| 中文摘要 |
台中縣一名一歲九個月小女孩，於2001 年12 月2 日起出現39° C 以下的發熱，輕微咳嗽等症狀，經診所診斷為手足口症，其後出現飯後嘔吐、嗜睡的情形，兩日後發生抽搐、臉色蒼白、呼吸困難、嘴唇青紫、四肢無力，有明顯肌躍式抽搐，轉至長庚醫院林口兒童分院，診斷為腸病毒重症併發肺出血。胸腔X 光檢查顯示兩側蝴蝶樣浸潤，經氣管插管處理後，住進小兒加護病房。心臟超音波檢查左心室射血比率（Ejection fraction）明顯降低，符合心臟衰竭。脊椎穿刺顯示無菌性腦炎，核磁共振顯示腦幹頸椎部位發炎，患者隨即接受靜脈注射免疫球蛋白及加護治療，生命徵象暫時穩定，但意識不清，四肢無力，手指蠕動，低熱仍見。三週後開始會診中醫聯合治療，患者於12 月24 日起持續合併服用中藥，第一階段以芳香化濁開竅醒神為主，酌加清熱利濕；第二階段以健脾益氣燥濕，辛溫宣肺開竅為主。病患於一週左右意識恢復清醒，二週之內四肢肌肉力量恢復正常。呼吸雖有進步，但仍須依賴呼吸器。與本院以往2 年加護病房治療腸病毒重症24 例病患相較，本例中西醫聯合治療腸病毒重症之療效甚為明顯，可為臨床參考。A one year and nine months old girl suffered from fever (up to 39°C), mild cough, postprandial vomiting and drowsiness. The case was diagnosed as hand-foot-mouth disease by a physician. Seizure, pallor, dyspnea, cyanosis, weakness and myoclonus were noted 2 days later, the patient was therefore transferred to Chang Gung Children’s Hospital, where she was intubated and admitted under the suspicion of having the life threatening enterovirus seventy one infection (EV 71) complicated with pulmonary hemorrhage. A chest X-ray revealed bilateral butterfly infiltration. A cardiac sonography report indicated decreased ejection fraction, compatible with congestive heart failure. The results of cerebrospinal fluid analysis suggested the presence of aseptic meningitis. Magnetic resonance image showed evidence of inflammation at the brain stem and cervical cord. After receiving intravenous immunoglobulin and other management at intensive care unit (ICU), the patient’s vital sign stabilized, although low grade fever, weakness, involuntary movements and deteriorated consciousness remained. Consultation with the department of Traditional Chinese Medicine (TCM) began 3 weeks after onset and the patient started receiving a two stage protocol of herbal medicine in addition to routine ICU care. The first stage of TCM treatment aimed to “resolve dampness, clear the heart and open the orifices with aromatic medicinals”, the second stage aimed “to fortify the spleen and dry dampness, and to diffuse the lung and open the orifices”. After 1 week of the above treatment, although remaining respirator dependent temporarily, the patient recovered significantly in both consciousness and motor status. A retrograde analysis of the past 2 years of medical records at Chang Gung Children’s Hospital revealed a total of 24 enterovirus critical cases. Such remarkable case is a good example for combined therapy of TCM and Western Medicine. |
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