GB 15995-1995 Diagnostic criteria and management principles for leptospirosis
Some standard content:
GB15995-1995
Leptospirosis is a zoonosis caused by different serotypes of pathogenic leptospira (Leptospira interrogans) of the genus Leptospira. It is widely distributed throughout the world, and the disease is serious in my country. Since leptospira invades multiple organs of the human body, the clinical manifestations are complex. Patients occur throughout the year, but often cause disease and epidemics in summer and autumn, rice harvest season and floods. People are generally susceptible to this disease, and the disease is more common in young and middle-aged people. Since the use of dead leptospira vaccine in the late 1950s, the management and control of infectious sources have been strengthened, and the basic construction of farmland water conservancy has been improved, the disease has shown a downward trend. Due to the large number of host animals of this disease, floods and waterlogging disasters have occurred frequently in my country in recent years, and there is a potential risk of epidemics. my country's preventive health care goal in 2000 requires a 40% reduction in the incidence of this disease. For this reason, it is very necessary to formulate diagnostic standards and treatment principles for leptospirosis suitable for the whole country, which is of great significance to ensuring people's health and agricultural production. Appendix A and Appendix B of this standard are both appendices of the standard. This standard is proposed by the Ministry of Health of the People's Republic of China. The responsible drafting unit of this standard is the Institute of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine, and the participating drafting units are Fujian Provincial Health and Epidemic Prevention Station and West China University of Medical Sciences.
The main drafters of this standard are Shi Manhua, Yu Enshu, Dai Baomin, and Liang Zhongxing. This standard is interpreted by the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health, which is the technical unit entrusted by the Ministry of Health. 368
National Standard of the People's Republic of China
Diagnostic criteria and principles of management of leptospirosis GB15995—1995
This standard is formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Communicable Diseases and the Measures for the Implementation of the Law of the People's Republic of China on the Prevention and Control of Communicable Diseases. 1 Scope
This standard specifies the diagnostic criteria and management principles of leptospirosis. This standard is applicable to the diagnosis and treatment of leptospirosis by medical, health and health care institutions and personnel at all levels and types. 2 Diagnostic principles
Leptospirosis is a zoonosis caused by pathogenic Leptospira of different serotypes. Humans are generally susceptible. The vast majority of patients are young and middle-aged farmers, with complex and diverse clinical manifestations, and there are also many atypical cases. Clinical diagnosis should be made based on epidemiological data and clinical manifestations. Confirmation requires isolation of Leptospira and detection of Leptospira-specific antibodies.
3 Diagnostic criteria
3.1 Epidemiological history
Contact with infected water or animal urine or blood 1 to 30 days before onset. 3.2 Early main symptoms and signs
3.2.1 Fever: Acute onset, with chills. In a short period of time, the body temperature can be as high as 39°C, often with remittent fever. 3.2.2 Myalgia: Myalgia all over the body, especially myalgia in the fat intestine. 3.2.3 Fatigue: General fatigue, especially obvious weakness in the legs. 3.2.4 Conjunctival congestion: In mild cases, it mainly occurs in the conjunctiva, outer border and upper and lower fornix. In severe cases, except for the cornea, the conjunctival blood vessels are dilated in a reticular pattern, without secretions, painless and not photophobic. 3.2.5 Gastrocnemius tenderness: Gastrocnemius tenderness on both sides, and severe cases refuse to press. 3.2.6 Lymph node enlargement: It mainly occurs in superficial lymph nodes and femoral lymph nodes, which are generally 1 to 2 cm in size, soft in texture, tender and without suppuration. The above three symptoms (i.e., cold and heat, soreness and pain, and general fatigue) and three signs (i.e., red eyes, leg pain, and lymph node enlargement) have five types of clinical manifestations of leptospirosis (influenza typhoid type, pulmonary hemorrhage and diffuse pulmonary hemorrhage type, jaundice hemorrhage type, renal type, and meningoencephalitis type). 3.3 Laboratory diagnosis
3.3.1 Leptospira can be isolated from blood, cerebrospinal fluid or urine [see Appendix A (Standard Appendix) A1]. 3.3.2 Leptospira nucleic acid detected in blood, urine or cerebrospinal fluid [see A2 in Appendix A (Standard Appendix)]. 3.3.3 The anti-Leptospira antibody titer of the patient's convalescent serum is 4 times or more higher than that of the early serum [see A3 in Appendix A (Standard Appendix)].
