① Mild type: most common, slow onset, mild symptoms, mild diarrhea, less than 4 times a day, alternating with constipation, no or only a small amount of blood mucus in stool, no systemic symptoms, lesions mostly confined to rectum and sigmoid colon, and normal blood condition.
② Moderate type: between mild and severe, with diarrhea more than 4 times a day and mild systemic symptoms.
③ Severe type: diarrhea with fever, fatigue, emaciation, anemia and other systemic manifestations, more than 6 times a day, bloody stool or mucus pus and bloody stool.
④ fulminant type: rare.
Generally, the combination of traditional Chinese and western medicine is adopted.
1.General treatment
(1) Rest: Patients with fulminant and acute attacks should stay in bed, closely observe the changes of their condition, and gradually resume their activities until the fever subsides and diarrhea stops. When chronic persistent mild cases cannot be completely relieved through efforts, they can also engage in moderate activities within their power.
(2) Diet and nutrition: Patients often suffer from malnutrition due to diarrhea and insufficient food intake, so they need to eat nutritious and digestible food. During the attack, don't eat vegetables, fruits and cereals rich in crude fiber, don't drink alcohol and eat too many condiments, and the daily protein intake should reach 2g/kg body weight, with a total calorie of 2,500 ~ 3,500kcal * a few meals for more than 3 months. When you have severe diarrhea, you can only eat a liquid diet. General patients can enter a low-residue diet without limiting the types of diet; Those with severe illness or deterioration of the condition should be fasted and given parenteral nutrition therapy. Through intravenous high-priced nutrition therapy, a large number of protein and calorie were supplemented from the vein to promote the rest of the whole gastrointestinal tract, achieve positive nitrogen balance and significantly reduce clinical symptoms. Diarrhea can easily lead to the loss of electrolytes such as sodium, potassium and calcium, and 2000～3000ml of10% glucose physiological saline can be intravenously dropped every day, and attention should be paid to supplementing potassium and calcium. In case of acute attack and diarrhea, vitamin A25000U, vitamin D 1000U, vitamin B1Kloc-0/0 mg, vitamin B2 5mg, pantothenate 20mg and vitamin C200mg should be given daily. If the time of prothrombin is prolonged, vitamin K can be given orally.
(3) Spasm and pain relief: Abdominal pain and diarrhea are partly caused by intestinal spasm, so spasmolytic drugs can relieve such symptoms. You can take belladonna with 0.3 ~ 0.5 ml, 3 ~ 4 times a day, or atropine intramuscular injection. Other anticholinergic drugs can be selected as appropriate. Combined subcutaneous or intramuscular injection of codeine15 ~ 30 mg and atropine 1mg can relieve severe abdominal pain, diarrhea and acute diarrhea. It must be noted that spasmolytics and sedatives are prohibited during toxic colon dilatation, so as not to aggravate the dilatation and lead to toxic colon dilatation. Except for severe diarrhea, anti-peristalsis antidiarrheal agents such as Yimentong can be used with caution for a short time, and morphine anesthetics are prohibited.
(4) Correcting anemia: When bleeding and plasma protein is too low, whole blood, plasma or hydrolyzed protein can be infused as appropriate. During the active period of the disease, especially when bleeding heavily, iron can't be taken orally, because it can not be effective immediately but can aggravate diarrhea. When the condition is relieved and bleeding stops, iron can be taken for treatment.
(5) Enhance the confidence in treating the disease: Regularization of life, combination of work and rest, avoiding mental stress and maintaining optimism are all helpful to the control and recovery of the disease. For those with severe mental stress, Lumina15 ~ 30mg, or Miritong 0.2 ~ 0.4g, chlorpromazine12.5 ~ 25mg, and Limonidine 10mg can be used for oral treatment three times a day. Recurrence of long-term illness and chronic cases are prone to pessimism, so clinical medical care should actively regulate and care, and sometimes cases that are ineffective in various treatments can be alleviated.
