麻痹性腸阻塞的針刺治療病例報告

A Case Report: Use of Acupuncture in Intestinal Obstruction

一位25歲男性實習醫師被縫合愛滋病病患的針扎到。他在服用預防性的抗病毒藥之後，出現麻痺性腸阻塞的症狀，包括有：排便困難，大便量減少，並且伴隨者有逐漸加重的噁心感、腹脹及腹痛。腹痛的情形是整個腹部皆脹痛，在吃東西後脹痛更嚴重，而在排氣後可以得到緩解。理學檢查發現：腹部是脹大的，敲診是鼓音，腹部有觸痛感，且腸音是減少的，幾乎聽不到。腹部X光檢查則發現腹部積有許多的糞便，並且在左上腹有明顯的腸氣分佈。 在急診室及住院的時候，他有陸續接受置入鼻胃管、服用緩瀉劑以及灌腸的治療，但是症狀並未改善。他也曾自行服用中藥，不過因為他持續有噁心嘔吐的症狀，將藥吐出來，腹脹痛的情形也沒有得到改善。在住院的第四天，會診了針灸科。針刺的穴位是：風池、天樞、中脘、氣海、合谷、足三里、三陰交、上巨虛、下巨虛，並且使用強刺激的手法。針刺當晚即有大量排氣。在持續接受針灸治療後，他的病情就有很明顯的改善。他開始大量的排氣並且大量解便，腹脹痛的症狀也明顯的改善，理學檢查也發現：腹部無脹氣；敲診無鼓音；聽診則腸音接近正常。於是他在住院的第十一天，經主治醫師評估過後出院。

A 25-year-old male intern was punctured by a needle while suturing wounds for an AIDS patient. After taking the preventive antiviral drugs, he started to have symptoms of paralytic ileus, including difficulty in stool passage, decrease of stool amount, nausea, abdominal distension and pain. The pain located throughout the entire abdomen, was worsened after eating and relieved by passing gas. On physical examination, abdominal distension was noted. The abdomen was tender on palpation and tympanic on percussion. There was a significant decrease of bowel sound on auscultation. Abdominal radiograph showed stool impaction and increased intestinal gas accumulation in the RUQ area. After admission, the patient was inserted with a nasogastric tube for decompression, given laxatives and enema. However his symptoms didn’t subside. He also took some Chinese herbal medicine by himself, but he couldn’t swallow any medication due to persistent nausea and vomiting. The abdominal pain and distension were also unimproved. On the 4th day of his hospitalization, acupuncture department were consulted. The acupuncture points used were Fengchi (GB20), Tianshu (ST25), Zhongwan (RN12), Qihai (RN6), Hegu (LI4), Zhusanli (ST36), Sanyinjiao (SP6), Shangjuxu (ST37), and Xiajuxu (ST39), and all points were applied with the strong stimulating technique. After the acupuncture, a large amount of gas was passed out on the very night. In the following days, the patient continued to receive acupuncture and his condition was significantly improved. He started to pass a lot of gas and a large amount of stool. The abdominal pain and distension was also significantly reduced. On physical examination, he no longer had abdominal distension. There was no tympanic sound on percussion and bowel sound was normoactive. His condition continued to improve and he was discharged after 11 days of hospitalization.