253.4 中西医共同治疗青少年外伤性弥漫轴突损伤─病例报告
TJ TCM.25(3) : 1-12, 2022
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中西医共同治疗青少年外伤性弥漫轴突损伤—病例报告
Treatment of Traumatic Diffuse Axonal Injury for Adolescent with Integrated
Treatment of Traditional Chinese and Western Medicine-A Case Report
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洪崚育1 黄仲谆1*
1 台中慈济医院中医部，台中，台湾
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【摘要】
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弥漫性轴突损伤（Diffuse axonal injury）约有92% 为交通事故所造成，其中57.3% 病患合并脑外损伤，83.6% 昏迷指数介於3-8 分。目前并无明确治疗指引，以稳定生命徵象、维持适当脑压、预防癫癇为主，二线疗法有低温疗法、钙离子阻断等。但令家属煎熬的是弥漫性轴突损伤患者其意识状态往往比影像学呈现的损伤还要严重，更有动物实验证实轴突损伤会产生与退化性脑病变类似的类淀粉蛋白（beta-amyloid peptide），故其相关治疗进展亦备受关注。本病例是一名13 岁青少年骑脚踏车自摔造成头部外伤，送急诊时格拉斯哥昏迷指数Glasgow Coma Scale（GCS）：E3V1M3，意识不清，於伤後第五天开始会诊中医。患者於创伤後约1 个月昏迷指数回复满分，顺利出院。此为儿童脑伤於早期中西医共同照护之相关经验。
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【关键词】弥漫性轴突损伤、创伤性脑损伤、中医药、中西医共同治疗
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Leng-Yu Hong1Chung-Chun Huang1*
1Department of Chinese Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Taichung, Taiwan
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【Summary】
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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.
【Keywords】diffuse axon injury; traumatic brain injury; traditional Chinese
medicine; combined Chinese and Western medicine treatment
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