雷射針灸合併中藥治療敗血症併發慢性腎損傷合併急性腎損傷病例報告

Laser Acupuncture Integrated with Chinese Herbal Medicine Treatment For Sepsis Combined with Acute-on-chronic Kidney Injury - A Case Report

本病例為一86歲女性，發燒數天後由某地區醫院被轉送至高雄某醫學中心之急診，經處理後發燒狀況於兩周內減緩又再發，且血液微生物檢驗為陽性，同時出現腎臟功能減退、寡尿、水腫、皮膚水泡等症狀，屬系統性感染之重症範疇，經西醫常規處置如利尿劑、抗生素等治療後水腫改善不明顯，仍有寡尿、意識不清狀態，於住院期間，照會西醫相關各科及中醫以期共同治療。中醫診斷發現此病患表現屬「關格」範疇，證型屬脾肺氣虛，腎陽不足，陽虛水泛，同時此患者嚴重水腫，考量接受侵入性治療易感染之風險，臨床判斷不適合傳統針灸，因此以雷射針灸搭配水煎藥及科學中藥，以補脾益肺、扶陽利水為治則做處置，此病患在處置後當日及往後兩周排尿量皆明顯增加，水腫狀況也在數周內改善。此病案報告透過回顧病史及治療經過、追蹤狀況，來分享雷射針灸合併中藥治療敗血症後慢性腎損傷併發急性腎損傷的中醫治療思路及療效，期望雷射針灸及中藥在相關內科重症輔助治療上能獲得更多推廣與實證。

The patient is an 86-year-old woman who was transferred from a regional hospital to the emergency room of a medical center in Kaohsiung due to a persistent fever lasting several days. Following treatment her fever subsided, but flared up again within two weeks. Blood cultures revealed the presence of a microorganism. She was diagnosed with acute kidney injury, oliguria, edema and skin vesicles-all symptoms of severe systemic infection. Treatment employing conventional western medical methodologies of diuretics and antibiotics did not lead to significant alleviation of symptoms of oliguria and edema in the unconscious patient. The Department of Chinese Medicine was consulted as part of the hospital's program of combined care. According to Chinese Medical Syndrome Differentiation, the pattern of the patient was spleen and lung Qi deficiency, kidney Yang deficiency and water accumulation syndrome (renal failure or dysuria and frequent vomiting). Because of severe edema and the immunocompromised state of the patient, we applied laser acupuncture instead of traditional acupuncture combined with Chinese herbal medicine to tonify the Yang, lung and spleen, and to clear the dampness. Urine output increased significantly following treatment and for two weeks after treatment, and edema was also alleviated. In this case-study, the treatment indicated by Chinese Medical Syndrome Differentiation and laser acupuncture achieved successful alleviation of sepsis-induced acute-on-chronic kidney injury, and we present this approach in the hope that it provides a useful clinical reference and evidence of its effectiveness in adjunctive critical care.