I. Prevention:
1) to strengthen women's health care, we should pay attention to diet care, eat more fresh fruits and vegetables, increase the intake of vitamins, enhance physical fitness and improve the body's anti-infection ability.
2) Adult women should pay attention to contraception, avoid or reduce induced abortion operations, and perform all kinds of reproductive system operations strictly aseptically to prevent germs from invading the pelvic cavity.
3) Strengthen health education, teach people the knowledge of preventing pelvic inflammatory disease, educate women to pay attention to menstrual and puerperal hygiene, try to avoid vaginal lavage, pay attention to postpartum hygiene and avoid postpartum infection.
Second, if surgical treatment, preoperative should make the following preparations:
1. No sex for 3 days before treatment.
2. Three days before treatment: the diet is light, with little residue: such as rice, noodles, meat, potatoes, cucumbers, pumpkins, loofah, bitter gourd, wax gourd and other fruits (pay attention to eating fiber-rich dishes such as beans, vegetables and green leafy vegetables, and don't eat too greasy food).
Two days before treatment: eat liquid diet such as porridge, millet porridge, yam porridge, rotten noodles, cereal soup, lotus root starch, hibiscus eggs and various soups (without residue). Don't drink water or soup containing white sugar, and don't drink all kinds of drinks.
0 days before treatment: eat rice soup, various soups (without residue), glucose water and other residue-free diets.
Treatment of chronic pelvic inflammatory disease with traditional Chinese medicine
1. TCM treatment
Clinically, heat and detoxification are the main methods, and dampness and blood stasis are the auxiliary methods. Chronic pelvic inflammatory disease is mostly the residue of pathogenic heat, which is bound to the blood of respecting benevolence and cannot be coagulated. Damp-heat stagnation, qi stagnation and blood stasis, qi deficiency and blood stasis, and cold-dampness stagnation are common in clinic, among which damp-heat type is the most common, and the treatment is mainly to clear heat and promote diuresis, promote blood circulation and remove blood stasis.
It is characterized by abdominal pain, aversion to or fear of cold, abdominal pain, dry throat and bitter taste, short and red urine, constipation, increased leucorrhea, yellow color, strong and smelly taste, and excessive or endless dripping during menstruation. The tongue is red, the coating is yellow and thick, and the pulse is slippery.
Prescription and medicine: Salvia Miltiorrhiza 18g, Paeonia Rubra 15g, Radix Aucklandiae 12g, Semen Persicae 9g, Flos Lonicerae 30g, Herba Taraxaci 30g, Poria 12g, Cortex Moutan 9g and Radix Rehmanniae 9g. When the pain is severe, add 9g of Rhizoma Corydalis. Some patients are of cold coagulation and qi stagnation type, and the treatment principle is to warm meridians to dispel cold, promote qi and promote blood circulation, and Guizhi Fuling decoction is often used to add and subtract. Codonopsis pilosula 15g, Atractylodes macrocephala 9g and Astragalus membranaceus 15g are added for patients with qi deficiency. Traditional Chinese medicine can be taken orally or by enema.
2. moxibustion
(1) acupoint selection
Key points: Qi Hai, Zhong Ji and Gui.
Matching points: Dachangshu and Accessory jaw.
(2) treatment
Give priority to the main points, and add points when the effect is not obvious. Take 2 ~ 3 points at a time. The operation can be performed by traditional ginger-separated moxibustion or acupoint moxibustion instrument. The traditional method is to make pure moxa into moxa cones with a diameter of 1.5cm and a height of 1.8cm, and put them on fresh ginger slices with a thickness of 0.4cm to ignite. Moxibustion is performed at each acupoint for 3 times, each time lasting about 6-7 minutes. Moxibustion lighting method: use the acupoint moxibustion instrument to fix the moxibustion head on the acupoint, and place fresh ginger slices with a thickness of 0.2 cm on the acupoint. Moxibustion lighting lasts for 20 minutes each time, and the temperature depends on the patient's comfort. All of the above are 1 time every day, and1time is a course of treatment, and the interval of treatment is 3-5 days. It takes about two or three courses of treatment.
3. Body acupuncture
(1) acupoint selection
Main acupoints: Guanyuan, Shuidao, Zusanli, Sanyinjiao, Huilai and Guo Li.
Matching points: lumbago plus Shenshu, Liao and Weizhong points; Leucorrhea, multi-machine, Yinling Spring; Irregular menstruation plus exposure to the sea and between the lines; Abdominal distension has pulse and qi sea; Inflammation block plus house.
(2) treatment
Choose 2 ~ 3 points at a time, and add points according to symptoms. The acupuncture sensation at Guanyuan point should reach the vagina and spread to the attachment when it comes back. The technique requires light and even lifting and inserting, combined with small twisting, and the focus is on qi circulation. When stopping the needle, it is best to let the patient feel abdominal pain, such as when stopping the needle. After the rest of the acupoints get angry, they should be used to tonify deficiency and stop diarrhea. Leave the needle 1.5 ~ 20 minutes, and warm the needle when you leave the needle at abdominal points. When acupuncture, it is not appropriate to directly stab the inflammatory site and the mass area. There is no need to warm the needle during menstruation. Every day or every other day 1 time,1time is a course of treatment. The treatment interval is 3 ~ 5 days.
4. Cupping
(1) acupoint selection
Main acupoints: Guanyuan, Shenshu, Sanyinjiao and Zusanli.
Matching points: Qi Hai, Waist Eye, Dazhui and Eight Jaws.