3.4 Case classification
3.4.1 Suspected case
Meet any of 3.1 plus 3.2.1 and 3.2.2, 3.2.3. Approved by the State Administration of Technical Supervision on December 15, 1995 and implemented on July 1, 1996
3.4.2 Confirmed case
GB159951995
Suspected case plus any of 3.2.4 or 3.2.5 or 3.2.6. 3.4.3 Confirmed cases
Suspected cases plus any one of 3.3.1 or 3.3.2 or 3.3.3. 4 Treatment principles
4.1 Early detection of patients, reporting of the epidemic to the epidemic prevention department, and early treatment. Penicillin injection is the first choice of treatment, which is effective, but attention should be paid to the prevention of Herxheimer's reaction [see Appendix B (Standard Appendix) B1.2.5]. Disinfect the patient's excrement. 4.2 Emergency measures for susceptible populations
Among the people who are exposed to the same epidemic source in the same area at the same time, if one person becomes ill, the rest of the people (who have not been vaccinated with Leptospira vaccine) should also be injected with penicillin, or oral doxycycline and other emergency measures should be taken for preventive treatment. 4.3 Immunization prevention for susceptible populations
For susceptible populations entering the Leptospira epidemic source, the Leptospira vaccine should be injected with a full course of basic injections 15 days before entering the epidemic source. 4.4 Monitor rat density and infection rate in areas where rice field-type leptospirosis is prevalent, and eliminate rats in the wild to reduce rat density. 4.5 Monitor pig infection rate in areas where flood-type leptospirosis is prevalent, and manage livestock as the source of infection, renew pig pens, and reduce pig infection rate based on the results.
GB15995—1995
Appendix A
(Standard Appendix)
Etiology and serological diagnosis methods for leptospirosis A1 Direct microscopic examination and separation of leptospires
A1.1 Direct microscopic examination of patient blood
A1.1.1 Take a drop of blood from an early patient, add a drop of distilled water to dissolve the blood cells, and check for active leptospires under a dark field microscope.
A1.1.2 Take 1-2 ml of venous blood from an early patient and place it in a sterile test tube for coagulation. Centrifuge and precipitate, and absorb the slightly white suspension at the junction of serum and blood cells. After smearing, check whether there are active leptospires under dark field microscope. A1.1.3 Differential centrifugation dark field examination method: Collect 1ml of venous blood from early patients and add it to a tube containing 2mL of sodium citrate saline. Centrifuge at 1000r/min for 10min, aspirate the upper plasma and place it in another clean tube, and centrifuge at 3000-3500r/min for 30-60min. Discard the supernatant, take a drop of the precipitate on the glass slide, and check whether there are active leptospires under dark field microscope. A1.2 Culture and isolation of pathogens
A1.2.1 Patient blood and urine culture: Collect blood from early patients and inoculate it in 2-3 tubes of Korthof culture medium aseptically, with 1-3 drops inoculated in each tube. The blood culture tube is cultured at 28℃. Take the culture every 5-7 days and observe whether there is growth of leptospires under dark field microscope. If there is growth, it is positive for separation. If no growth is observed, the culture should be continued for 60 days. If no leptospira is found, the negative treatment should be performed. Collect 30-50 mL of midstream urine from patients who have been ill for more than two weeks and place it in a sterile centrifuge tube and centrifuge it at 3500-4000 r/min for 1 hour. Take 0.3-0.5 mL of sediment and inoculate it in 2-4 tubes of the above culture medium and incubate it at 28°C. Take samples for microscopic examination every 5-7 days. To improve the detection rate and reduce contamination, give the patient 2-4 g of sodium bicarbonate (NaHCO:) the night before collecting urine specimens. At the same time, add 100-400 μg/mL 5-fluorouracil or 1/2000 sulfadiazine to the culture medium. A1.2.2 Inoculate golden hamsters or young guinea pigs (weighing between 120-140 g) with blood and urine from patients. A1.2.3 Strain grouping and typing identification: Use grouping serum to perform agglutination test with newly isolated leptospira to determine the bacterial group. The cross-agglutinin absorption test or typing factor serum is used to determine the bacterial type. A2 Detection of Leptospira nucleic acid
Use polymerase chain reaction and molecular hybridization technology to detect Leptospira nucleic acid. A3 Serological diagnosis method
A3.1 Microscopic agglutination test (MAT)
A3.1.1 Selection and preparation of antigens: The representative strains of 15 types of 15 groups of Leptospira in my country are cultured in Korthof or TepckM medium at 28℃ for 5~~7 days and examined under a dark field microscope. There are no less than 50 strains in each 400-fold field of view. Those that are active in movement and have no self-agglutination can be used as agglutinating antigens.
