Analysis:
1 Acute herpes simplex virus encephalitis
I. Antiviral treatment: preferred cyclic guanosine, 10mg/kg each time, dissolved in 100ml solution within 1-2h IV, every 8h, 10 days as a course of treatment.
Second, high-dose hormone (hydrocortisone 100-500mg/d or dexamethasone 10-20mg/d) and 20% mannitol drip to reduce the cranial pressure and reduce cerebral edema, if necessary, temporal muscle decompression surgery.
Third, high fever, convulsions, mental confusion, restlessness, should be given physical cooling, stop convulsions, sedation treatment.
Four, coma, should pay attention to airway patency, water, electrolyte balance, maintain nutrition, oral hygiene, to prevent bedsores, lung and urinary tract infection. Can be a small dose of blood transfusion, human albumin or compound amino acids.
Fifth, the application of interferon, transfer factor and immunoglobulin to enhance immunity.
Sixth, the recovery period can be physiotherapy, ***, acupuncture and so on to help the limb function recovery.
2 subacute sclerosing total encephalitis
3 idiopathic uveal cerebritis
1. Adequate and persistent dilation of pupils. Keep the pupil active to prevent the development of posterior iris adhesions.
2. Topical and systemic application of corticosteroids, dexamethasone spotting, subconjunctival and parabulbar injections. Dexamethasone or hydrocortisone orally or intravenously. Early with a large number of fast reduction later slow reduction, 1 month do not reduce sharply. It should be maintained for 3 to 6 months. Also need to supplement potassium.
3. High-dose vitamin systemic application.
4. Adjuvant drugs: ATP, coenzyme A, inosine and other systemic applications.
5. Immunosuppressive drugs such as cyclophosphamide can be tried in severe cases.
6. Traditional Chinese medicine: clearing heat and detoxification, li Wenming eyesight Chinese medicine.
4 epidemic encephalitis B
1. Treatment of high fever Room temperature should be reduced to below 30℃. High temperature patients can use physical cooling or drug cooling, so that the body temperature is maintained between 38 ~ 39 ℃ (anal temperature). Generally can intramuscular injection of anandamide, adults 0.5g, every 4 to 6 hours, young children can be anandamide anal plug, to avoid excessive antipyretic drugs, so as not to cause dehydration due to profuse sweating.
2. Convulsions can be treated with sedative antispasmodic agents, such as diazepam, chloral hydrate, phenytoin sodium, amytal sodium, etc., should be the cause of the occurrence of convulsions to take the appropriate measures: ① due to cerebral edema caused by the person should be dehydrated medication is the main treatment, available 20% mannitol (1 ~ 1.5g/kg), in 20 ~ 30 minutes of intravenous drip, if necessary, 4 ~ 6 hours repeat use. At the same time can be combined with furosemide, adrenocorticotropic hormone, etc., in order to prevent the rebound after the application of dehydrating agents. (ii) For those who suffer from hypoxia of brain cells due to blockage of respiratory secretion and difficulty in ventilation, oxygen should be given, the airway should be kept open, and tracheotomy and pressurized breathing should be carried out if necessary. ③ Due to high temperature caused by the person, should be cooled mainly.
3. Treatment of respiratory impairment and respiratory failure When the deep coma patient's throat phlegm sound increases and affects respiration, the secretion can be attracted through the mouth or nasal cavity, using *** drainage, nebulized inhalation, etc., in order to keep the airway open. If respiratory failure occurs due to cerebral edema or brain herniation, dehydration and adrenocorticotropic hormone can be given. Breath holding occurring due to convulsions can be treated as convulsions. If spontaneous respiration stops due to pseudo medullary paralysis or medullary cerebral palsy, tracheotomy or intubation should be performed immediately and a pressurized artificial respirator should be used. If spontaneous respiration exists, but the respiration is shallow and weak, respiratory stimulants such as sanguinarine, niclosamide, ritalin, and epsilon, etc., can be used (can be used alternately).
4. Treatment of circulatory failure Circulatory failure caused by cerebral edema, cerebral hernia and other brain lesions, manifested by pallor, cold extremities, small pulse pressure, delivery There is central respiratory failure, it is appropriate to use dehydration to reduce intracranial pressure. If there is cardiogenic heart failure, cardiotonic drugs such as cediran should be added. If the circulatory failure is caused by hyperthermia, coma, excessive water loss, resulting in blood volume insufficiency, then the main focus should be on volume expansion.