不要任由下肢肿胀肆意发展

菡萏尘雾 · 发表于 2011-9-29 16:14:49

本帖最后由菡萏尘雾于 2011-9-29 16:21 编辑

As a former nurse, Diane Huberty knows the dangers of leg swelling. Leftuntreated, it can become a vicious cycle of swelling, leading to vein and valvedamage, leading to more swelling.

作为一名前护士，Diane Huberty知道腿部肿胀的危险性。如果不进行治疗，肿胀会陷入恶性循环，导致静脉和静脉瓣膜损害，引起更严重的肿胀。

But as a person who’s lived withALS for almost 20 years, Huberty also had to learn about leg swelling the hardway.

但作为一名将近20年的ALS患者，Huberty也不得不认识到：腿部肿胀是难以消除的。

"My legs are ghastly,"writes Huberty of Fort Wayne, Ind., in an articleabout leg swelling on her Web site, Nursing Tips for Living with ALS.

“我的腿太可怕了”，Huberty在她的个人网站“ALS护理小技巧”上写到。

"They look fine when I amlying down, but the minute I sit up they turn hideous shades of red and purpleand blue and gray," she writes. "If I am not careful to prevent asmuch swelling as I can, they are swollen like sausages by noon and miserablyuncomfortable, and absolutely painful by evening."

“我躺下的时候，双腿看起来挺好的，但当我一坐直，它们就会出现一块块可怕的红色、紫色、蓝色和灰色阴影。”她写道，“如果我不是小心翼翼地尽量防止肿胀发生，双腿在中午的时候就会肿的像香肠一样，非常难受，而且绝对会一直疼到晚上。”

Leg swelling, a possible sideeffect of ALS inactivity, can range from minor discomfort to outright pain and,as Huberty describes, it can get worse if you don’t deal with it.

腿部肿胀是ALS病人无法活动而出现的副作用，它可能引起一些轻微的不舒服和明显的疼痛。如果不加以处理，肿胀会变的越来越严重。

What causes leg swelling?

什么导致的腿部肿胀？

Unfortunately, there’s no "upelevator" in the circulatory system. Blood returning from the feet to theheart has to be pushed and squeezed along like a packet of catsup.

不幸的是，人体循环系统中，没有“向上的电梯”。血液从足部回流心脏的过程是被动进行的，就像挤压一包番茄酱一样。

Walking helps this process becausemuscle contractions compress the veins and force blood up against gravity. Aseries of one-way valves along the way keeps blood from draining back down.

行走（活动）可以帮助这一回流过程，因为肌肉收缩可以压缩血管从而帮助血液对抗重力回流。血管内有一系列单向开放的瓣膜，可以防止向上回流的血液倒流。

When walking ceases, it’s harder toget blood back up from the feet. Constant sitting also constricts blood flow byputting pressure on the veins.

当行走（活动）停止时，血液从足部的回流更加困难。持续的静坐也会给血管施加压力，压缩血液的流动。

As blood pools, theveins expand and water seeps out into the surrounding tissues, causingswelling, or edema. When this happens repeatedly, veins become leaky and waterseeps out more easily, causing faster swelling. Meanwhile, the valves bearingthe weight of the pooled blood can fail, allowing blood to drain back down.Such valve damage is permanent, leading to more circulatory problems.

如果血液回流不畅，形成堆积，静脉血管就会扩张，水分会渗透到周围的组织中，造成肿胀或者水肿。当这种情况反复出现时，静脉血管会变的脆弱，水分更容易流失渗透，导致更严重的肿胀。同时，如果血液堆积较多，瓣膜就会失去功能，允许血液倒流。瓣膜的这种损害是永久性的，会引起更多循环方面的问题。

循环不畅.jpg

It’s dangerous

这是有危险的

Besides the unsightly swelling,edema can cause a painful burning sensation. Feet and legs can become sensitiveto hot and cold temperatures, and as circulation gets worse, the skin of thelegs and feet can become fragile and damaged.

除了难看的肿胀，水肿还会造成痛苦的灼热感。脚和腿会变的对冷热温度变化敏感。随着循环的进一步变差，腿部和足部的皮肤会被损害变脆。

But the most dangerous side effectof leg swelling is the increased risk of developing a deep venous thrombosis orblood clot that can travel to the lungs (pulmonary embolism). (See "WarningSigns" below.)

然而，腿部肿胀最危险的副作用是会增加深静脉血栓或血凝块形成的风险，这些血栓和凝块有可能移动到肺部（造成肺血管阻塞）。（参看下面的“警示信号”）

Edema treatment

水肿的治疗

"Prevention and treatment arethe same," says Kathy Peters, MDA’s ALS HealthCare Services Coordinator in Shawnee Mission, Kan. "Elevate, elevate,elevate."

“预防与治疗的手段是相同的” Kathy Peters（MDA的ALS健康中心护理服务协调员）说，“抬高、抬高、再抬高！”

Raising your feet so they’re on thesame level as or higher than your heart lets gravity do the work of movingblood. A tilt-in-space wheelchair and hospital bed "are probably the mostcomfortable and efficient for this," Peterssays.

抬高脚部，使它们与心脏在同一高度或者高于心脏，这样可以借助重力作用帮助血液回流。可倾斜的轮椅或者是护理床“很可能是最舒服和有效的” Peters说。

Many people with ALS use anordinary reclining armchair to put up their feet. Huberty warns that this canactually lead to more swelling. The recliner’s footrest section is designed sothat most of your leg weight rests on your calves, which can constrict the veryveins you’re trying to help.