A3.1.2. Operation method: After the patient serum is inactivated in a 56℃ water bath for 30 minutes, use physiological saline at two dilutions of 1:50 (early patient serum) or 1:100 (recovery period) and 1:500 for qualitative testing: take 50μL of each of the two dilutions of serum and the physiological saline used as a control, and take the culture fluid of 15 representative strains and add them to the three wells in each column in turn. After shaking, incubate at 37℃ for 1.5-2h. Use an inoculation loop to pick up the reaction solution and the control, place them on a slide and observe the agglutination under a dark field microscope. If the 1:100 and 1:500 diluted serum agglutinates with a group of leptospira antigens, it is necessary to further dilute the serum to agglutinate with the group of leptospira antigens to determine its agglutination titer. The agglutination titer is calculated as the dilution multiple of the original serum × 2.
A3.7.3 Determination of endpoint agglutination titer: The highest serum dilution that shows ++ agglutination (i.e. 50% leptosome agglutination in the field of view) is taken as the endpoint agglutination titer.
GB 15995-1995
A3.2 Indirect enzyme-linked immunosorbent assay (indirect ELISA) The ultrasonic antigen is coated on a polystyrene microplate. Then, the antibody to be tested (first antibody) and the enzyme-labeled antibody (second antibody) are combined in sequence. After color development, the OD value at 492nm is measured. If the OD value of the sample to be tested exceeds 2.1 times that of the negative sample, it can be judged as positive. A3.3 Dot enzyme-linked immunosorbent assay (Dot-ELISA) The ultrasonic antigen is coated on a 45μm nitrocellulose membrane. The following steps are the same as indirect ELISA. The blue spots are positive when hydrogen peroxide-tetrachlorophenol is used as the substrate, and the blue spots are negative. The highest serum dilution that appears positive is used as the titer determination endpoint. Patient serum titer greater than or equal to 1:20 or a 4-fold increase in the titer of the double cylinder serum is of diagnostic significance. A4 medium preparation method
A4.1 Korthof medium composition and preparation method A4.1.1 Composition
Protein Chen (can be substituted by trypsin Chen) 400 mg Sodium chloride (NaCl) 700 mg
Potassium chloride (KCl) 20 mg
Sodium bicarbonate (NaHCO,) 10 mg
Potassium dihydrogen phosphate (KH,PO4) 120 mg
Sodium bicarbonate (12 crystal water) (NazHPO4·12H,O) 440 mg Calcium chloride (CaCl2) 20 mg (If the precipitation is removed after autoclaving or boiling, this component can be omitted) Distilled water 500mL
A4.1.2 Preparation
A4.1.2.1 Dissolve the above components in distilled water, boil for 20 minutes, filter, adjust the pH to 7.2, and dispense into flasks, 100mL per bottle, and autoclave at 15 pounds for 30 minutes.
