中醫藥研究論叢

211.13 流感併肺炎急性呼吸衰竭之中醫會診病例報告
TJ TCM.21(1) : 155-170, 2018
流感併肺炎急性呼吸衰竭之中醫會診病例報告
A Case Report: Chinese Medicine was consulted for Influenza Complicated with Acute Respiratory Failure
張廷瑋1 戴有志1*
1 佛教慈濟醫療財團法人台北慈濟醫院中醫部,台北,台灣
【摘要】
49 歲男性,有B 型與C 型肝炎病史,2016 02 月初因流感併發急性呼吸衰竭重症,在他院插管治療後一個多月後轉入住慈濟加護病房進行後續脫離呼吸器的醫療處置。西醫雖持續給予抗生素與抗病毒藥物,病人肺炎仍無法完全緩解,且併發菌血症,同時也歷經重新插管與氣切的照護。患者在2016 04 13 日當晚,病人經歷嚴重的失眠後,隨即出現幻覺與譫妄的現象,因而影響拔管的進度。經身心科醫師處置後,幻覺與譫妄無明顯改善,且呼吸呈現不穩定模式。應家屬的要求,於2016 04 15 開始會診中醫。中醫以滋陰、益氣、與清熱為主要治則,並配合因勢利導的概念,以汗與下途徑導邪外出。歷經一個半月的時間,成功協助患者脫離呼吸器,也順利讓患者出院。回顧此病案,我們認為病人的體重、肺泡氧氣梯度與SpO2/FiO2比值,可用來說明中醫介入後的療效參數,希冀可做為未來中醫會診同類型病人的參考指標。
【關鍵詞】流感併發重症、急性呼吸衰竭、呼吸器、譫妄、熱入營分、大定風
Chang Ting-Wei1 Tai Yu-Chih1*
1Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation,
Taipei, Taiwan
【Summary】
A 49-year-old man, with a history of hepatitis type B and C infection, suffered from influenza complicated with acute respiratory failure in early February 2016. He was treated with endotracheal tube and ventilator to keep his respiration fluent in other hospital for 1 month. He was transferred to Tzu Chi intensive care unit on March 16th 2016 for the following weaning process. In the intensive care unit, he suffered from the extubation because of incomplete remission of pneumonia, and concurrent bacteremia though treated by antibiotics and antiviral drugs continuously. However, at the night of 2016/4/13, he appeared hallucinations and delirium after severe insomnia. According to his poor responses to the treatment and the request of family, they consulted traditional Chinese medicine (TCM) on 2016/4/15. Chinese medicine doctor adopted to supplement with Yin and Qi and clear heat as a main rule. Besides, based on his condition, the second supporting rule is to resolve the exterior through sweating and precipitation. After treated with TCM for one and a half months, he weaned successfully, and was also discharged.Reviewing the case, we thought the body weight body, the alveolar oxygen gradient, and the SpO2 / FiO2 ratio are most likely as reference parameters to observe the therapeutic benefits.
KeywordsInfluenza complication, acute respiratory failure, ventilator, delirium, heat into the construction, Dading wind beads