2. Antibacterials:
(1) Sulfonamides: Sulfonamides were used to treat this disease as early as 1940s. Sulfonamides which are not easily absorbed by gastrointestinal tract are the first choice, among which sulfadiazine salicylate (SASP) has the best effect. After oral administration, it is decomposed into sulfapyridine and 5-aminosalicylic acid in the intestine, which has special affinity for colon and intestinal wall tissue and plays an anti-inflammatory role. Mostly used for light and medium-sized patients. The initial dose was 0．5g, taken orally four times a day. Increase 1g every 2 ~ 3 days until the clinical effect is obtained. The daily total amount is generally 3 ~ 6g, and can be as high as 8g in some cases. After the condition is stable, the maintenance dose is1.5 ~ 2g/day, and the treatment must last for more than 4 weeks, and then the dosage will be reduced every 3 ~ 5 weeks until1~ 2g is taken every day, and it will be maintained for at least one year. Then consider stopping the drug to reduce the recurrence rate. For those who are prone to relapse after drug withdrawal, the minimum dose can be selected for long-term maintenance treatment, and the effective rate is above 8%. The side effects of this medicine include nausea, vomiting, dizziness, headache and general malaise, occasionally causing leukopenia, joint pain and rash. Hemolysis, proteinuria and pancreatitis. The occurrence of side effects is related to the dosage, and the side effects increase significantly when the daily dosage is more than 4 g. Other sulfonamides, succinyl sulfathiazole, peptidyl sulfathiazole and compound sulfamethoxazole can also be used. Patients with serious illness and those who have been relieved by corticosteroid treatment can also be treated with sulfonamides as maintenance treatment; However, this product is not suitable for the treatment of fulminant severe patients. Other antibacterial drugs are also not suitable for the treatment of ulcerative colitis, unless there are toxic megacolon and suppurative complications.
(2) Antibiotics: Patients with mild poisoning should not use antibiotics. Patients with acute fulminant and toxic colon dilatation should be treated with broad-spectrum antibiotics, and bacterial culture should be done before use. Penicillins, chloramphenicol, clindamycin, tobramycin, new cephalosporin and cephalosporin can all be selected as appropriate. In order to avoid gastrointestinal symptoms, antibiotics should not be taken orally.
(3) Metronidazole: 1975 Ursing first reported the curative effect of Metronidazole on intestinal inflammatory diseases. After 1976, there are more and more reports in China. The general usage is 1200mg taken orally 3-4 times a day for 3-6 months, and no serious side effects have been reported. The shorter the course of the disease, the better the curative effect, and the effective rate is 60% ~ 70% for patients with a course of more than one year.
Glucocorticoid and adrenocorticotropic hormone
These drugs can inhibit inflammation and immune response and relieve toxic symptoms, especially in view of some common coexisting diseases of this disease, such as arthritis, uveitis and erythema nodosum, etc. Hormone therapy has a good short-term effect, and the effective rate can reach 90%. Furthermore, hormones can also increase patients' appetite and improve patients' mood. Prednisone15 mg/day, low dose maintenance can significantly reduce the recurrence rate. Generally, it is used in cases where the above treatment is ineffective, acute attack or fulminant. It is not suitable for patients complicated with peritonitis or abscess formation in abdominal cavity. Attention should be paid to hypokalemia and the relief of subjective symptoms in the process of medication, which may cover up the continuous development of the disease and even cause intestinal perforation.
(1) oral corticosteroid: for patients with obvious disease activity and extensive lesions, prednisone can be taken orally 40 ~ 60 mg a day in 3 ~ 4 times. After the disease is controlled, it is gradually reduced to10 ~15 mg per day, and the drug is generally stopped after half a year. In order to reduce the recurrence after drug withdrawal, sulfasalazine salicylate was given during or after drug withdrawal. If oral glucocorticoid has no effect for 2 ~ 3 weeks, adrenocorticotropic hormone should be considered.
(2) Local medication: If the lesion is confined to the rectum sigmoid colon, suppository or enema can be used, and some patients can absorb drugs from the diseased mucosa to make the whole body work. You can choose ① anal suppository containing hydrocortisone 10mg, 2 ~ 3 times a day. ② Dissolve hydrocortisone succinate 50 ~100 mg or prednisolone 20 ~ 40 mg in 50 ~100 ml liquid, and keep enema1~ 2 times a day. You can also add SASP and proper amount of procaine or traditional Chinese medicine decoction at the same time,10 ~/kloc-. (3) After enema, ask the patient to adopt various postures, such as supine or prone position, left and right lateral position, etc. for15 ~ 20 minutes, so as to distribute the medicine evenly on the mucosal surface.
(3) Intravenous medication: it can be used for patients with fulminant type, severe activity type and oral failure. Intravenous infusion of adrenocorticotropic hormone or glucocorticoids is generally effective, and the dosage is 25 ~ 50u per day. The dosage of hydrocortisone is 200 ~ 300 mg per day, or 200 ~ 300 mg of hydrocortisone sodium hemisuccinate or 40 ~ 60 mg of 2 1 prednisolone monophosphate can be used. The course of treatment is usually10 ~14 days. After the disease is controlled, oral preparations are used. Prednisone 60mg／/day, taken orally, and then reduced as appropriate. If there is recurrence, the dose can be increased appropriately.