A4.1.2.2 Inactivate rabbit serum at 56℃ for 30 minutes. A4.1.2.3 Add the A4.1.2.1 solution to the inactivated rabbit serum with aseptic operation to a final concentration of 8% to 10%. A4.2TepckHm medium (phosphate buffer solution) Composition and preparation method Mother solution 1/15mol/L NazHPO4 12H,0 12g/500mL distilled water Phosphate buffer 1/15mol/L KH,PO 4.5g/500mL distilled water Take 1/15mol/L NazHPO4· 12H,O 80 mL, 1/15 mol/L KH,PO 20 mL, mix, adjust pH 7.2-7.4, add 900mL distilled water, mix, divide into test tubes, and sterilize at 15 pounds for 30 minutes, then add inactivated rabbit serum with aseptic operation to a final concentration of 8%-10%.
Appendix B
(Standard Appendix)
Treatment plan for leptospirosis
The treatment of this disease should pay attention to the timely elimination of pathogens in the body with effective antibiotics, which is of great significance to controlling the development of the disease. Rest, careful care, attention to nutrition, and appropriate supplementation of heat energy and vitamin B and C should be emphasized. The clinical manifestations of leptospirosis can be divided into five types, namely influenza typhoid type, pulmonary hemorrhage and diffuse pulmonary hemorrhage, jaundice hemorrhage, renal type, and meningoencephalitis type.
B1 Influenza typhoid type
B1.1 Antibacterial therapy
Antibacterial therapy is the most basic treatment measure for leptospirosis and the core of early treatment. Penicillin G is the first choice, gentamicin 372
second choice, doxycycline, tetracycline, etc. can also be used as appropriate. GB15995-1995
B7.1.1 Penicillin treatment: 800,000 to 1.2 million IU per day for adults, divided into 2 to 3 intramuscular injections. For patients with severe symptoms of infection and poisoning, the dose can be increased to 1.6 to 2.4 million IU per day, divided into intramuscular injections every 4 to 6 hours. The dose can be reduced as the body temperature drops. The course of treatment is generally 5 to 7 days, and the dose for children can be reduced as appropriate. Within 15 minutes to 5 hours after the first dose of penicillin, pay close attention to the occurrence of Herxheimer's reaction. B1.1.2 Other antibiotic treatments: Other antibiotics can be selected for patients who are allergic to penicillin. B1.1.2.1 Gentamycin: Adult dose is 240 mg per day (child dose is 5 mg/kg body weight), divided into 3 intramuscular injections. After the body temperature returns to normal 24 hours later, it is changed to 80 mg, and injected intramuscularly once every 12 hours. The course of treatment is 7 days. B1.1.2.2 Tetracycline: Adult dose is 2 g per day, divided into 4 times orally or intravenously, and the course of treatment is 7 days. B1.1.2.3 Doxycystin: Adult dose is 100 mg twice a day, and the course of treatment is 7 days. B1.1.2.4 Azobenzylpenicillin: The dosage is 3~4g per day for adults (80~120mg/kg body weight for children), divided into 3~4 intramuscular injections or intravenous drips.
B1.1.2.5 Other antibiotics such as erythromycin, kanamycin, pioneer, oleandomycin and midecamycin can also be used. B1.2 Symptomatic supportive therapy
B1.2.1-General supportive therapy: Pay attention to bed rest, give easily digestible food, and appropriately supplement B vitamins and vitamin C. B1.2.2 High fever treatment: Physical cooling can be applied. Antipyretic analgesics can be used under the premise of a clear diagnosis. B1.2.3 Fluid replacement: The total amount of intravenous fluid replacement for 24 hours is 2000~~2500mL for adults, mainly 5% glucose saline, and an appropriate amount of 10% glucose 500mL to supplement the body's need for increased heat energy consumption. B1.2.4 Nose: Nose bleeding is a common symptom of