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本案例为一位55 岁女性，於109/04/27 因下楼梯时意外跌倒，造成重大创伤性脑损伤、意识改变、头皮血肿、颅底骨折及鼻腔出血，於当日送至急诊後，经电脑断层检查显示为创伤引起之硬脑膜下血肿（Subduralhematoma, SDH）、蜘蛛膜下出血（Subarachnoid hemorrhage, SAH）， 随後施行开颅手术及血肿清除後并放置脑室外引流（External ventricular drain,EVD）、颅内压（Intracranial Pressure, ICP） 及大脑灌流压力（Cerebralperfusion pressure, CCP）侦测器，後转至外科加护病房照护。因应家属要求，故於05/04 会诊中医。中医介入初期以针灸并搭配水煎药治疗，帮助患者恢复意识及脱离呼吸器。针灸治疗取手足阳明经之穴（曲池、足三里）以补益气血，并酌加胆经穴位（悬钟）加强筋骨功能、脾经（太白）穴位调理肠胃，肺经穴位（尺泽、列缺）强化呼功能，并配合大肠经、胃经（合谷、足三里）其补土生金之概念，再加醒神开窍穴位处理意识昏迷。中药水煎剂治疗以补气养血、活血化瘀为主要治则，配合补土生金、宣肺化痰、醒神开窍之方药，巩固治疗效果。患者於05/13 成功脱离呼吸器并於05/15 转至普通病房，06/21 意识恢复清醒、语言及肌力复原状况良好後出院。本病患经中医协同治疗後恢复良好，缩短住院天数，故藉此病例报告以提出治疗经验，供临床上叁考运用。
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Ya-Lun Li1Sung-Yan Huang1*
1Department of Chinese Medicine, Changhua Christian Hospital, Changhua, Taiwan
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This case is a 55-year-old woman who was sent to the emergency department on 109/04/28 with a CT scan showing trauma-induced Subarachnoid hemorrhage (SDH), subarachnoid hemorrhage (SAH). After performing craniotomy and hematoma removal, External ventricular drainage (EVD) and Intracranial Pressure (ICP) and Cerebral perfusion pressure (CCP) detectors were placed, and then she was sent to the surgical intensive care unit for care. Chinese medicine was consulted due to family requirements. In the early stage of treatment, acupuncture combined with Chinese medicine decoction was used to promote recovery of consciousness and detachment from the respirator. Acupuncture the points of the Yangming meridian of the hands and feet (LI11, ST36) to nourish Qi and blood, acupoints of the gallbladder meridian (GB39) to strengthen the function of muscles and bones, acupoints of the spleen meridian (SP3) to regulate the stomach, acupoints of the lung meridian (LU5, LU7) strengthens the exhalation function, and cooperates with the large intestine meridian and stomach meridian (LI4, ST36), and add come of the acupoints awaken the consciousness to deal with coma. Traditional Chinese medicine decoction treatment is based on the main principles of nourishing Qi and nourishing blood, promoting blood circulation and removing blood stasis. Combining with the prescriptions of nourishing gastrointestinal function, improving lung function, and refreshing the mind to consolidate the therapeutic effects. The patient successfully detached from the respirator and was transferred to the general ward. Then, she was discharged after regaining consciousness, and her speech ability and muscle strength had progressed. The patient recovered well after the coordinated treatment of traditional Chinese medicine. The case report was used to provide treatment experience for clinical reference.
【Keywords】Traumatic brain injury; conscious coma; integrated Chinese and
Western medicine; acupuncture; Chinese medicine
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261.5 中西医结合早期介入处置颅脑损伤之病例报告