(4) Combined medication: For patients with serious illness and wide range of lesions, oral and rectal or venous and rectal combined medication can be used.
4. Immunosuppressants Since 1962, antimetabolites and alkylating agents have been used in some cases. If the above treatment is ineffective or ineffective, and there is no surgical indication, azathioprine, 6-MP, cyclophosphamide, etc. can be considered to reduce the dose required for steroid-induced remission. 6-sulfopurine1.5 mg/kg daily, and azathioprine1.5 ~ 2.5 mg/kg daily, and orally taken in batches; The course of treatment is about one year. But its curative effect has not been confirmed so far. This kind of drug is toxic and has many side effects, especially on the hematopoietic function of bone marrow, so the blood picture should be checked regularly during the medication. Sodium cromoglycate can prevent mast cell degeneration and inhibit immediate allergic reaction. Cases of chronic ulcerative proctitis were treated with this product orally or by enema, and achieved certain curative effect.
Surgical treatment The lesions of most mild patients are confined to the rectum or sigmoid colon, which can be controlled by rest, satiety control and medical treatment, but some patients with severe attacks, extensive lesions and serious complications often need surgical treatment.
(1) acute colitis: when there are the following situations: ① fulminant colitis, whose clinical situation is still deteriorating after 3-7 days of full formal medical treatment; (2) severe attack, after two weeks of medical treatment, the condition is still unstable; (3) toxic colonic ectasia, which can not be relieved after 24 ~ 72 hours of observation and can tolerate emergency enterotomy; ④ Colon perforation or massive bleeding.
(2) Chronic colitis for more than ten years: long-term total colitis, especially frequent occurrence; The incidence of colon cancer has increased significantly, and it is suspicious of canceration or canceration.
(3) Others: For patients with intractable pyoderma gangrenosum and those with persistent or severe uveitis, colon resection is also preferred. Patients with complications, repeated massive bleeding, or intestinal stenosis or obstruction, or perianal abscess and fistula formation also have indications for surgical treatment. If the case is properly selected and handled, the patient can fully recover. Although colectomy can radically cure ulcerative colitis, postoperative patients must live with ileostomy. Because the rectum cannot be preserved when this operation is performed. At present, the mortality rate of the improved colectomy is obviously reduced, and the life adjustment after ileostomy is improved, which makes colectomy as a treatment for ulcerative colitis gradually accepted by people. Although surgical treatment has its advantages, the postoperative ileum dysfunction, intestinal obstruction, mucosal prolapse or retraction at ileostomy, delayed healing of perianal wound, anxiety about mental or nervous impotence, and the change and inadaptability of natural lifestyle make both doctors and patients and their relatives feel wary and afraid of surgical treatment. Therefore, the most certain indication of immediate surgery can only be those serious complications that have no other treatment options. Secondly, surgical treatment should also be considered for those who are ineffective or ineffective in various medical treatments, such as persistent symptoms, which make it impossible for patients to maintain their normal life function, especially those who need a large dose of hormones to control symptoms.
6. Physical therapy
Intestinal peristalsis caused by intestinal inflammation, diarrhea and abdominal pain, can choose diathermy treatment, ultra-high frequency electric field treatment. Some patients may suffer from constipation due to intestinal spasm and dysfunction. In order to calm their whole body and reduce the excitability of intestinal muscles, hydrotherapy, such as warm water bath and abdominal hot compress, can be used. Sun lamp or infrared lamp abdominal irradiation; Diathermy therapy; Abdominal DC electrotherapy; Calcium ion penetration, whole body ultraviolet irradiation and other methods of treatment. Physical therapy can directly act on abdominal organs or on gastrointestinal tract through skin reflection, thus playing the role of spasmolysis, analgesia, anti-inflammation and improving local circulation, and is often used as an auxiliary treatment measure in clinic.
In short, because the etiology and pathogenesis of this disease are not clear, and the clinical manifestations are complex, there are many complications. So far, western medicine internal medicine treatment can only strive for remission, but it can't cure the disease.
food therapy
1. Dietary precautions
1, low fat, less fiber. Foods that are oily and contain too much fat are not easy to digest, and their bowel-sliding effect will aggravate diarrhea symptoms. Cooking methods are mainly steaming, boiling, stewing and stewing; Dietary fiber can promote intestinal peristalsis and stimulate intestinal wall, which is not good for sick intestine, so it needs to be restricted. Foods containing more fiber, such as leeks, celery, soybean sprouts and onions, should be avoided.
