Disuse syndrome

Introduction A long-term bed rest (or long-term bed rest, bedridden) refers to a clinical phenomenon in which the elderly suffer from diminished daily life due to long-term illness and disability, and some or all of them need help, including long-term bed rest, sitting chairs and Old people who can only live indoors can not go out. Long-term bed rest can cause various complications and worsen the condition. Due to a series of clinical manifestations caused by prolonged bed rest and braking, known as disuse syndrome or hypokinesia syndrome, it is difficult for the elderly to get rid of this state once they enter this state. The consequences of staying in bed for a long time are serious. Once it happens, the hope of rehabilitation is small, and it should be focused on prevention.

Cause

Cerebrovascular disease

Cerebrovascular disease is the leading cause of prolonged illness in the elderly (more than 50%) 1 severe stroke: the elderly with severe cerebrovascular accident after the acute phase of treatment, although saved lives, but left the symptoms of neurological deficits Physical activity, including loss of recognition, loss of function, ataxia caused by deep sensory disturbances, bilateral hernia or severe flaccid paralysis. This situation often has no hope of improvement or almost no improvement, thus allowing the patient to stay in bed for a long time. 2 stroke combined with other diseases: some patients with cerebral thrombosis, especially elderly patients, although left behind, but on the basis of acute myocardial infarction, or lower extremity amputation to make the disease worse, resulting in long-term bed rest, this situation is called compound Sexual disability.

2. Bone and joint diseases

The following diseases can cause long illness in bed. 1 Fracture: Fracture is also one of the main reasons for the elderly to stay in bed for a long time (20%). In the bedridden elderly, the femoral neck fracture caused by the fall is the most, followed by the fracture of the femur and tibia, the spine and the tibia. After the fracture, the plaster is fixed, and the bed rest is easy to cause the muscle or bone atrophy to cause the joint contracture or rigidity. The patient is bedridden. 2 osteoarthrosis: rheumatoid arthritis, gouty arthritis, diabetes, osteoarthrosis, etc., to the late stage, causing joint deformation, rigidity, and restricting patient activity further leads to bedridden.

3. Senior age

Nearly half of the elderly with longevity can not take care of themselves due to the effects of various diseases such as disability and aging. Therefore, prolonged life expectancy and increased proportion of sickness are one of the common causes of prolonged bed rest. Due to aging, older people can cause bed-ridden even if they have a cold, and cause a series of chain reactions to develop into bedridden in the short term.

4. Other

Other diseases are: 1 senile dementia and severe psychosis: senile dementia and severe mental illness patients often suffer from long-term bed rest due to decreased self-care ability or unattended care. 2 progressive disease: some diseases may be effective in the early treatment and rehabilitation, but due to the progressive development of the disease, the disease gradually worsens, and finally lead to long-term bed rest such as spinal side sclerosis and cerebellar atrophy. 3 Post-fall syndrome: As a result of decreased activity after falls, joint stiffness and physical weakness, further reducing the range of activities, and ultimately bedridden. 4 misuse syndrome: due to improper treatment or rehabilitation, such as medication or surgical errors do not meet the neurophysiological hemiplegia rehabilitation training, massage techniques, etc., can lead to long illness in bed. 5 advanced tumor and organ failure: elderly patients are bedridden due to pain, dysfunction and systemic failure caused by advanced tumors and advanced organ failure caused by chronic diseases.

an examination

Related inspection

Autonomic nerve function test

(1) The nervous system:

1 Sensory changes: Elderly people who are bedridden for a long time are often accompanied by paresthesia and a decrease in pain threshold. When paralyzed patients involve sensory afferent nerve fibers, they quickly show a loss of sensation or sensation below the level of injury.

2 motor function decline: long-term bedridden patients all exercise is lower than those who perform sedentary activities every day. This situation is more obvious in people with restricted exercise caused by flaccid paralysis.

