缺氧性腦病變合併肺炎之中西醫結合治療病例報告－穿心蓮使用時機探討

Integrated Treatment of TCM and Western Medicine for Hypoxic Encephalopathy Combined with Pneumonia - The Applicable Timing of Andrographis Paniculata(Chuan-Xin-Lian): A Case Report

10.7102/JTCIM.202006_18(1).0003

陳冠澧(Chen, Kuan-Li)；鄭宇真(Cheng,Yu-Chen)；黃仲諄(Huang, Zhong-Zheng)

穿心蓮 ； 缺氧性腦病變 ； 肺炎 ； 中醫 ； Andrographis paniculata ； Chuan-xin-lian ； hypoxic encephalopathy ； pneumonia ； Chinese medicine

中醫內科醫學雜誌

18卷1期（2020 / 06 / 01）

27 - 37

繁體中文

缺氧性腦病變（Hypoxic encephalopathy）主因爲腦部缺乏血液灌流而造成神經學上的病變，若傷及意識則需使用人工設備維持生命，低溫療法延緩腦細胞壞死，並監測腦波，注意營養攝取以及預防感染。其中呼吸器肺炎感染（Ventilator-acquired pneumonia/VAP）為常見感染症，且隨使用天數而增加。除致死率上升外，平均延長住院時間7－9天，增加醫療成本。本案例為一名65歲女性於因術後出血而引發缺血性休克，症狀穩定後因缺氧性腦病變而意識不清使用呼吸器，而照會中醫共同治療，並於住院10天後出現肺炎症狀，在使用抗生素5天但病程仍持續之情況下，於中藥飲片中加入穿心蓮後病人的臨床症狀、影像學以及實驗室數據上皆有改善。分享此案例提供先進同道討論，希望中醫在院內肺炎感染臨床用藥上，能找出更有效率的用藥方式。

A 65-year-old female who suffered from hypovolemic shock after receiving the surgery of cardiac catheterization was shown unconsciousness due to hypoxic encephalopathy. After being hospitalized for 10 days, the chest x-ray revealed peribronchial wall thickening and infiltration of bilateral lung fields. Shortness of breath and a significant amount of white-yellowish sputum was also observed, which leads to the diagnosis of pneumonia. Despite the treatment of antibiotics, the symptoms showed no sign of subsiding. Nevertheless, the data and overall symptoms improved massively after the intervention of Chinese medicine, namely Andrographispaniculata. In conclusion, this case was provided in order to provoke a profound discussion regarding the fact that Chinese medicine may potentially play a crucial role in the treatment of pneumonia infection.

1. (2019).台灣中藥典.衛生福利部.
2. （清）陳修園(2017).醫學三字經.學苑出版社.
3. Kalil, AC,Metersky, ML,Klompas, M(2016).Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.Clin Infect Dis,63,e61.
4. Klompas, Michael,File, Thomas M(2019).Michael Klompas, Thomas M File, Treatment of hospital-acquired and ventilator-associated pneumonia in adults, Uptodate, 2019 https://www.uptodate.com/contents/treatment-of-hospital-acquired-and-ventilator-associated-pneumonia-in-adults.https://www.uptodate.com/contents/treatment-of-hospital-acquired-and-ventilator-associated-pneumonia-in-adults
5. Metersky, ML,Wang, Y,Klompas, M(2016).Trend in Ventilator-Associated Pneumonia Rates Between 2005 and 2013.JAMA,316,2427.
6. Weinhouse, Gerald L,Young, Bryan(2020).Gerald L Weinhouse, MDG Bryan Young, MD, et al, Hypoxic-ischemic brain injury in adults: Evaluation and prognosis, Uptodate, 2020 https://www-uptodate-com.hlsw.tzuchi.com.tw:8443/contents/hypoxic-ischemic-brain-injury-in-adults-evaluation-and-prognosis.https://www-uptodate-com.hlsw.tzuchi.com.tw:8443/contents/hypoxic-ischemic-brain-injury-in-adults-evaluation-and-prognosis
7. 王洪圖(2004).黃帝內經素問白話解.人民衛生出版社.
8. 侯毓昌,王雅惠,劉國同(2010)。穿心蓮乙素（andrographolide）經由抑制iNOS 和gp91phox/NADPH oxidase 2（NOX2）的表現保護缺血型中風大鼠腦組織。中醫藥雜誌，21(3,4)，85-98。
9. 施桂秀,陳偉強,丁志英(2019)。穿心蓮內酯抗人體呼吸系統感染及機制研究進展。廣東醫學，40(11)，1660-1664。
10. 張琦,崔慶新(2018)。穿心蓮內酯及其衍生物的體內分佈與抗炎機制研究進展。生命的化學，38(1)，8-14。
11. 張曉,唐力英,吳宏偉(2018)。穿心蓮現代研究進展。中國實驗方劑學雜誌，24(18)，222-234。
12. 陳榮洲(2011).中醫內科證治學.弘祥出版社.

1. 鄭宇真,黃仲諄,陳冠澧,洪崚育,邱慧玲,方則淳(2020)。中西共同治療敗血性休克患者病例報告。中醫內科醫學雜誌，18(2)，48-59。