My daughter is only one and a half years old this year. She has viral encephalitis and has been in hospital for more than ten days. She's still awake! Ask when you will wake up.

At present, there are no specific antiviral drugs for viral encephalitis in clinic, mainly symptomatic treatment and supportive treatment. Most children are not life-threatening after active treatment, but children with serious illness can leave different degrees of sequelae due to brain tissue damage. Children with these sequelae can get satisfactory results through early intervention and nursing and comprehensive training in a planned way. Here is an introduction.

At present, there are no specific antiviral drugs for children with viral encephalitis, mainly symptomatic treatment and supportive therapy. Most of them may be life-threatening after timely treatment, but children with serious illness may have different degrees of sequelae due to brain tissue injury, such as limb paralysis, dyskinesia, muscle spasm and so on. This will affect their future quality of life and social burden. Early intervention of exercise therapy can improve their motor function and reduce their disability [1]. 30 cases of viral encephalitis with motor dysfunction were treated with traditional antiviral drugs and hyperbaric oxygen, and early intervention exercise therapy was carried out, and compared with 30 cases of viral encephalitis treated with traditional conventional drugs.

1 objects and methods?

1. 1 Participants Sixty children with limb motor dysfunction caused by viral encephalitis who were admitted to the undergraduate department from February 2002 to February 2004 were randomly divided into early intervention exercise group and control group, including male 18 and female 12, with an average age of 3.6 years. D, right hemiplegia 14 cases, left hemiplegia 12 cases, quadriplegia 4 cases. There were 30 cases in the control group, including 65438 06 males and 65438 04 females, with an average age of (3.2 4.2) years and a course of 65438 0 ~ 30 years. D, right hemiplegia 12 cases, left hemiplegia 15 cases, quadriplegia 3 cases. There was no significant difference in age, sex, HJ status and course of disease between the two groups. (P & gt0.05),? Comparable. ?

1.2 Methods The control group was treated with conventional traditional therapy, hyperbaric oxygen therapy, acupuncture and medium frequency electrotherapy. The early intervention exercise group was given early intervention exercise therapy on the basis of conventional traditional drug therapy. The specific methods and steps are as follows: 1) Put the limb position on the affected side of hemiplegic spasm, and give gentle limbs, except special joints. Patients with passive joints, first the healthy side and then the affected side, twice a day, 20? Minimum/time. 2) After the child is conscious and his vital signs are stable, go to the functional training room for physical exercise functional training. The methods are: upper limb abduction, elbow extension and arm rotation, wrist extension and finger extension, lower limb adduction and internal rotation, hip flexion and ankle flexion. According to the spastic pattern of upper and lower limbs, sitting, kneeling and standing are used to protect stretching and righting reactions in balance function training. According to the child's growth and development, train the ability to look up, turn over, sit, climb, stand, walk and change positions in turn. And train children to take care of themselves such as eating, dressing, urinating, moving and hand coordination. According to children's psychological characteristics, choose games and children's favorite children's songs to be included in the training, and train twice a day for 30? Minimum/time. At the same time, get the cooperation of parents, encourage and guide parents to participate in the training. ?

2 results?

Comparing the curative effects of limb recovery between the two groups, among the 30 patients in the early intervention exercise group, 6 cases were basically recovered, 65,438+04 cases were markedly effective, 8 cases were effective and 2 cases were ineffective, and the total effective rate was 93.33%. In the control group of 30 cases, 3 cases were basically cured, 8 cases were markedly effective, 7 cases were effective, and 2 cases were ineffective/kloc-0. The total effective rate was 60.00%. (χ? 2=9.844，P=0.020，P & lt0.0 1)。 ?

It is suggested that conventional traditional medicine has a certain effect on limb dysfunction of viral encephalitis in children, but early intervention exercise therapy is more effective. See table 1. ?

Table 1 Comparison between early intervention exercise group and control group (omitted)

Attention:? χ? 2=9.844，P=0.020，P & lt0.0 1。 ?

3 observation and nursing?

3. 1 closely observe the patient's condition, closely observe the vital signs of the child, such as the changes of consciousness, pupils and muscle tension, and deal with the changes of the condition in time, so as not to delay the rescue opportunity, such as unequal pupils, irritability, jet vomiting and elevated blood pressure, suggesting the possibility of increased intracranial pressure or cerebral hernia, suggesting that mental aspects such as drowsiness or confusion turn into coma, suggesting that the condition is aggravated, and immediately report to the doctor. ?

