產後出血、西醫術後之中醫治療病例報告

Post-Operative Treatment of Postpartum Hemorrhage by Integrative Medicine: A Case Report

產後出血是分娩期嚴重併發症，若短時間大量失血可發生失血性休克，嚴重者危急產婦生命。我們報導這位30 歲的產婦，有經行腹瀉及經行疲倦的月經史，曾於2007 年接受一次人工流產。患者預產期為2013 年6 月5 日。2013 年5 月29 日下午，GA39+1，覺腹部規則宮縮， 故至婦產科待產。2013 年5 月30 日產婦因第二產程超過2 小時，接受剖腹手術，手術過程中因為嚴重子宮收縮乏力與子宮血管破裂，發生產後大出血。經宮縮劑、子宮按摩、血管縫合與輸血後，患者生命徵象雖已穩定，然產後疲倦，胸悶，活動則喘，輕微頭暈的貧血症狀仍持續， 因此會診中醫尋求治療。中醫辨證為氣血兩虛、血瘀水飲，治則為補益氣血、活血化瘀兼溫陽利水。新產期處方以官方產後生化湯為主，加重補益氣血的藥；產後期則以聖愈湯加減活血化瘀藥治療。服藥後，疲倦胸悶明顯改善，血色素回升至13.2 g/dL。由此病例我們探討產後血崩中醫病因、病機與治則。並整理現代產後期間的用方（藥）並討論中西藥合治的優勢與安全性。Postpartum hemorrhage (PPH) is a serious complication during labor. Massive blood loss in a short time period may lead to hypovolemic shock, and may even cause death. A 30-year-old female patient, suffering from diarrhea and fatigue during menstruations, presented with anemia and fatigue after delivery. At GA39+1, the patient experienced regular uterine contractions, at which time the patient came to the delivery room, and received a Cesarean Section due to the prolonged duration of her labor (the 2nd stage of labor continued over 2 hours). During the operation, she suffered from massive bleeding caused by severe uterine atony and rupture of the uterine vessels. Vital signs were stabilized after administering uterotonic drugs. The ruptured vessels were sutured and the patient was given a blood transfusion, however the symptoms of anemia, such as fatigue, chest tightness, dyspnea on exertion and dizziness, still persisted. The patient then requested a consultation with the Traditional Chinese Medicine (TCM) physician. The pattern differentiation arrived by the TCM physician was at Qi and blood vacuity, with blood stasis and retention of fluids. The therapeutic principles were to supplement Qi and nourish blood, quicken the blood, dispel stasis and disinhibit water. During the early puerperium stage, we administered the formula Sheng Hua Tang and combined medicinals which supplemented qi and nourished the blood. During the late puerperium stage, we changed the prescription to Shenq Yuh Tang with herbs that transformed stasis. The chest tightness and fatigue subsided after treatment, and hemoglobin levels increased to 13.2 g/dL. In this case report, we discuss the cause, mechanism and principle of treatment of PPH from the TCM perspective. We also reviewed the evidence of the Chinese medicinal therapy during the postpartum period and elucidated on the advantages of the combination of Modern Medicine and TCM.