3 autonomic nervous system instability: elderly patients with long-term bed rest, excessive autonomic activity or insufficient activity, it is difficult to maintain the balance of autonomic activity, so patients can not adapt to daily changes such as posture changes, autonomic nervous system instability and cardiovascular system Certain influence.

(2) Muscle system:

The most obvious signs of prolonged bed rest occur in patients with muscle system paralysis.

1 muscle strength, endurance loss: after 1 week in bed, muscle strength can be lost 20%, after each bed for 1 week will reduce the remaining muscle strength by 20%; in the absence of any motor nerve damage, if the dominant side grip force is 50kg, Only 40kg after 1 week of braking, 25kg after 3 weeks and 32kg after 3 weeks, and so on. The rate of muscle strength recovery is much slower. It is calculated by the person who participates in the exercise program with maximum muscle strength every day, and only increases the original muscle strength by 10% per week. Loss of endurance is the result of decreased muscle strength, and its rate of occurrence is consistent with decreased muscle strength.

2 Disuse muscle atrophy: muscle volume reduction is one of the most obvious signs of long-term bed rest, and it is also the cause of muscle strength loss. In patients with flaccid paralysis, the action potential of the lower motor unit disappears, and the muscle fiber that it occupies loses its contractile ability, and muscle atrophy gradually occurs. A patient with spastic paralysis caused by impaired upper motor neurons or a patient with splint fixation. Muscle atrophy can be only 30% to 35% of normal volume.

3 poor coordination and muscle contracture: muscle atrophy, muscle weakness and limited endurance caused by poor coordination of movement, manifested in the upper and lower limbs seriously affect the ability of patients to complete activities of daily living. The main cause of disharmony in patients with central nervous system damage is affecting the movement of the motor unit or higher-level center, but the bed itself also plays a role. Muscle atrophy, often accompanied by muscle contracture, is more common in knee flexors and extensors, which pose serious obstacles to standing and walking.

(3) Skeletal system:

1 Osteoporosis and ectopic calcification: Osteoporosis is caused by decreased muscle activity and hydroxyproline and calcium excretion after bed rest, resulting in osteoporosis, so elderly people in bed are more prone to fracture than their peers. The transfer of bone calcium causes transient or persistent hypercalcemia, often accompanied by calcium deposits in damaged soft tissue, which is called ectopic calcification.

2 joint fibrosis and joint rigidity: these two kinds of damage are also the main manifestations of prolonged bed rest. Because of the reduction of joint movement in the bed, the muscles around the joints are gradually replaced by connective tissue and the ectopic calcification of the soft tissues around the joints. The joints become stiff and cannot perform a full range of activities, causing irreversible deformities, causing permanent rigidity of the joints. Causes deformed arthritis and inflammation around the joints.

3 low back pain: prolonged bed rest caused by back muscle contracture, lumbar lordosis increased pelvic forward tilt, easily cause back pain.

(4) Cardiovascular system:

1 Heart rate increases: In the elderly who are in bed for a long time, the sympathetic tension exceeds the vagus nerve and the basal heart rate increases.

2 reduction of cardiac reserve: the myocardial contractility of the elderly decreased, the cardiac output decreased, and the heart rate increased after long-term bed rest, the diastolic filling time shortened the end-diastolic volume, and the cardiac function storage was further reduced than before bed, so the patient can only be limited. Physical activity, because excessive exertion may cause significant tachycardia and angina, can also be said to be a manifestation of potential cardiac insufficiency.

3 Orthostatic hypotension: This is one of the most common symptoms of cardiovascular system discomfort after prolonged bed rest. The elderly who stayed in bed for a long time had obvious reduction of venous venous return in both lower limbs when standing up and sitting up, which prevented the diastolic ventricular filling ventricular stroke volume from decreasing, thus significantly lowering the standing blood pressure.