很多ALS病人使用普通的靠背椅来抬高脚部。Huberty警告说：这实际上会导致更严重的肿胀。相对而言，躺椅会比较合适，它的脚凳部分设计合理，可以使大部分腿部重量由小腿承担，这样有助于压缩腿部静脉。

Second, putting up your feetwithout "unfolding" at the hips can further impede circulation."If you spend most of your time in a recliner, I strongly recommend thatyou bring the footrest up only when you lower thebackrest," she advises.

另外，把脚蜷在臀部而不是伸展开来会进一步妨碍循环。“如果你的大部分时间是在躺椅上度过的，我强烈建议：不要把脚蜷缩起来，除非你放低躺椅的靠背（躺着）”她建议道。

A diuretic, commonly prescribed toreduce swelling due to fluid retention, is "absolutely not indicated"for people with ALS, says Joan Wilson Appel, physician assistant and clinicalresearch coordinator at the Ronny and Linda Finger MDA/ALSCenter at Baylor Collegeof Medicine in Houston.

一般认为利尿剂可以减少因体液潴留引起的肿胀，但这“绝对不表示”适用于ALS病人，Joan Wilson Appel（休斯顿贝勒医学院Ronny and Linda Finger MDA/ALS中心助理医师和临床研究协调员）说。

The problem isn’t one thatdiuretics will solve, and ALS patients already have trouble keeping wellhydrated, she says.

紧紧靠利尿剂是无法解决问题的，而且ALS病人在保持水分方面已经遇到了问题，她说。

Similarly, a low-salt diet won’thelp swelling that’s due to inactivity, although it’s beneficial for peoplewith hypertension or congestive heart failure.

同样的，低盐饮食虽然对高血压或充血性心力衰竭病人有好处，但无法减轻因无法活动而导致的肿胀。

Blood clot warning signs

血凝块的警示信号

Watch for the signs of a clot in your legs, says Joan Wilson Appel.

Initial symptoms of a clot in the legs include:

要注意腿部出现血凝块的信号，Joan Wilson Appel说，最初的症状包括：

one leg that’s more swollen than the other
一条腿比另一条肿胀的更厉害
swelling that doesn’t go down overnight
肿胀过夜都不消去
pain upon standing or stretching calf muscles
站立或者伸直小腿肌肉时发生疼痛
redness
发红
heat
发热
discomfort
不舒服
any combination of these
上述症状的任意组合

If you suspect a blood clot, don’t massage the area. Contact a doctor immediately for an evaluation, Appel urges, noting "pulmonary emboli are extremely dangerous and not uncommonly result in death."

如果怀疑存在血凝块，不要按摩、揉捏那个部位。立即联系医生诊断和评估严重程度。Appel警告说：“肺部栓塞是相当危险的，致死也并非十分罕见。”

Symptoms of a clot that’s traveled to the lungs include sudden-onset chest pain and shortness of breath.

血凝块转移至肺部的症状包括：突发性胸部疼痛，呼吸短促。

Preventing swelling

预防肿胀

Movement helps prevent swelling —even passive range-of-motion and stretching exercises performed by a caregiverseveral times a day.

活动有助于防止肿胀——即使仅仅是是护理人员帮助进行的一定范围内的被动活动和伸缩练习，一天几次，也是有好处的。

"Make it part of each andevery day, just like hygiene," Appel suggests. Similarly, a gentle footmassage improves circulation and reduces swelling, Peterssays.

“让活动成为每日生活的一部分，就像是一种保健” Appel建议。同样的道理，柔和的足部按摩也可以改善循环，减少肿胀，Peters说。

Frequent repositioning in awheelchair or recliner is important to keeping blood in the veins flowingfreely and helps prevent blood clots as well. When sitting upright, make sureyour legs don’t dangle, Huberty adds. Rest your feeton a low box or footstool to take pressure off the backs of your thighs.

在轮椅或者躺椅上频繁改变姿势是重要的，这样可以保证血液在静脉血管中自由流动，有助于预防血凝块的产生。端坐的时候，确保腿不要悬空，Huberty补充道。把脚放在低盒子或者脚凳上，从而减轻大腿后部的压力。

Compression stockings that bind thecalves and feet tightly, and medical devices that inflate/deflate to squeezelegs and feet, are other ways to keep blood moving along.

弹性较好，有压缩力的丝袜可以紧紧地束缚小腿和脚。可充/放气的医疗设备也可以给腿和脚部施加压力。这是保证血液流动的其他方法。

Huberty has found that spendinga longer stretch of time in bed helped her leg swelling immensely. When herhusband’s schedule changed so that she could spend 10 unbroken hours in bed atnight — as opposed to seven hours in bed and three hours in a recliner later inthe day — her swelling began later in the day and was less intense.

Huberty发现躺在床上时间更长的话，腿部肿胀可以很大的改善。当丈夫的时间安排改变，她晚上可以在床上躺10个小时——而不是之前的7个小时在床上，3个小时在躺椅上——她的肿胀在一天中出现的时间更晚，也轻微一些。

"Now I don’t have to lie downin the afternoon in order to be comfortable in the evening," she says.

“现在我不用像以前一样不得不在午后就躺下从而使晚上好受一些”她说。

Treatment for leg swelling in ALS

ALS腿部肿胀的治疗办法

Elevate your feet higher than the heart. Lower the backrest of your recliner when raising the footrest.
抬高腿部（高于心脏）。提高脚凳的时候，降低躺椅的靠背。
Move your legs. Even passive range-of-motion and stretching will help.
活动腿部，即使是被动的在一定范围内活动和伸展也是有好处的。
Change your position frequently.
频繁改变身体姿态
Use compression stockings.
穿着紧绷有压迫力的丝袜
Don’t count on diuretics or a low-salt diet. These won’t reduce the edema caused by inactivity.
利尿剂或者低盐食物的作用有限，并不能减少因为静止不动造成的水肿。
Call your doctor immediately if you suspect a blood clot.
如果怀疑有血凝块，立即就医！