台北市中医师公会中医药研究论丛

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231.13 到院前心跳停止患者急救後诊断缺氧性脑病变意识不清之中医早期介入

TJ TCM.23(1) : 163-176, 2020

DOI : 10.6516/TJTCM.202003_23(1).0013

到院前心跳停止患者急救後诊断缺氧性脑病变意识不清之中医早期介入

Early Intervention of Chinese Medicine to an OHCA Patient after ROSC Diagnosed Hypoxic Ischemic Encephalopathy (HIE) with Consciousness Disturbance: A Case Report

王嘉涵1　王人澍1,2　黄仲谆1*

1 佛教慈济医疗财团法人台中慈济医院，台中，台湾

2 慈济学校财团法人慈济大学学士後中医学系，花莲，台湾

【摘要】

台湾地区到院前心跳停止病患的存活率不足8%，由於大脑对缺血的高度敏感，大部分急救後恢复自发性循环的患者，经常有意识障碍，仅7% 可活着出院，当中只有1%可生活自理，且到院前心跳停止的患者在住院之後，病情大都不稳定，入院後的第一周往往成为是否存活的关键时期。本文探讨一则心跳停止到院前死亡的病患，大脑缺血导致细胞坏死等一连串的病理机转，中医将其过程及产物视其为气血两虚，因虚致实，形成痰湿而郁阻化热，最终让脑部供血更形恶化。在这里的关键是，将缺血性细胞坏死的病理产物视为痰湿，在现代医疗环境维持其生命徵象与中西结合的高度信任之下，中医团队得以在病发非常初期即介入共同照护，以祛痰化瘀法为主轴，才有超乎预期的疗效。

【关键词】到院前心跳停止、缺氧性脑病变、祛痰化瘀、神昏、早期介入

Chia-Han Wang1Jen-Shu Wang1,2Chung-Chun Huang1*

1Department of Taichung Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation,

Taichung, Taiwan

2School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan

【Summary】

The survival rate of OHCA patients in Taiwan is under 8%. About 7% of them after ROSC could be discharged, but only 1% could live independently. The key to improve survivability and state of consciousness is the treatment at the first week after ROSC. This article emphasizes on two points. One is the importance of early intervention of Chinese medicine, and the other is the pathophysiology of HIE under both concepts of Western and Chinese medicine. This case consulting with Chinese medicine within 30 hours after ROSC recovered well by being treated with the method of Dispel Phlegm and Transform Turbidity. We hope the mode of viewing inflammation after brain ischemia happening as phlegm-heat will become the priority at early stage for doctors.

Keywords： out-of-hospital cardiac arrest (OHCA), hypoxic ischemic encephalopathy (HIE), dispel phlegm and transform turbidity,consciousness disturbance, early intervention

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