極重度新冠肺炎之中醫會診病例報告

A Case Report: Chinese Medicine Consultation for Critical Coronavirus Disease (COVID-19)

10.6516/TJTCM.202203/SP_25.0015

林家琳(Chia-Lin Lin)；王明仁(Ming-Jen Wang)；陳朝宗(Chao-Tsung Chen)

新冠肺炎 ； 急性呼吸窘迫症候群 ； 呼吸衰竭 ； 呼吸器 ； 中醫藥 ； Coronavirus disease COVID-19 ； acute respiratory distress syndrome ； respiratory failure ； ventilator ； traditional Chinese medicine

中醫藥研究論叢

25卷特刊（2022 / 03 / 05）

115 - 136

繁體中文

78歲女性，無任何慢性疾病或手術史，2021年06月09日因呼吸道感染症狀至聯合醫院仁愛院區求診，隨即確診新冠肺炎，收治於普通專責病房。住院10天後於2021年06月20日，因呼吸衰竭及血氧飽和濃度低下而插管轉至加護病房治療。西醫依照治療指引給予抗病毒藥物、類固醇與廣效抗生素。入住加護病房次日便於2021年06月21日應家屬要求，會診中醫。中醫以清熱解毒、化濁利濕、清肺排痰、理氣和中，使氣機通暢為主要治則。由於新冠肺炎病人的緣故，中醫四診可行性受到大幅的限制，故需輔以抽血檢查與X光影像協助辨症。中醫介入治療至2021年07月07日共歷時17日。病人於2021年07月12日成功脫離呼吸器並轉入普通病房，於07月29日順利出院，而後固定回胸腔內科回診，且持續追蹤未發現有嚴重後遺症。從這個案例，我們展示新冠肺炎重症病人中醫早期介入的益處。我們同時也說明血液生化檢查、胸腔X光與動脈血氧分析如何輔助新冠肺炎中醫治療，並且用於檢視中醫介入後的療效，希冀可做為未來中醫會診同類型病人的參考指標。

A 78-year-old woman with no notable medical history came to Taipei City hospital Ren-Ai branch seeking medical treatment on 2021/06/09 due to symptoms of respiratory tract infection. She was diagnosed with COVID-19 and admitted to our coronavirus ward. 10 days after admission, the patient developed respiratory failure with low oxygen saturation levels and was promptly intubated and transferred to the intensive care unit. Antiviral agents, systemic corticosteroids and broad spectrum antibiotics were prescribed in accordance to available guidelines. Traditional Chinese medicine (TCM) was consulted at the request of the patient's family members and treatment was initiated on 2021/06/21. The TCM principle of treatment included clearing heat and promoting diuresis, resolving dampness with aromatics, invigorating spleen and regulating stomach to facilitate qi-flowing. Due isolation requirements of COVID patients, the utilization of the four diagnostics methods of TCM were severely limited, so bloods exams and chest x-rays were crucial to guiding the prescription of TCM. TCM treatment was provided simultaneously with standard treatment of COVID-19 until 2021/07/07 for a total of 17 days. The patient was successfully extubated and transferred back to a normal ward on 2021/07/12. She was discharged on 2021/07/29 and has returned regularly to our chest medicine outpatient department for appointments ever since. Continuous follow up of the patient showed that she did not have any sequelae often seen in patients recovering from COVID-19. From this case, we demonstrated how early TCM intervention could help patients with severe COVID-19 infection. We illustrated how diagnostics tests including hemograms, biochemistries, chest x-rays and arterial blood gases could aid in the prescription of TCM for COVID-19 patients, as well as serve as parameters for observation of the therapeutic benefits. We hope this case could serve as a reference for similar patients encountered during TCM consult in the future.

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