Chinese Medicine Inpatient Consultation for Relieving Postoperative Ileus-A Case Report
梁祐尔1 许尧钦1 林廉证2 黄颂俨2*
1奇美医疗财团法人奇美医院中医部，台南，台湾
2彰化基督教医疗财团法人彰化基督教医院中医部，彰化，台湾
【摘要】
术後肠阻塞（Postoperative ileus, POI）是手术并发症之一，一般认为术後四日仍未恢复正常的肠道生理功能，则为病理性术後肠阻塞，除了增加患者不适、不利术後恢复、延长住院时间及浪费医疗资源外，甚至产生诸多并发症而危及患者生命。本病例为一70岁女性，过去有高血压、高胆固醇血症、第二型糖尿病伴肾病变病史，此次因车祸入院，影像学检查显示肝脏撕裂伤伴随腹膜腔积血、肢体多处骨折，经历7小时的开放性复位及内固定术（Open Reduction and Internal Fixation, ORIF），手术隔日开始腹胀便秘，西医诊断为麻痹性肠阻塞，经鼻胃管低位引流及33天静脉营养的保守治疗後，虽恢复肠道营养，但仍存在严重的腹胀及便秘，腹胀影响呼吸而困难拨管，又後期意识差，遂寻求中医帮助。中医诊察後辨证为脾虚湿滞、腑气不通、宗气不足，以香砂六君子汤加减治疗，初期配合行气导滞、宣肃肺气药物，并搭配针灸运行气血，後期加强补益气血以帮助患者脱离呼吸器，经过二十馀日的中医治疗，消化功能改善并意识恢复，也成功脱离呼吸器、下转一般病房，最终返家接受门诊复健及追踪。
【关键词】术後肠阻塞、POI、困难拨管、香砂六君子汤、针灸
【Summary】
Postoperative ileus (POI), one of the postoperative complications, not only increases patient discomfort, slows patient recovery, prolongs hospital stay, wastes medical resources, but also causes complications that can be life-threatening. In this case, a 66-year-old woman presented to our emergency department following a car accident. A liver laceration accompanied with hemoperitoneum and multiple extremity fractures was found and Open Reduction Internal Fixation surgery was performed smoothly. However, the absence of stool passage and abdominal distention was observed in our intensive care unit the next day, with radiologic confirmation, paralytic ileus was diagnosed. Conservative therapy of nasogastric decompression with 33 days of peripheral nutrition was administered. Eventually, she could tolerate the oral diet, but still had constipation and severe abdominal distension, which affected her breathing and made it difficult to extubate. Moreover, deterioration in the level of consciousness was observed in the latter period, so her family sought the help of traditional Chinese Medicine. Diagnosed with qi deficiency and stagnation, addition of Xiang Sha Liu Jun Zi Tang and acupuncture was prescribed. After twenty or so days of shared TCM care, the patient not only digestion improved and consciousness clear, but was extubated smoothly. Here are the medical records for one month providing a reference of the treatment of postoperative ileus with Chinese medicine.
【Keywords】
Postoperative ileus； POI； difficult extubation； Xiang Sha Liu Jun Zi Tang； acupuncture
254.7 术後麻痹性肠阻塞合并困难拨管：中医会诊病例报告