leptospirosis. For general nose bleeding, use cotton balls or gauze to diffuse 1% ephedrine or 0.1% adrenaline into the nose. Large doses of vitamin C and K can also be used. B1.2.5 Prevention and treatment of Herxheimer's reaction: Since Herxheimer's reaction can aggravate the condition and even develop into diffuse pulmonary hemorrhage, its prevention and treatment are of great significance. For patients with high fever, those entering the epidemic area for the first time, pregnant women and children with leptospirosis, the condition is more serious. When treated with penicillin G, Herxheimer's reaction is prone to occur. Therefore, for such patients, while using the first dose of penicillin G, a large dose of hydrocortisone 100mg plus 5% or 10% glucose solution 20mL should be slowly injected intravenously, followed by hydrocortisone 200mg plus 5% or 10% glucose solution 100mL and 200mL dripping in sequence, and the total amount should be dripped within 4 hours. The dosage for children is reduced as appropriate. The treatment of Herxheimer reaction is 20-50 mg of promethazine and/or chlorpromazine, intramuscular injection. Hydrocortisone 100-300 mg is diluted and dripped intravenously, and other symptomatic treatments are given as appropriate. B2 Pulmonary hemorrhage and diffuse pulmonary hemorrhage type
B2.1 Antibacterial therapy: Same as influenza typhoid type. B2.2 Hydrocortisone therapy
B2.2.1 Prodromal stage: The first dose of 50-100 mg of hydrocortisone is added to 10-20 mL of 5% glucose solution and slowly injected intravenously, and the push is completed in 10-20 minutes. Subsequently, 100 mg of hydrocortisone is added to 100 mL of 5% glucose solution and slowly dripped intravenously. The general daily dose of hydrocortisone is 200-500 mg.
B2.2.2 Critical stage: The first dose of 100 mg hydrocortisone is added to 20 mL of 5% glucose solution and slowly injected intravenously. It takes 10 to 20 minutes to push it. Or 200 to 300 mg hydrocortisone is added to 100 mL of 5% glucose solution and slowly dripped intravenously. The general daily dose of hydrocortisone is 200 to 800 mg.
B2.2.3 Critical stage: Sodium succinate hydrocortisone 200 to 300 mg is added to 20 mL of 5% to 10% glucose solution and slowly pushed intravenously. Later, 200 to 300 mg hydrocortisone is added to 100 mL of 5% glucose solution and dripped intravenously as appropriate. The daily dose of hydrocortisone is 800 to 1500 mg.
B2.3 Sedative therapy
B2.3.1 Prodromal stage: First choice is chlorpromazine and promethazine 25~~50mg each intramuscular injection. If effective sedation cannot be achieved after 30~60 minutes, then use pethidine 50~100mg intramuscular injection. Promethazine and chlorpromazine are used to maintain the condition. After the condition stabilizes for 24 hours, the drug can be stopped. B2.3.2. Extreme stage: First, use promethazine 50mg, intramuscular injection. If the patient cannot be sedated, use 10% fluoral hydrate 30mL enema, and then use diazepam 10 mg intramuscular injection.
GB15995—1995
B2.3.3 Critical stage: Because there are varying degrees of respiratory failure in this stage, the use of large doses of pethidine and chlorpromazine should be particularly cautious. For those who are extremely irritable at this time, promethazine 50mg, intramuscular injection, and 10% chloral hydrate 30mL enema can be used. B2.4 Cardiotonic drug therapybzxz.net
B2.4.1 Trichosanthes kirilowii test K: 0.25mg is added to 10mL of 10% glucose solution and slowly injected intravenously. The dosage for 24 hours should not exceed 1 mg.
B2.4.2 Digoxin (Cedilamide): The first dose of 0.4 mg is added to 20 mL of 10% glucose solution and slowly injected intravenously. The dosage for 24 hours should not exceed 1.6 mg.
