運用中西醫結合概念協助一位中風患者之照護經驗

A Nursing Experience by Using the Integration of Chinese and Western Medicine on a Stroke Patient

本篇個案報告描述一位有十年紅斑性狼瘡病史的32歲的音樂教師，因帶領學生參加音樂比賽過度勞累，導致賽後右邊肢體出現偏癱、右嘴角歪斜等現象，經送醫救治，被診斷為梗塞型中風，於2011年7月2日入院治療。2011年8月18日至12月30日，個案除西醫治療外，又尋求中醫診治。筆者於此段護理時間，依據中醫的評估方法四診(望、聞、問、切)收集資料，並依八綱（陰、陽、表、裏、寒、熱、虛、實）及中醫辨證來確立個案的護理問題，發現個案有(1).身體活動功能障礙與神經肌肉障礙有關/中經絡型中風脈絡空虛風邪入中等健康問題(2).失眠/心脾兩虛及焦慮造成(3).便秘/氣虛造成的虛秘。依據評估結果，筆者建議數個穴位，由家屬回家執行穴位按壓以幫助個案改善患肢氣血循環，並依食物屬性給予飲食指導協助調整體質，不僅協助個案改善生理問題，也希望透由此報告分享能引發更多護理人員將中西醫結合概念應用於臨床，以提升照護品質。

The case study in the report describes a 32-year-old music teacher who had had a history of lupus erythematosus for ten years, then suffered a stroke episode while participating in a competitive music contest with her students in 2nd July, 2011. The diagnosis was occluded stroke with hemiplegia of right side extremities and obliqueness of right mouth. From 18th Aug. to 30th Dec. in 2011, the patient was not only being treated by Western Medicine, but also seeking treatment of Traditional Chinese Medicine (TCM). During the treatment period, the author collected the data by using the four Chinese Medicine diagnostic methods: observing, smelling/listening, asking, and palpating. The author identified the nursing problems of the patient by using the differentiation of eight principles and other differentiation of syndromes in TCM. These eight principles include Ying and Yang, exterior and interior, cold and hot, virtual and real. The case study found the patient had the following health problems: (1) Neuromuscular malfunctions due to meridian stroke; (2) Insomnia due to weakness of spleen and heart meridians and anxiety; and (3) Constipation due to weak physique. Based on the diagnostic results, the author suggested the family (1) perform massage on the patient's specific acupressure points at home to improve blood and Qi circulation；(2) become educated about the foods required for the patient's specific body constitution. Through the case report, we hope the integration of Western Medicine and TCM may be suggested to patients to elevate their quality of life in the future.