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中医药研究论丛
 271.7坏死性筋膜炎之中医会诊病例报告
TJ TCM.27(1) : 77-90, 2024
DOI : 10.6516/TJTCM.202403_27(1).0007
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坏死性筋膜炎之中医会诊病例报告
A Case Report of the Treatment of
Necrotizing Fasciitis with Chinese Medicine
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谢宗运1 萧逸婷1 王甯祺2 林政宪3,*
1 国防医学院三军总医院中医部，台北，台湾
2 国防医学院三军总医院感染及热带医学科，台北，台湾
3 卫生福利部台北医院中医科，台北，台湾
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【摘要】
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摘要
坏死性筋膜炎为一种严重的感染症，主要侵犯皮下组织、筋膜与脂肪，若处理不当会造成严重的败血症，引起休克，甚至死亡。本病例为一位81岁女性，过去曾罹患高血压、第二型糖尿病与缺血性脑中风，平时可用助行器行走。本次入院前一周因跌倒造成臀部挫伤，近几日开始出现呼吸短促伴随全身虚弱无力等症状，来到本院急诊时出现呼吸衰竭的现象，且右侧臀部皮肤红肿伴随皮下捻发音，经一连串检查後诊断为双侧臀部坏死性筋膜炎。整形外科评估应
该要动手术，但患者因为全身麻醉的风险过高因而改采保守治疗。在西医输液补充、呼吸器辅助与抗生素治疗的基础上，加上中医温养脾肾阳气的药物，以推动营卫气的运行，促进组织的修复。在将近两个月的中西医共同照护之後，患者伤口恢复情况良好，顺利出院。本会诊病例说明，在中医辨证求因、审因论治的原则之下，中医对於严重的感染性疾病也能够发挥一定的疗效。
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【关键词】坏死性筋膜炎、中医药
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Tsung-yun Hsieh1 Yi-ting Hsiao1 Ning-chi Wang2 Chen-shien Lin3,*
1Department of Chinese Medicine, Tri-Service General Hospital, National Defense Medical
Center, Taipei, Taiwan.
2Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine,
Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
3Division of Chinese Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.
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【Summary】
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Summary
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.
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【Keywords】
Necrotizing fasciitis; Chinese medicine.
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