(2) treatment
The main point is the main point, and when the effect is not good, add or change the matching point. Choose 2 ~ 3 acupoints at a time, massage the acupoints first, and then prick with a triangular needle after the surrounding collaterals are exposed, and determine the times and depth of pricking according to the severity of the disease, and then cupping for 5 ~ 10 minutes by throwing fire or attracting. The amount of bleeding varies from 3 to 5 ml to tens of ml.
You can take the jar and suck it out with flash fire first, and let it stand 15 ~ 20 minutes. Then you can use a triangular needle (or a skin needle) to quickly prick more than ten times, and the puncture will be scattered and lightly pricked, depending on the micro-bleeding. Then moxa stick moxibustion 15 minutes.
The acupoint application method is 1 time every day or every other day, and the acupoints are used alternately.1time is a course of treatment.
5. Acupoint application
(1) acupoint selection
Key points: Lower abdominal pain: return, waterway and lumbago: Mingmen, Shenshu, Qihaishu and Yaoyangguan; Lumbosacral pain: Guanyuanshu, Bladder Shu, Maxilla, Accessory jaw, inflammatory mass: Ashi point.
Location of Ashi point: focus.
(2) treatment
Preparation and application: 30g of ginger, 24g of saffron, 5g of cinnamon/kloc-0, 8g of white mustard seed and Arisaema cum bile18g, 2 1 g of ephedra, 2 1 g of raw Pinellia ternata, 2 1 g of raw aconite, 3g of red lady and red bud. Decoct the medicinal materials with 5 kg of fragrant oil to remove residues, add 240 g of Plumbum Preparatium, 4 g of musk and 30 g of Garcinia Garcinia to 1.5 kg of oil to each kg of oil, and spread it into a large plaster weighing 6 g and a small plaster weighing 3 g for later use.
When in use, the selected acupoint area is cleaned and dried, the plaster is heated, baked and melted, and then pasted on the acupoint. Except for Ashi point, which uses big plaster, others use small plaster. Change the dressing in summer 12 hours 1 time, and in winter 1 time. Stop menstruating, 12 times is a course of treatment.
Step 6 warm the needle
(1) acupoint selection
Main acupoints: Guanyuan, Huilai and Zusanli.
(2) treatment
Let the patient urinate first. 1 Insert a 5 ~ 2-inch filiform needle into the acupoint area, and use moderate stimulation 1 ~ 2 minutes after getting angry. Then put a piece of 2 ~ 3 cm long moxa stick on the needle handle and light it. In order to prevent burns, a paper pad can be placed in the acupoint area, and the needle can be taken out after the moxa stick is burned and the needle is cold. Once a day, 10 is a course of treatment, and the interval of treatment is 3 days. It usually takes three courses of treatment.
Western medicine treatment of chronic pelvic inflammatory disease
1. General therapy
Relieve patients' ideological worries, enhance treatment confidence, increase nutrition, exercise, pay attention to the combination of work and rest, and improve physical resistance. Avoid reinfection or spread infection.
2. Physical therapy
(1) Function: Warming can promote the local blood circulation of pelvic cavity, improve the nutritional status of tissues and increase metabolism, thus facilitating the absorption and regression of inflammation. At the same time, combined with related drug therapy, it promotes the absorption and utilization of drugs by the body.
Commonly used are short wave, ultrashort wave, microwave, laser and ion penetration (penicillin, streptomycin and other drugs can be added).
(2) Contraindications:
1) menstruation and pregnancy.
2) There are malignant tumors in reproductive organs.
3) accompanied by bleeding.
4) Medical complications such as heart, liver and renal insufficiency.
5) Active tuberculosis.
6) High fever.
7) Allergy, etc.
3. Antibacterial drug therapy
Long-term or repeated combination therapy of various antibacterial drugs sometimes has no obvious effect, but for young people who need to preserve their reproductive function or are in acute attack, they can be selected, and it is best to use anti-chlamydia or mycoplasma drugs at the same time.
4. Other drugs
At the same time of applying antibacterial drugs, chymotrypsin 5mg or hyaluronidase 1500U can be injected into muscle, every other day 1 time, and 7 ~ 1 time is1course of treatment, which is beneficial to adhesion decomposition and inflammation absorption. Individual patients should stop taking drugs when they have local or systemic allergic reactions.
Some cases were treated with antibiotics and dexamethasone at the same time, taking dexamethasone 0.75mg orally, three times a day, and paying attention to the gradual reduction of dexamethasone before stopping the drug.
5. Surgical therapy
Some patients with chronic pelvic inflammatory disease, due to long-term inflammatory stimulation, lead to adhesion around organs, anti-inflammatory drugs are not easy to enter, leading to recurrent attacks, affecting patients' physical and mental health.
According to the patient's age, severity of the lesion and fertility requirements, the scope of operation was determined, and unilateral appendectomy or total hysterectomy plus bilateral appendectomy was performed. Young women should try to preserve ovarian function. For patients with hydrosalpinx or tubal ovarian cyst who require fertility, salpingostomy or fenestration is feasible. For those over 40 years old who have a large inflammatory mass (more than 6cm in diameter) in the pelvic cavity with abdominal pain, surgical treatment can be considered.
If there is pus in the uterine cavity, you need to enlarge the uterus. Patients with infected lesions, recurrent acute inflammatory attacks or severe pelvic pain should undergo surgery after the above conservative treatment fails. The operation is based on the principle of complete cure to avoid the chance of recurrence of the remaining lesions.