First, western medicine treatment;
Emergency measures: 1) In case of acute attack, stay in bed. (2) Avoid using drugs that may cause thrombocytopenia. (3) To prevent trauma and prohibit unnecessary puncture wounds. (4) Oral administration of large doses of vitamin C and Anluoxue can achieve certain hemostasis. (5) Take oral prednisone 40 ~ 60mg/ day, and gradually reduce it after the symptoms are controlled. (6) Immunosuppressants such as azathioprine 75 ~ 150mg/ day or cyclophosphamide 200mg can be used after splenectomy, once every 1 ~ 2 days. (7) If there is massive bleeding, it should be sent to the hospital as soon as possible. Treatment: Patients with severe bleeding symptoms should stay in bed to prevent trauma and avoid using drugs that may lead to thrombocytopenia.
1. Glucocorticoid is the first choice for this disease, which has a certain clinical effect on both acute and chronic attacks. Glucocorticoid can reduce vascular permeability, inhibit antigen-antibody reaction, and inhibit the phagocytosis of platelets by mononuclear phagocyte system, especially macrophages in spleen. The curative effect of this disease is similar to that of various glucocorticoid preparations. In severe cases, hydrocortisone 200 ~ 300 mg or dexamethasone 10 ~ 30 mg can be used for short-term intravenous drip every day. Generally, 30 ~ 60 mg of prednisone can be taken orally every day. Severe bleeding can be appropriately increased. When the condition improves, platelets will gradually decrease after 2 ~ 3 weeks. Acute type takes 4 ~ 8 weeks as a course of treatment, and high-dose treatment should not exceed 2 weeks; Chronic type often needs a small dose of 4 ~ 6 months. This medicine is still effective for relapsed patients. 2. Splenectomy is an important method to treat chronic patients, and its mechanism lies in reducing the production of platelet antibodies and eliminating the destruction sites of platelets. The remission rate of splenectomy can reach 75%-90%, but about 30% and 50% of them relapse, so it is not the first choice. Indications of splenectomy: ① glucocorticoid therapy failed for 2 ~ 6 months; ② The curative effect on glucocorticoids is poor, or it is easy to relapse when the dosage is reduced; 8 contraindications to glucocorticoid; ④ Radionuclide labeled platelets have a high radiation index in the spleen. If the accessory spleen is removed during the operation, the curative effect may be better. It is generally believed that patients with normal platelet count for more than half a year after splenectomy are cured. Three, immunosuppressants are ineffective for glucocorticoid, and those who are unwilling to cut spleen after splenectomy or have poor curative effect can be treated with immunosuppressants alone or combined with low-dose glucocorticoid. Vincristine is usually injected intravenously 1 ~ 2mg/ week; Cyclophosphamide (daily 100 ~ 150 mg) was injected intravenously or orally in divided doses; Azathioprine 100 ~ 150mg/ day, taken orally in batches. The course of treatment of immunosuppressant is 4 ~ 6 weeks. After remission, it gradually decreases and generally lasts for 3 ~ 6 months. Immunosuppressants are effective in the treatment of this disease in the near future, but it is still easy to relapse after stopping the drug, and it has the side effect of inhibiting hematopoietic function. Fourth, other therapies Danazol (Danaz0 1) is a synthetic androgen, which has no positive side effects. It may reduce antibody production and increase platelet count through the action of inhibitory T lymphocytes. The dosage is 200 ~ 400 mg per day, which can be combined with glucocorticoid and is an effective drug for the treatment of refractory ITP. Transfusion of fresh blood has a good hemostatic effect, and platelet suspension can also be transfused. Because of repeated infusion, it is easy to produce the same antibody and cause the destruction of platelets more quickly. Therefore, transfusion of platelet suspension is only suitable for the rescue of critically ill patients, preparation before splenectomy or intraoperative application. High dose gamma globulin can inhibit the production of autoantibodies and is suitable for refractory cases of acute massive hemorrhage. The efficacy of monoclonal antibodies has yet to be confirmed. Plasma exchange is suitable for acute type, and its purpose is to reduce a large number of platelet antibodies in a short time.
Second, Chinese medicine treatment;
This disease belongs to the category of "acupuncture" and "blood syndrome" in traditional Chinese medicine. Etiology: excessive heat toxin, qi failing to take blood, and poor blood circulation; It may also be caused by liver excess and spleen deficiency, and liver depression and spleen failing to control blood. Long-term illness will lead to spleen and kidney yang deficiency or liver and kidney yin deficiency. Yangxue Runpi Decoction can not only nourish blood and replenish blood, but also improve the immune function of the body, effectively repair the serious damage caused by long-term use of hormones and chronic illness, thus effectively improving the visceral function and enhancing the immunity of the body.