中西醫結合早期介入處置顱腦損傷之病例報告

Early Interventional Treatment of Traumatic Brain Injury with Integrated Traditional Chinese and Western Medicine-A Case Report

10.6516/TJTCM.202303_26(1).0005

李亞倫(Ya-Lun Li)；黃頌儼(Sung-Yan Huang)

創傷性腦傷 ； 意識昏迷 ； 中西醫結合 ； 針灸 ； 中藥 ； Traumatic brain injury ； conscious coma ； integrated Chinese and Western medicine ； acupuncture ； Chinese medicine

中醫藥研究論叢

26卷1期（2023 / 03 / 30）

51 - 67

繁體中文;英文

本案例為一位55歲女性，於109/04/27因下樓梯時意外跌倒，造成重大創傷性腦損傷、意識改變、頭皮血腫、顱底骨折及鼻腔出血，於當日送至急診後，經電腦斷層檢查顯示為創傷引起之硬腦膜下血腫（Subdural hematoma, SDH）、蜘蛛膜下出血（Subarachnoid hemorrhage, SAH），隨後施行開顱手術及血腫清除後並放置腦室外引流（External ventricular drain, EVD）、顱內壓（Intracranial Pressure, ICP）及大腦灌流壓力（Cerebral perfusion pressure, CCP）偵測器，後轉至外科加護病房照護。因應家屬要求，故於05/04會診中醫。中醫介入初期以針灸並搭配水煎藥治療，幫助患者恢復意識及脫離呼吸器。針灸治療取手足陽明經之穴（曲池、足三里）以補益氣血，並酌加膽經穴位（懸鐘）加強筋骨功能、脾經（太白）穴位調理腸胃，肺經穴位（尺澤、列缺）強化呼功能，並配合大腸經、胃經（合谷、足三里）其補土生金之概念，再加醒神開竅穴位處理意識昏迷。中藥水煎劑治療以補氣養血、活血化瘀為主要治則，配合補土生金、宣肺化痰、醒神開竅之方藥，鞏固治療效果。患者於0/13成功脫離呼吸器並於05/15轉至普通病房，06/21意識恢復清醒、語言及肌力復原狀況良好後出院。本病患經中醫協同治療後恢復良好，縮短住院天數，故藉此病例報告以提出治療經驗，供臨床上參考運用。

This case is a 55-year-old woman who was sent to the emergency department on 109/04/28 with a CT scan showing trauma-induced Subarachnoid hemorrhage (SDH), subarachnoid hemorrhage (SAH). After performing craniotomy and hematoma removal, External ventricular drainage (EVD) and Intracranial Pressure (ICP) and Cerebral perfusion pressure (CCP) detectors were placed, and then she was sent to the surgical intensive care unit for care. Chinese medicine was consulted due to family requirements. In the early stage of treatment, acupuncture combined with Chinese medicine decoction was used to promote recovery of consciousness and detachment from the respirator. Acupuncture the points of the Yangming meridian of the hands and feet (LI11, ST36) to nourish Qi and blood, acupoints of the gallbladder meridian (GB39) to strengthen the function of muscles and bones, acupoints of the spleen meridian (SP3) to regulate the stomach, acupoints of the lung meridian (LU5, LU7) strengthens the exhalation function, and cooperates with the large intestine meridian and stomach meridian (LI4, ST36), and add come of the acupoints awaken the consciousness to deal with coma. Traditional Chinese medicine decoction treatment is based on the main principles of nourishing Qi and nourishing blood, promoting blood circulation and removing blood stasis. Combining with the prescriptions of nourishing gastrointestinal function, improving lung function, and refreshing the mind to consolidate the therapeutic effects. The patient successfully detached from the respirator and was transferred to the general ward. Then, she was discharged after regaining consciousness, and her speech ability and muscle strength had progressed. The patient recovered well after the coordinated treatment of traditional Chinese medicine. The case report was used to provide treatment experience for clinical reference.

1. Chelly, H,Chaari, A,Daoud, E,Dammak, H,Medhioub, F,Mnif, J,Hamida, CB,Bahloul, M,Bouaziz, M(2011).Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases.J Trauma,71(4),838-846.
2. Venkatakrishna Rajajee, Management of acute moderate and severe traumatic brain injury, UpToDate, last updated: June 10, 2022, retrieved from https://www.uptodate.com/contents/management-of-acute-moderate-and-severe-traumatic-brain-injury?search=traumatic%20brain%20injury%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
3. Shih, Chun Chuan,Lee, Hsun Hua,Chen, Ta Liang,Tsai, Chin Chuan,Lane, Hsin Long,Chiu, Wen Ta,Liao, Chien Chang(2013).Reduced use of emergency care and hospitalization in patients with traumatic brain injury receiving acupuncture treatment.Evidence-based Complementary and Alternative Medicine
4. Shih, Chun-Chuan,Hsu, Yi-Ting,Wang, Hwang-Huei,Chen, Ta-Liang,Tsai, Chin-Chuan,Lane, Hsin-Long,Yeh, Chun-Chieh,Sung, Fung-Chang,Chiu, Wen-Ta,Cherng, Yih-Giun,Liao, Chien-Chang(2014).Decreased Risk of Stroke in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study.PLoSOne,9(2),e89208.
5. 台灣神經外科醫學會：輕度及嚴重頭部外傷治療準則。取自：https://www.neurosurgery.org.tw/nsr/tbi/main.htm
6. 林家瑋,蔡宛真,邱文達,林天仁,江培業,林乾閔,陳俊甫,甘宜弘,蔡行瀚,蔡卓城(2004)。台灣地區外傷性顱內出血之研究。中華民國急救加護醫學會雜誌，15，20-28。
7. 陳文秀,劉祈辰,郭哲彰(2007)。中西醫結合治療重型顱腦損傷病例報告。台灣中醫科學雜誌，2，64-76。
8. 陳萍和(2010)。腦外傷綜合症中醫治療病例報告。台灣中醫臨床醫學雜誌，3，174-179。
9. 程士德(2018).內經講義.中國:上海科學技術出版社.
10. 黃玨穎,陳貞如,鄭棋安,陳榮洲(2012)。頭部重度外傷意識昏迷中西結合治療甦醒病例報告。中西整合醫學雜誌，2，33-46。
11. 衛生福利部統計處，108 年度死因統計年報：108 年死因統計結果分析。取自：https://dep.mohw.gov.tw/DOS/cp-4927-54466-113.html