3.2 Keep the respiratory tract unobstructed. Because children with severe viral encephalitis stay in bed for a long time, swallowing reflex is weakened or disappeared, which is easy to form oral and respiratory secretions retention and block the airway, leading to dyspnea, asphyxia and convulsion. In this group of cases, 6 children have a lot of secretions in the mouth and airway. We observe closely, suck sputum at any time, cooperate with atomizing inhalation, knock on the back, knock when the child is lying on his side, the nurse's fingers are together, the back of his hand is raised, and the fingertips are raised. Sensitive, in order to promote sputum discharge. Avoid sputum aspiration within half an hour after meals, so as not to irritate the child's throat and cause vomiting. ?

3.3 Strengthen basic nursing, and give oral care to children who are fasting or have gastric tube indwelling, three times a day. If the eyelids cannot be closed, cover your eyes with gauze and use 0.25% chloramphenicol eye drops. We set up a turn-over card for unconscious or paralyzed children, and turn over every 2 hours and record it. Massage the bony process with safflower alcohol, and use an air cushion on the parts of the body that are easy to be compressed to avoid bedsores. At the same time, keep the limbs in the functional position for limb massage and passive training at an early stage to avoid dysfunction caused by limb deformation, and flush the bladder for children with indwelling catheter to prevent urinary tract infection. ?

3.4 Maintain venous access, because children with viral encephalitis are treated for a long time, and use dehydrating agents regularly to reduce or prevent brain edema and cerebral hernia. In order to avoid repeated venipuncture to increase the pain of children and aggravate convulsions, our department adopts indwelling needle infusion and deep vein catheterization for critically ill children to ensure timely medication. In order to ensure the rapid infusion of mannitol within half an hour, the infusion speed was accurately controlled by infusion pump, and the effect was ideal. ?

3.5 Do a good job in psychological care of children and their families. Children with viral encephalitis, because of their acute illness, can lead to sequelae and death. As family members, they are very nervous, psychologically afraid and worried about the prognosis. In view of this situation, we use warm, cordial and caring nursing services to communicate and cooperate with family members to enhance their confidence in treatment and promote their early recovery. ?

4 discussion?

4. 1 early intervention of exercise therapy can promote the compensation and reconstruction of brain function, and exercise training can promote the germination of nerve fibers in cerebral cortex [2], stimulate the germination and growth of synapses, and increase the number of blood vessels in cerebral cortex. After brain injury, the earlier the rehabilitation treatment, the better. According to reports, it is currently believed that after children's vital signs are stable and neurological symptoms no longer develop, 48? H can start early rehabilitation training. In the acute stage of the disease, the children in this group put their limbs in position, that is, the limbs were properly passive, and early intervention training was carried out after the vital signs were stable. The total effective rate is 93.33%, and the curative effect is obviously better than that of the control group. Therefore, early intervention exercise therapy is an important part of treating motor dysfunction of viral encephalitis. ?

4.2 At present, the early intervention exercise therapy for cerebral palsy hemiplegia, which is recognized and popular in China, is based on the principle of inhibiting abnormal exercise patterns and promoting normal exercise patterns, and is suitable for the rehabilitation of motor disorders caused by viral encephalitis [3]. In general, hemiplegia is the main limb movement disorder in children with viral encephalitis, and some of them are quadriplegia. During the training, while improving the limb function, we should also gradually train the children's overall sports ability such as raising their heads, turning over, crawling, sitting, standing and walking. It is very important to use games and music in children's early rehabilitation training. Games and music can not only avoid boring functional training, but also promote brain rehabilitation after injury and improve children's language and cognitive ability. At the same time, it is far from enough to give parents the importance of participating in rehabilitation, especially when children are forced to use training, they need parents' full cooperation, and technical guidance to guide parents' rehabilitation lays the foundation for future family rehabilitation training. ?

5 conclusion?

Early intervention of exercise therapy can obviously improve the recovery of motor function, reduce muscle tension and improve limb motor ability in children with limb motor disorder caused by viral encephalitis. Early intervention of exercise therapy is better, and the methods can be varied. To adapt to children's psychology, we must combine drugs, acupuncture, hyperbaric oxygen, intermediate frequency electrotherapy and other treatments, which is conducive to children's rehabilitation.

Reference materials?

[1] Huangyan, Fengguang Liu. Rehabilitation treatment of limb motor dysfunction in children with viral encephalitis [J]. Modern Rehabilitation, 200 1, 5 (2): 40-44?

Gao Qian, Wu Zongyao, Yao Zhibin, et al. Effect of exercise training on cholinergic fiber density in cerebral cortex after focal cerebral ischemia in mice [J]. China Clinical Rehabilitation, 2003,7 (16):? 2? 274-? 2? 275?

[3] Li Zhezhi, Feng Jing. Rehabilitation effect of Bobath technique on children with viral encephalitis and hemiplegia [J]. Modern Rehabilitation, 200 1, 5 (1): 86