Ear acupuncture: select acupuncture points such as spleen, stomach, lung, kidney, endocrine, etc., with needles for 1 week each time, the acupuncture points on both sides can be used alternately.

Polyradiculoneuropathy

In the acute stage, the patient should stay in bed. When accompanied by respiratory muscle palsy, Western medicine should be used as the rescue method. Assisted breathing with a ventilator can improve tissue hypoxia and relieve carbon dioxide retention. There are many respiratory secretions and poor sputum output. Make tracheotomy to clear the secretions of the respiratory tract and clear the airway; control the infection and add an effective amount of antibiotics; those who have the conditions can cooperate with the plasma exchange and the application of hormones to control the progress of the disease; according to the patient's TCM syndrome, it can be supplemented with traditional Chinese medicine. If AIDP is in a mild condition, it can also be treated with traditional Chinese medicine alone to regulate the body's immune function. Emergency treatment for patients during the recovery period has been suspended. Continue to take traditional Chinese medicine, combined with acupuncture, massage, qigong and other comprehensive treatments to promote nerve function recovery and prevent disease recurrence .

Preventive measures for polyradiculoneuropathy

1. Strengthen physical exercise. Physical exercise can strengthen the physique, "the righteousness is in the inside, the evil cannot be done." Physical fitness is not easy to infect diseases.

2. Prevent colds. Prevent upper respiratory infections, gastrointestinal infections, etc. If you have a fever and have weak limbs, go to the hospital for treatment in time.

3. Medical personnel should improve their understanding of AIDP and make timely diagnosis and treatment. Especially for patients with respiratory muscle paralysis and bulb paralysis, three early morning rescue, lower gastric tube when swallowing difficulties; early tracheotomy when coughing is weak; artificial respiration when breathing is difficult.