B2.5 Infusion therapy
The initial rescue should be 5% glucose solution, 10% glucose solution or 5% glucose saline. Try to avoid using hypertonic solutions such as mannitol (except for pulmonary edema and cerebral edema). If it is not necessary, acid should not be corrected immediately (except in severe cases). Low molecular weight dextran should not be immediately infused (except in shock and DIC). The total amount of patients with more serious conditions on the first day is 800-1000 mL. B2.6 Oxygen therapy
B2.7 Hemostatic therapy: If there is jaundice, liver dysfunction, or coagulation disorder, give vitamin K10~~20 mg intravenous drip, or vitamin K 37. 6 mg intramuscular injection, twice a day. Large doses of vitamin C can also be used, intravenous drip, vitamin C dosage 3~5g. B3 Jaundice hemorrhagic type
The treatment of this type should emphasize that the dosage of anti-leptospirosis drugs should be relatively large and the course of treatment should be relatively long. In view of the fact that this type of cases often have varying degrees of liver (or) kidney function damage, attention should be paid to the liver and kidney function and their changes when using drugs for treatment. B3.1 Penicillin G sodium or potassium salt is preferred, with a daily dose of 2.4 million IU, divided into 3 intramuscular injections. For those with renal insufficiency, penicillin G sodium salt is used, and the course of treatment is 7~10d. For those who are allergic to penicillin but have normal renal function, 80mg of cindapsin can be used, injected intramuscularly once every 8 hours, and the course of treatment is 7~10d.
B3.1.1 Typical jaundice hemorrhagic type: Vitamin C 3~~5g, vitamin K, 40mg, inosine 200mg added to 10% glucose 500~1000mL intravenous drip, once a day, 10~14d as a course of treatment, you can also add hemostatic drugs such as Anluoxue or Yunnan Baiyao. Severe jaundice can be treated with short-term treatment of 30~40mg of prednisolone or prednisone daily, which can relieve jaundice and improve liver function. B3.1.2 Mild jaundice hemorrhagic type: In addition to anti-infection, general supportive symptomatic treatment is used. B3.1.3 Severe jaundice hemorrhagic type: Because this type has severe jaundice, liver failure and (or) renal failure and (or) heavy bleeding, the condition is very serious and often life-threatening.
B3.1.3.1 Liver failure: Fresh plasma or freeze-dried plasma or human albumin or fresh blood is intravenously dripped 2~3 times a week, and repeatedly exchanged for use.
B3.1.3.2 Severe bleeding: Fresh blood, platelets and blood products should be transfused in time. Use of large doses of vitamin K, vitamin C and general hemostatic drugs. For gastrointestinal bleeding, 8 mg of norepinephrine can be taken orally in 100-200 mL of ice water, or 10 IU of posterior pituitary hormone can be diluted with 10% glucose solution and injected or dripped intravenously. B3.1.3.3 Renal failure: Treat according to the treatment principles of acute renal failure (see B5). B4 Meningoencephalitis type
B4.1 Treatment of meningitis type, this type is mild. B4.1.1 Antibacterial treatment: Penicillin is not easy to pass through the blood-brain barrier, the dose can be appropriately increased, and the course of treatment can be appropriately extended. The adult dose of penicillin G is 3.2 million IU per day, intramuscular injection or intravenous drip for 5-7 days. Ampicillin or azoxycillin 2g per day, for a course of 6 days. B4.1.2 Treatment of headache: general symptomatic treatment. B4.2 Treatment of meningoencephalitis: This type of disease is serious and has a high mortality rate. In addition to adequate antibiotic treatment, attention should be paid to preventing and treating cerebral edema and brain herniation, and preventing complications such as infection.
B4.2.1 Antimicrobial treatment: large doses of penicillin, 8 to 12 million 1U per day, intravenous drip, or aminocyanocbine, 4 to 6g per day for adults, 7 to 10 days of treatment.
GB15995--1995
B4.2.2 Use of adrenal cortex hormones: patients with cerebral edema, especially those with severe symptoms of poisoning, should use adrenal cortex hormones for a short period of time. Hydrocortisone and dexamethasone can be used, and dexamethasone is more effective, 10 to 20 mg·intravenous push, 3 to 4 times a day. B4.2.3 Dehydration therapy: When there are signs of cerebral edema, especially when brain herniation is formed, 20% mannitol or 25% sorbitol 200mL is injected intravenously. Large doses of diuretics such as furosemide and ethacrynic acid can also be used. B5 Renal type
B5.1 Early treatment
B5.1.1 Improve systemic and renal blood circulation. Fluid replacement therapy should be performed for insufficient blood volume to improve renal blood flow. B5.1.2 Diuretics, mannitol, and sorbitol are all osmotic diuretics and should be used early. If there is diffuse pulmonary hemorrhage or severe myocarditis, direct intravenous injection should be used with caution or not at all. B5.2 Treatment of oliguria or urine retention
B5.2.1 General supportive therapy: restrict protein diet, ensure sufficient heat energy, 100~400g of glucose per day, and maintain daily calories of about 6688 joules.
