中西合併治療輸血後急性肺損傷──病例報告並文獻探討

Integrated Chinese and Western Medicine Treatment for Transfusion Related Acute Lung Injury- A Case Report and Literature Reviews

輸血相關之急性肺損傷（Transfusion Related Acute Lung Injury, TRALI），指 的是輸血後因肺部過敏反應，造成呼吸喘促、低血氧之現象。目前西醫的標準治 療是給予支持性治療。本病例為一位 48 歲患有乳癌且有骨轉移之女性，因化療後 造成其正常血球性貧血與血小板低下，並有喘促，欲改善上述症狀而會診中醫。 在會診過程中，西醫給予輸注血小板後，病人喘促插管治療且肺部 X 光顯示為雙 側肺水腫，診斷為 TRALI|中醫則診斷為肺脾腎不足、陽虛水泛，配合給予真武 湯加減治療，在中西合併治療六日後病人成功移除氣管內管。回顧相關文獻，治 療輸血後反應之文獻為數不多，藉此個案分享進行分析討論，以探討中醫治療急 性輸血後肺損傷之治療思路。

Transfusion Related Acute Lung Injury (TRALI) is defined as the onset of respiratory distress which caused by allergic reaction of lung after blood transfusion. Until now, the standard treatment of TRALI is supportive care including mechanical ventilation and additional oxygen. A 48-year-old female with a history of breast cancer with bone metastasis, she suffered from normocytic anemia, thrombocytopenia and dyspnea after receiving chemotherapy. To relieve her dyspnea, the patient consulted Chinese medicine department. Meanwhile, platelet transfusion was given and the patient complained severe dyspnea and was intubated afterwards. The diagnosis was TRALI due to the chest x-ray that revealed bilateral lung edema. The Chinese medicine diagnosis was deficiencies of the lungs, spleen and kidneys as well as edema due to yang insufficiency| therefore, Zhenwu variant Decoction were prescribed. After 6 days of integrated treatment, the patient was successfully extubated. There are limited literatures concerning Chinese medicine treatment for TRALI| this case report can be a reference for clinical practices and research.