中西醫共同治療青少年外傷性瀰漫軸突損傷－病例報告

Treatment of Traumatic Diffuse Axonal Injury for Adolescent with Integrated Treatment of Traditional Chinese and Western Medicine-A Case Report

10.6516/TJTCM.202209_25(3).0004

洪崚育(Leng-Yu Hong)；黃仲諄(Chung-Chun Huang)

瀰漫性軸突損傷 ； 創傷性腦損傷 ； 中醫藥 ； 中西醫共同治療 ； diffuse axon injury ； traumatic brain injury ； traditional Chinese medicine ； combined Chinese and Western medicine treatment

中醫藥研究論叢

25卷3期（2022 / 09 / 30）

39 - 52

繁體中文

瀰漫性軸突損傷（Diffuse axonal injury）約有92%為交通事故所造成，其中57.3%病患合併腦外損傷，83.6%昏迷指數介於3-8分。目前並無明確治療指引，以穩定生命徵象、維持適當腦壓、預防癲癇為主，二線療法有低溫療法、鈣離子阻斷等。但令家屬煎熬的是瀰漫性軸突損傷患者其意識狀態往往比影像學呈現的損傷還要嚴重，更有動物實驗證實軸突損傷會產生與退化性腦病變類似的類澱粉蛋白（beta-amyloid peptide），故其相關治療進展亦備受關注。本病例是一名13歲青少年騎腳踏車自摔造成頭部外傷，送急診時格拉斯哥昏迷指數Glasgow Coma Scale（GCS）：E3V1M3，意識不清，於傷後第五天開始會診中醫。患者於創傷後約1個月昏迷指數回復滿分，順利出院。此為兒童腦傷於早期中西醫共同照護之相關經驗。

Diffuse axonal injury occurred about 92% in traffic accidents, of which 57.3% had Brain damage, and 83.6% had a Glasgow Coma Scale between 3-8 points. There is currently no specific guideline for treatment of diffuse axonal injury .The main principle is on stabilizing vital signs, maintaining proper brain pressure, and preventing epilepsy. Second-line therapies include therapeutic hypothermia, calcium channel blocker, etc. However, the family members were worried about patients who was in a coma with diffuse axonal injury. The damage is more serious than the imaging findings. Moreover, animal experiments had confirmed that axon damage can produce beta-amyloid peptides which were similar to neurodegenerative disorder. Therefore, most of the related treatment has also attracted .This article introduces a case of a 13-year-old male with traumatic brain injury after falling off a bicycle. In the emergency department, which the GCS is E3V1M3, he received traditional Chinese medicine after five days. The patient's GCS returned to full marks about 1 month after the trauma and was discharged smoothly. This is the relevant experience of children with brain injury in the early combined treatment of Chinese and Western medicine.

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