| 中文摘要 |
這位85 歲病人有高血壓、糖尿病與冠狀動脈疾病（one vessel disease）的過去病史，因98/9/4 跌倒發生延遲性顱內出血（delayed ICH）施行緊急鑽孔開顱術（Emergent burr hole craniotomy）。而後因為發生肺部感染，導致出現呼吸困難，脈搏變快115/ 分，兩側肺下葉出現有濕囉音，昏迷指數（GCS score）下降E3V3M6，嗜睡狀，下肢肌力降到2-3 分，氧氣飽和度只有91.6%、心肌性肌酸磷激脢（CK-MB）和心肌旋轉蛋白（Troponin-I）正常，胸部的X 光片顯示雙下肺葉感染，心臟肥大，肺動脈怒張和肺部有積水等現象，白血球數量和發炎指標CRP分別為11800 和167，肝功能指數AST 和ALT 分別上升至1211 和676，發生急性肝炎。此外術後雙手出現不自主的顫抖，疑似癲癇發作。此病例於10/11 開始會診中醫針灸科治療，經過中醫四診的總合後，辨證為心陽不足，腎陽虛衰，瘀阻絡脈，肺失宣肅，陰液不足，虛風內動，治則為醒腦開竅、補益心腎陽氣、活血化瘀、兼宣降肺氣及濡養陰液以平肝息風。故中醫治療的部份採取針灸及肉桂穴位貼敷湧泉的方試，在中西合併治療約20 日後，病人的心跳節律、呼吸型態、血壓、血糖的控制逐漸恢復正常，尿液的排出量亦增加，惟意識狀態未能完全恢復，推測與病人先前反復的感染、高血糖、及血塊壓迫缺氧等原因造成大腦皮質受損，但西醫的處置合併針灸及穴位貼敷對其心衰、感染和血糖的情況確有一定的助益。故針灸、穴位貼敷可能為改善及穩定急性心臟衰竭西醫治療的輔助性療法。A 85-year-old woman experienced chronic heart disease in acute stage after brain injury status post emergent burr hole craniotomy. Due to combined with pneumonia, the patient suffered from unconsciousness and dyspnea. Besides, oliguria, hypertension, abnormal of liver function and tremor of hand are also noted. The chest X-ray revealed Cardiomegaly, widening of ascending aorta & rounding of left heart border compatible with HCVD. Owing to aggravation of clinical progress, the consultation of Chinese acupuncture was made for further investigation. Based on the Chinese medical differential diagnosis, we confirmed that she had deficiency of heart-yang, deficiency of kidney-yang, stasis of blood, impaired diffusion and depurative descending of lung qi, insufficiency of yin-fluid and liver wind stirring. Therefore, western drug combined with acupuncture and cinnamon point-patch on Yongquan (KI 1) treatment was given. After twenty days, the respiratory pattern and heart function improved. And blood pressure, urine output, and blood sugar are also stabilized. Therefore, acupuncture and cinnamon point-patch might be the complementary therapy of chronic heart disease in acute stage. |
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