4 edema: limb movement can promote venous return, limbs that cannot be moved due to disuse can easily lead to venous stasis, which increases the hydrostatic pressure of capillaries, and edema occurs when liquid penetrates into the interstitial space. If the edema lasts for a long time, fibrinogen in the plasma penetrates into the blood vessels to form fibrin, which is easy to cause contracture. The contraction can increase the degree of disuse, resulting in a vicious circle.

5 venous thrombosis: long-term bed rest, the pump function of the epiphyseal muscle is significantly reduced or disappeared, the venous blood stasis of the lower extremities, coupled with the elderly often in a hypercoagulable state can easily cause venous thrombosis.

(5) Respiratory system:

1 Reduced vital capacity and large volume of ventilation: When the elderly in bed are maximally inhaling or exhaling vigorously, the intercostal muscles, diaphragm and abdominal muscles rarely contract, and the muscles of the respiratory muscles are weakened, and the costal joints and costal cartilage joints cannot withstand. The full range of activities resulted in a significant reduction in lung capacity, effective breathing and maximum ventilation.

2 hypoxia: the above-mentioned restrictive damage and horizontal posture (bed) on the pulmonary circulation, the ventilation / blood flow ratio was significantly reduced. For example, elderly people in bed can have hypoventilation and excessive blood flow in the lower part of the lungs, causing significant arteriovenous short circuit to reduce arterial oxygen tension and lead to hypoxia. If the patient increases metabolism due to infection or exercise, hypoxia is more pronounced.

3 septic pneumonia: bed rest makes the cilia clearance function of the respiratory tract clear, the secretion of mucus in the respiratory tract is easy to accumulate in the lower bronchus, and the respiratory movement is limited and the cough reflex is weakened. It is easy to cause bacteria and viruses to multiply in the lung and cause pneumonia. . The elderly suffer from chronic malnutrition resistance or improper feeding, which causes food to enter the airway and is more likely to induce lung infection.

(6) Digestive system:

The gastrointestinal activity of the elderly in bed is completely reduced, which not only affects the peristaltic performance, but also affects the secretion function of the digestive gland.

1 loss of appetite: inactive elderly need to reduce calorie, bed-induced anxiety - depression, can cause significant loss of appetite, and ultimately lead to malnutrition.

2 constipation: long-term bedridden elderly due to increased sympathetic tone, decreased gastrointestinal motility, increased intestinal absorption of water, liquid and fiber intake is too small, prone to constipation. Constipation for a long time can cause obstruction of the stool or even intestinal obstruction.

(7) Endocrine and urinary systems:

1 polyuria: mainly occurs in the early stage of bed rest, because the body is in the horizontal position, part of the extracellular fluid is transferred to the venous side of the microvascular bed to increase venous return, and excitatory right atrial volume receptor reflex inhibits the secretion of vasopressin. Causes polyuria.

2 Increased urinary sodium excretion: This is a temporary phenomenon that occurs with the initial polyuria.

3 excessive urinary calcium: prolonged bed rest caused by osteoporosis, bone calcium continuously into the blood and finally increased urinary calcium excretion.

4 kidney stones and urinary tract infections: due to urinary calcium significantly excessive bladder function damage and placement of the urethra, prone to urinary tract infection. Excessive urinary calcium, urinary retention, and urinary tract infections can cause stones in the renal pelvis or lower urinary tract. Repeated urinary tract infections and stones can gradually damage kidney function.

(8) Skin system:

1 Skin atrophy: Subcutaneous fat is reduced due to loss of appetite and malnutrition, skin aging leads to thinning of the skin and degeneration of elastic fibers, resulting in loss of skin fullness.

2 acne: This is a common clinical manifestation of long-term bed rest, more common in the humerus, ischial tuberosity and external hemorrhoids. This is not only a circulatory disorder caused by simple mechanical compression, but also related to local moisturization and pollution caused by malnutrition manure and urine.

Differential diagnosis

Clinical needs are differentiated from sputum, muscle weakness and hereditary diseases.

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