| 中文摘要 |
這是位十八歲男性患者，於2007/05/24被汽車撞擊，意識昏迷，經送至就近醫院緊急給予急救，腦部電腦斷層顯示為顱內出血伴隨腦室出血。由於狀況不樂觀，在患者家屬的堅持下，轉送本院急診進一步救治，並於2007/05/24實施顱骨切開術移除血腫（craniotomy with removalof hematoma）後轉送加護病房觀察。在加護病房期間由於持續高燒約39oC，給予抗生素治療和冰袋降溫，但體溫仍維持在38~39oC。於是在2007/6/21會診中醫，會診時患者呈現昏迷，下巴痤瘡色暗紅，唇乾，身熱汗出；痰黃黏量平；肢體僵硬，有力，雙側上肢屈曲，下肢強直；大便祕結；中醫診斷為氣滯血瘀，痰熱擾心，處以蒿芩清膽湯加減以清熱養陰，理氣化瘀，化痰降濁。經中醫治療後體溫逐漸下降至37oC，且意識逐漸恢復，並後續轉院復健治療。此病患經中醫四診及詳細辨證論治方式，施以方藥，結果整體症狀持續改善，發熱獲得控制，並且意識狀態進步，堪為中西醫結合治療顱腦損傷發熱的一有效臨床案例。This case is an eighteen year old male student, who had suffered from car accident on May 5, 2007. Due to the comatose consciousness, he was received CPR and sent to nearby hospital. The brain CT showed intracranial hemorrhage with intraventricular hemorrhage. Then he was transferred to our hospital for advanced treatment. The brain hemorrhage progressed and he received craniotomy with removal of hematoma on May 24, 2007. He was sent to ICU and high fever was noted. Even the antibiotics were used, but the temperature was still over 39 oC. He was consulted with traditional Chinese medicine treatment on June 21, 2007. The patient presented comatose, skin rash under jaw, dry mouth, and high temperature with sweating. The sputum showed yellowish and sticky and physical examination revealed bilateral arm flexation, and lower leg extention. The stool constipation was treated by ducolax. Under the impression of blood stasis due to qi stagnation and internal harassment of phlegm-heat, the modified formular of “huang qin qing dan tang” was given to nourish yin, clear heat, regulate qi, resolve stasis, resolve phlegm, and downbearing the turbid. After combining care with Chinese medicine, the fever was controlled, and patient’s consciousness improved. The case indicated that the cooperation of Chinese medicine and Western medicine would be a promising treatment modality for central fever after brain damage. |
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