Thromboangiitis obliterans

Acupuncture accident caused by thrombosis obliterans, caused by the injection point . China since 1973, seven cases reported so far , either in the upper or lower extremities of the extremities has occurred . There are adults, but mostly for pediatric thrombosis obliterans, often caused necrosis of the extremities , and often subject to amputation ( toe ) surgery , a lifetime of pain to the patient .

[ Reason ] injury

Thromboangiitis obliterans , is a medium , small veno-occlusive disease, often involving the lower limbs. Early lesions were full vasculitis, then thrombosis, occlusion of the lumen leads to necrosis of the extremities , mainly due to improper because acupoint injection.
First, acupuncture reasons: larger vessels through the hole in the region or around the distribution is more rich in blood vessels . In the full three years of the most common. If a 5 -year-old male children , because of purulent discharge bloody mucus stool , carry out bilateral Zusanli closed , liquid chosen by 12.5% of chloramphenicol per hole 0.25ml, daily symptom relief. But three days later and found the left foot points closed at redness, swelling , pain, middle left anterior tibial bone pale skin necrosis , a month after radiography , tibia has been found dead bone formation , and finally cured by surgery [ 1 ] . Secondly, the stimulus is located more than tendons, ligaments and other dense tissue near acupoints, such as doors, etc. God also prone because such organizations affect blood circulation , prevent drug absorption , stimulate blood vessel walls , causing inflammation of the lining of blood vessels , thrombosis , occlusion of the lumen , leading to necrosis of the extremities .
Second, the drug causes: watching from the reported incidents were caused by injection of chlorpromazine or chloramphenicol .
( A ) , drug irritation is too large, can be caused by reflex local blood disorder . Such as chlorpromazine , the Department of strong acidic drugs, generally with a 2.5% solution of the current (1ml containing chlorpromazine 25mg), a pH of 4 to 4.5. For point injection should be diluted , reducing acidity, reducing the injection of local irritation , avoid tissue necrosis.
( Two ) , injection volume is too large, or repeated at a point injection . Can stimulate blood vessel wall , forming a whole vasculitis and thrombosis, caused limb necrosis. Especially in pediatric patients , due to the delicate tissue , the possibility great.
Third, the operation causes: failure to conventional point injection , acupoints are not allowed , partial warp from the hole, or due to misuse of the blood vessels, they did not withdraw the blood , which inject greater irritant drugs . In this case , drug stimulation vessels, causing vascular spasm, vascular produce non -infectious inflammation of the full -thickness , intraluminal thrombus formation and gradually machine, and finally vascular occlusion, limb necrosis . In addition , acupuncture buried properly, can lead to .

Clinical manifestations

Can be divided into two stages.
Early : injection site swelling, pain . Point area of skin was purple, flushing or pale yellow hairs gradually fall off, the skin surface is dry , local tenderness, pale extremities , numbness , coldness . Limb arterial pulse weakened or even disappear , often due to persistent pain at night and can not sleep.
Late : the symptoms gradually worsened. Due to serious blood circulation disorders , limb toe ( finger ) side black, shriveled , gangrene, gangrene can be divided according to the scope of the secondary ; gangrene limited to the toes subordinate level, gangrene extended toe plantar metatarsal joints and two subordinates ; gangrene extended heel, ankle or leg is three .
General thrombosis obliterans longer course. Develop slowly, but due to the improper point injection duration is short and fast progress , gangrene phenomenon can occur in a short time . Deserve special attention.

[ Prevention ]

First, the rational use of medicines : Avoid irritation of drugs for injection, such as when you need to apply , but also by the dilution method , etc. , so that the pH close to the human body pH , and reduce the dose . In muscular thin acupuncture larger vessels have passed , you should use the smallest dose ( usual dose of 1 /5 ) . Do not repeated injections of such drugs in the same points.
Second, strict adherence to routine : In addition to quasi- acupoints , acupuncture direction accurately , but before the injection should Withdrawing moment, in the absence of blood back to the situation before pushing drugs. In addition . When the needle hit a vein wall , patients often have pain, the needle shall mention , changing the direction of piercing .
Third, observe : injection site swelling , etc. Once the phenomenon should be further examination. Can not be sloppy engaged , as a general infection treatment .

[ Approach ]

A drug treatment : Application vasodilator drugs such as Tolazoline , niacin , as well as intravenous infusion of 2.5% magnesium sulfate solution to dilate blood vessels, relieve spasms and promote collateral circulation . Dextran , can extend and improve microcirculation and thrombosis collateral circulation , but in the early acute development should not be used , applied proportionally hormone ( in the acute phase ) and antibiotics (with local or systemic infection ) prevented. Chinese medicine treatment also has a significant effect , such as the application Simiao decoction , Angelica injection , Danshen injections. Severe pain were given analgesics.
Second, complementary therapies : patient supine, Taigaohuanzhi to 45 °, maintain 1 ~ 2min, then make limb sagging 2 ~ 5min, while the up , down, inside , outside and other sports 10min. Repeat five times daily number back . History of smoking should quit.
Third, local processing : dry gangrene , should be protected and allowed to dry , to be clear boundary gangrene , amputation may be suffering from toe under sterile conditions , or for debridement . If severe gangrene , infection continues to expand and can not control , shall be high amputation .