創傷性腦損傷術後意識障礙的針刺療法－－病例報告

Acupuncture Therapy for Treating Consciousness Disorder in Post-operative Patients with Traumatic Brain Injury: A Case Report

根據2009 年衛生署統計，事故傷害是臺灣十大死因的第六位，其中創傷性腦損傷佔所有外傷的12.5%，並導致55%的患者死亡。隨著神經重症醫學的發展，許多病情危重的腦外傷患者得以存活。不幸的是病人雖然活下來，卻是在無意識的存在和永久的殘疾之中。一位72 歲的男性發生車禍，造成雙側額葉及右枕葉重度腦挫傷、創傷性顱內出血、及左脛骨和腓骨開放性骨折等多重傷害。由於他的病情危重且昏迷指數（Glasgow coma scale, GCS）為E1VeM2，故接受急救及減壓性顱骨切除術（Decompressive craniectomy）。術後患者仍昏迷伴隨左側偏癱，GCS為E4V1M4。術後核磁共振造影發現雙側額葉、左枕葉及右顳- 頂- 枕葉有腦血腫且週圍伴隨腦水腫。在GCS 9 分的情況下會診中醫並開始針刺治療。我們使用水溝和十二井穴針刺治療其意識 障礙，每週3 次。經過5 次針刺治療，病人可以正確應答，GCS進步至15 分，其左側肌力也有所改善。總之，一位有經驗的醫師可以運用針刺促進腦外傷患者手術後的意識恢復。In Taiwan, traumatic brain injury (TBI) accounts for 12.5% of all traumatic injuries and leads to death in 55% of the cases. The lives of many critical TBI patients have been saved because of developments in the field of neurointensive care medicine. However, an unfortunate outcome of this disease is that patients experience loss of consciousness and permanent disability. A 72-year-old male farmer was involved in an automobile accident that caused him severe TBI with brain contusion in the bilateral frontal and right occipital lobes, traumatic intracranial hemorrhage, facial bone fracture, and left tibial and fibula open fracture. His Glasgow Coma Scale (GCS) score was E1VeM2, which indicated that he was in a critical condition; hence, he received emergency medical treatment and underwent decompressive craniectomy. Even after the operation, he did not retain consciousness; his GCS score was E4V1M4, and he experienced left hemiplegia. Brain magnetic resonance imaging (MRI) showed multiple hematomas with perifocal edema in the bilateral frontal, left occipital and right temporoparieto- occipital regions. When his GCS score was still 9 two weeks later, he underwent counseling and subsequently received acupuncture treatment. Three times a week, we treated the patient by strong stimulation at GV26 (Shuigou) and the twelve Well points by using the half needling technique. After 5 acupuncture treatments, the patient could respond verbally, and his GCS score improved to E4V5M6; the muscle power of the left extremities also improved. Therefore, we believe that an experienced physician can use acupuncture for treating consciousness disorder in postoperative TBI patients.