2. Pay attention to protein and vitamin intake. In the daily diet, some digestible and excellent protein foods, such as fish, eggs, bean products, green leafy vegetables rich in vitamins, fresh fruit juice and vegetable juice, are appropriately selected to supplement the nutritional consumption caused by long-term diarrhea. Patients with chronic enteritis have poor digestion and absorption function, so it is advisable to adopt digestible semi-liquid diet or soft food with less residue, and it is not advisable to eat too much at one time.
3, add water, salt, etc. If chronic enteritis is accompanied by dehydration, you should drink light salt boiled water, vegetable soup, vegetable juice and fruit juice in time to supplement the lack of water, salt and vitamins.
4. Eat less gas-producing foods and sweets. When the exhaust and bowel sounds are too strong, you should eat less sucrose and foods that are easy to produce gas and ferment, such as soybeans, sweet potatoes, white radishes, pumpkins and soybeans.
5. Pay attention to food hygiene. Patients with chronic enteritis are weak and have poor resistance, especially gastrointestinal infection, so they should pay more attention to food hygiene. Do not eat cold, hard and spoiled food, abstain from alcohol and spicy and irritating condiments, and try not to eat in restaurants and food stalls outside.
Recommendation of dietotherapy prescription
1 radix paeoniae alba drink
Formula: Paeonia lactiflora15g, Poria cocos 20g, Atractylodes macrocephala15g, Ginger10g, Radix Aconiti Lateralis15g and brown sugar 20g.
Production: 1) Bake the attached tablets, and first boil for 30 minutes to remove water; Cleaning Radix Paeoniae Alba, Poria, Atractylodis Rhizoma and Rhizoma Zingiberis Recens, and slicing.
2) Put the above medicines into a saucepan, add appropriate amount of water, bring them to a boil over strong fire, then decoct them with slow fire for 30 minutes, remove residues, add brown sugar and stir well.
Edible: for tea.
Efficacy: anti-inflammatory and antidiarrheal. Especially for patients with chronic enteritis.
2 Chuanxiong Angelica Tea
Formula: 5g of Chuanxiong rhizome, 5g of ginseng, 5g of poria cocos, 5g of angelica, 5g of atractylodes macrocephala, 5g of white peony root, 5g of cassia twig and 50g of millet.
Preparation: 1) Wash the above medicines; Wash the millet, put it into aluminum pot, and add some water.
2) Bring aluminum pot to a boil on a strong fire, then simmer for 30 minutes, and remove the slag.
How to eat: daily 1 time, for tea.
Efficacy: anti-inflammatory and antidiarrheal.
3 ginseng hawthorn tea.
Formula: ginseng10g, hawthorn10g, atractylodes macrocephala10g, poria cocos15g, lotus seed10g, yam10g, dried tangerine peel 6g, Alisma orientalis 6g and licorice 6.
Preparation: 1) Wash the above medicines, put them into aluminum pot, and add appropriate amount of water.
2) Bring aluminum pot to a boil over strong fire, then simmer for 25 minutes, cease fire, filter off residue, and add white sugar and stir well.
Edible: for tea.
Efficacy: tonify spleen and stomach and stop diarrhea. It is especially good for patients with enteritis with malnutrition and dull skin.
4 clove noodles
Formula: 2g clove, Tsaoko 1 piece, 250g white noodles, 3g monosodium glutamate, 3g salt and 3g pepper.
Production: 1) Beat clove and Amomum tsao-ko into fine powder (Amomum tsao-ko is cored).
2) Add a proper amount of clear water into aluminum pot, bring it to a boil over strong fire, add white noodles, bring it to a boil again, and add pepper, salt, clove, Amomum tsao-ko, monosodium glutamate and noodles until cooked.
How to eat: once a day, eat noodles100g each time, thirsty soup, and eat with dinner.
Efficacy: Warm the gastrointestinal tract and stop diarrhea. Has good curative effect on patients with chronic enteritis and diarrhea.
5 Huangqi barley porridge
Formula: rice100g, astragalus root 30g, coix seed 30g.
Production: 1). Wash and slice Radix Astragali; Rice and coix seed are washed clean.
2). Put the rice, astragalus root and coix seed into a pot, add appropriate amount of water, bring to a boil over strong fire, and then simmer for 40 minutes.
How to eat: daily 1 time, with porridge100g each time. Eat for dinner.
Efficacy: tonify vitality and stop diarrhea. It is especially good for patients with chronic enteritis due to spleen deficiency.