B5.2.2 Pay close attention to water and electrolyte balance. Strictly control fluid intake, prevent pulmonary edema, and record fluid intake and output. The daily fluid replacement amount is the insensible water loss plus the sensible water loss.
B5.2.3 Correct acidosis.
B5.2.4 Dialysis therapy For severe azotemia, hyperkalemia and symptoms of uremia, peritoneal dialysis and hemodialysis are more reliable.
B5.2.5 Treatment of other complications - secondary infection. B5.3 Treatment of polyuria: Pay attention to replenishing body fluids and electrolytes, prevent secondary infection and complications, and gradually increase protein intake. 373Liver failure and/or renal failure and/or massive bleeding, the condition is very serious and often life-threatening.
B3.1.3.1 Liver failure: fresh plasma or freeze-dried plasma or human albumin or fresh blood is intravenously infused 2 to 3 times a week, and is exchanged repeatedly.
B3.1.3.2 Massive bleeding: fresh blood, platelets and blood products should be transfused in time. Use of large doses of vitamin K, vitamin C and general hemostatic drugs. For patients with gastrointestinal bleeding, 8 mg of norepinephrine can be taken orally in divided doses with 100 to 200 mL of ice water, or 10 IU of posterior pituitary hormone can be diluted with 10% glucose solution and injected or dripped intravenously. B3.1.3.3 Renal failure: Treat according to the treatment principles of acute renal failure (see B5). B4 Meningoencephalitis type
B4.1 Treatment of meningitis type, this type is mild. B4.1.1 Antimicrobial treatment: Penicillin is not easy to pass through the blood-brain barrier, so the dosage can be appropriately increased and the course of treatment can be appropriately extended. The adult dose of penicillin G is 3.2 million IU per day, intramuscular injection or intravenous drip for a course of 5 to 7 days. Ampicillin or azathiocarbamide 2g per day, for a course of 6 days. B4.1.2 Treatment of headache: general symptomatic treatment. B4.2 Treatment of meningoencephalitis: This type of disease is serious and has a high mortality rate. In addition to adequate antibiotic treatment, pay attention to the prevention and treatment of cerebral edema and brain herniation, and prevent complications such as infection.
B4.2.1 Antimicrobial treatment: Large doses of penicillin are 8 to 12 million 1U per day, intravenous drip, or aminoacidin is used, 4 to 6g per day for adults, for a course of 7 to 10 days.
GB15995--1995
B4.2.2 Use of adrenal cortex hormones: Patients with cerebral edema, especially those with severe poisoning symptoms, should use adrenal cortex hormones for a short period of time. Both hydrocortisone and dexamethasone can be used. Dexamethasone works better. 10-20 mg·intravenous push, 3-4 times a day. B4.2.3 Dehydration therapy: If there are signs of cerebral edema, especially when brain herniation occurs, 20% mannitol or 25% sorbitol 200 mL intravenous push, and large doses of diuretics such as furosemide and ethacrynic acid can also be used. B5 Renal type
B5.1 Early treatment
B5.1.1 Improve systemic and renal blood circulation. Fluid replacement therapy should be performed for insufficient blood volume to improve renal blood flow. B5.1.2 Diuretics, mannitol, and sorbitol are all osmotic diuretics and should be used early. If there is diffuse pulmonary hemorrhage or severe myocarditis, direct intravenous injection should be used with caution or not at all. B5.2 Treatment of oliguria or urine retention period
B5.2.1 General supportive therapy: restrict protein diet, ensure sufficient heat energy, 100~400g of glucose per day, and maintain daily calories of about 6688 joules.
B5.2.2 Pay close attention to water and electrolyte balance. Strictly control fluid intake, prevent pulmonary edema, and record intake and output. The daily fluid replacement volume is the insensible water loss plus the sensible water loss.
