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Reheat method
Reheating is the key to treat scleredema in children, and the principle of rewarming is gradual rewarming. At the same time, we should supply enough calories, use antibiotics rationally and control infection.
1, mild to moderate:
If the temperature of anus is 30-34℃ and the temperature difference between axilla and anus is positive, put the child in an incubator at 30℃, and adjust the incubator to 30-34℃ through an automatic temperature control device or manually.
When adjusting, the temperature of the box should be increased by 1℃ every hour, so that the child can return to normal body temperature within 6- 12 hours. Basic medical units can use hot water bottles, hot kang, electric blanket and so on to keep warm.
2. Serious:
When the anal temperature is less than 30℃, the temperature difference between armpit and anus is negative. First, put the child in an incubator with a temperature higher than 1-2℃ and start rewarming. Monitor the anus temperature and armpit temperature 65438 0 times per hour, and increase the incubator temperature by 65438 0℃. Adjust the incubator temperature to a moderate temperature according to the child's gestational age and body temperature recovery.
The temperature of critically ill children 12-24 hours returned to normal; If there are no conditions, you can use your mother's arms to keep warm or a hot water bottle to keep warm.
3. Children with severe scleredema:
Children with severe scleredema can be treated with warm water bath (water temperature 30-40℃). Put the umbilical cord-protecting part of the head water into the water, every time 15 minutes, every day 1-2 times; Dry it after bathing and put it in a warm box at 30-32℃ for heat preservation.
You can also use the far infrared rescue table (open warm box) to quickly re-warm. The bed surface temperature starts from 30℃, and the body temperature increases 15-30 minutes.
With the increase of body temperature, the temperature of the far-infrared rescue platform gradually increases (the highest temperature is 33℃), and it is placed in a warm box preheated to a moderate temperature after recovering the normal body temperature.
The bed temperature of far infrared rescue table is easily affected by convection, and plastic film should be covered above children.
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Related factors determining the curative effect of rewarming
The effect of rewarming therapy is mainly related to the individual differences of children, the way of using heat, the area, time and temperature of hyperthermia.
Generally speaking, in order to obtain satisfactory re-heating effect, the selection of re-heating tools should ensure its thermal stability, strong penetration, fast conduction speed and convenient observation and nursing.
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Several common rewarming therapies
In clinical treatment, in order to improve the curative effect of neonatal scleredema and prevent complications, different rewarming methods or comprehensive rewarming methods can be selected according to the degree of illness of children.
1, hot water bottle:
Suitable for children with mild scleredema.
Disadvantages: Hot water bottle has poor rewarming effect, and it is only used as a local heat preservation and auxiliary rewarming means. Because of dry heat, the temperature is difficult to control, and the penetration is not strong, and the area of hyperthermia is small, which is only suitable for children with mild scleredema.
2. Warm box:
Advantages: The temperature and humidity of the incubator can be controlled by itself to make it reach a suitable temperature and humidity, so it has a satisfactory rewarming effect. Children sleep naked in an incubator without clothes, and the whole body skin is directly and evenly heated, which is beneficial to the recovery of body temperature and convenient for operation and observation. At the same time, the incubator has isolation function, which can effectively reduce the incidence of infection, and it is the most commonly used rewarming method at present.
3, warm bath massage method:
Advantages: Warm bath massage can relax muscles, dilate blood vessels, accelerate blood circulation, promote metabolism, accelerate the repair and growth of skin muscles, and thus enhance the body's immunity.
At the same time, water can improve thermal conductivity, speed up thermal conductivity and increase heat capacity. Coupled with the mechanical massage of water, it can promote telangiectasia, make local scleredema and fever, promote body surface microcirculation and improve muscle nutrition, thus achieving the purpose of warm-up.
After warm water massage, the peripheral circulation of children with scleredema can be obviously improved, which shows that the temperature of limbs increases obviously, the skin color changes from dark red to ruddy, the sucking ability is improved, and the response to external stimuli is obviously enhanced.
Disadvantages: But warm bath massage can't keep the body temperature constant for a long time.
4, far infrared radiation:
Advantages: Far-infrared radiation has the strongest penetrating power, and can conduct heat to subcutaneous fat and viscera, and the penetrating distance is as deep as 4~5cm, because it can improve microcirculation on body surface and in vivo, dilate microvessels, accelerate blood circulation in vivo, and ensure that the temperature of body viscera rises synchronously with the temperature of body surface, so as not to cause blood redistribution and further aggravate the condition.