壞死性筋膜炎之中醫會診病例報告

A Case Report of the Treatment of Necrotizing Fasciitis with Chinese Medicine

10.6516/TJTCM.202403_27(1).0007

謝宗運(Tsung-yun Hsieh)；蕭逸婷(Yi-ting Hsiao)；王甯祺(Ning-chi Wang)；林政憲(Chen-shien Lin)

壞死性筋膜炎 ； 中醫藥 ； Necrotizing fasciitis ； Chinese medicine

中醫藥研究論叢

27卷1期（2024 / 03 / 30）

77 - 90

繁體中文;英文

壞死性筋膜炎為一種嚴重的感染症，主要侵犯皮下組織、筋膜與脂肪，若處理不當會造成嚴重的敗血症，引起休克，甚至死亡。本病例為一位81歲女性，過去曾罹患高血壓、第二型糖尿病與缺血性腦中風，平時可用助行器行走。本次入院前一週因跌倒造成臀部挫傷，近幾日開始出現呼吸短促伴隨全身虛弱無力等症狀，來到本院急診時出現呼吸衰竭的現象，且右側臀部皮膚紅腫伴隨皮下捻髮音，經一連串檢查後診斷為雙側臀部壞死性筋膜炎。整形外科評估應該要動手術，但患者因為全身麻醉的風險過高因而改採保守治療。在西醫輸液補充、呼吸器輔助與抗生素治療的基礎上，加上中醫溫養脾腎陽氣的藥物，以推動營衛氣的運行，促進組織的修復。在將近兩個月的中西醫共同照護之後，患者傷口恢復情況良好，順利出院。本會診病例說明，在中醫辨證求因、審因論治的原則之下，中醫對於嚴重的感染性疾病也能夠發揮一定的療效。

Necrotizing fasciitis (NF) is a serious infectious disease that mainly invades subcutaneous tissue, fascia, and fat. If NF is not treated properly, it will cause severe sepsis, shock, and even death. This case is an 81-year-old female who has past history of hypertension, type 2 diabetes and ischemic stroke, and can still be able to walk with a walker. A week before admission, she fell accidentally and caused buttocks contusion. Symptoms such as shortness of breath accompanied by general weakness began to appear. When she was sent to the emergency department of our hospital, she developed respiratory failure and the skin on the right buttock was red and swollen with subcutaneous crepitations. After a series of examinations, she was diagnosed bilateral buttock necrotizing fasciitis. Surgery was indicated but the patient was conservatively treated because of the high risk from general anesthesia. On the basis of Western medicine fluid supplementation, respirator assistance and antibiotic treatment, Chinese medicine is added to warm and nourish the spleen and kidney Yang-qi, so as to promote the operation of Ying-qi and Wei-qi and promote tissue repair. After two months of combined care with traditional Chinese and Western medicine, the patient's wound recovered well and was discharged from the hospital smoothly. This combined care case shows that under the principles of TCM syndrome differentiation, seeking causes, examining causes and treating, TCM can also play a certain curative role on severe infectious diseases.