B5.2.3 Correct acidosis.
B5.2.4 Dialysis therapy When severe azotemia, hyperkalemia, and symptoms of uremia appear, the use of peritoneal dialysis and hemodialysis is more reliable.
B5.2.5 Treatment of other complications - secondary infection. B5.3 Treatment of polyuria: Pay attention to replenishing body fluids and electrolytes, prevent secondary infection and complications, and gradually increase protein intake. 373Liver failure and/or renal failure and/or massive bleeding, the condition is very serious and often life-threatening.
B3.1.3.1 Liver failure: fresh plasma or freeze-dried plasma or human albumin or fresh blood is intravenously infused 2 to 3 times a week, and is exchanged repeatedly.
B3.1.3.2 Massive bleeding: fresh blood, platelets and blood products should be transfused in time. Use of large doses of vitamin K, vitamin C and general hemostatic drugs. For patients with gastrointestinal bleeding, 8 mg of norepinephrine can be taken orally in divided doses with 100 to 200 mL of ice water, or 10 IU of posterior pituitary hormone can be diluted with 10% glucose solution and injected or dripped intravenously. B3.1.3.3 Renal failure: Treat according to the treatment principles of acute renal failure (see B5). B4 Meningoencephalitis type
B4.1 Treatment of meningitis type, this type is mild. B4.1.1 Antimicrobial treatment: Penicillin is not easy to pass through the blood-brain barrier, so the dosage can be appropriately increased and the course of treatment can be appropriately extended. The adult dose of penicillin G is 3.2 million IU per day, intramuscular injection or intravenous drip for a course of 5 to 7 days. Ampicillin or azathiocarbamide 2g per day, for a course of 6 days. B4.1.2 Treatment of headache: general symptomatic treatment. B4.2 Treatment of meningoencephalitis: This type of disease is serious and has a high mortality rate. In addition to adequate antibiotic treatment, pay attention to the prevention and treatment of cerebral edema and brain herniation, and prevent complications such as infection.
B4.2.1 Antimicrobial treatment: Large doses of penicillin are 8 to 12 million 1U per day, intravenous drip, or aminoacidin is used, 4 to 6g per day for adults, for a course of 7 to 10 days.
GB15995--1995
B4.2.2 Use of adrenal cortex hormones: Patients with cerebral edema, especially those with severe poisoning symptoms, should use adrenal cortex hormones for a short period of time. Both hydrocortisone and dexamethasone can be used. Dexamethasone works better. 10-20 mg·intravenous push, 3-4 times a day. B4.2.3 Dehydration therapy: If there are signs of cerebral edema, especially when brain herniation occurs, 20% mannitol or 25% sorbitol 200 mL intravenous push, and large doses of diuretics such as furosemide and ethacrynic acid can also be used. B5 Renal type
B5.1 Early treatment
B5.1.1 Improve systemic and renal blood circulation. Fluid replacement therapy should be performed for insufficient blood volume to improve renal blood flow. B5.1.2 Diuretics, mannitol, and sorbitol are all osmotic diuretics and should be used early. If there is diffuse pulmonary hemorrhage or severe myocarditis, direct intravenous injection should be used with caution or not at all. B5.2 Treatment of oliguria or urine retention period
B5.2.1 General supportive therapy: restrict protein diet, ensure sufficient heat energy, 100~400g of glucose per day, and maintain daily calories of about 6688 joules.
B5.2.2 Pay close attention to water and electrolyte balance. Strictly control fluid intake, prevent pulmonary edema, and record intake and output. The daily fluid replacement volume is the insensible water loss plus the sensible water loss.
B5.2.3 Correct acidosis.
B5.2.4 Dialysis therapy When severe azotemia, hyperkalemia, and symptoms of uremia appear, the use of peritoneal dialysis and hemodialysis is more reliable.
B5.2.5 Treatment of other complications - secondary infection. B5.3 Treatment of polyuria: Pay attention to replenishing body fluids and electrolytes, prevent secondary infection and complications, and gradually increase protein intake. 373
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