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231.13 到院前心跳停止患者急救後診斷缺氧性腦病變意識不清之中醫早期介入

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診斷缺氧性腦病變意識不清之中醫早期介入

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　黃仲諄1*

1 佛教慈濟醫療財團法人台中慈濟醫院，台中，台灣

2 慈濟學校財團法人慈濟大學學士後中醫學系，花蓮，台灣

【摘要】

台灣地區到院前心跳停止病患的存活率不足8%，由於大腦對缺血的高度敏感，大部分急救後恢復自發性循環的患者，經常有意識障礙，僅7% 可活著出院，當中只有1%可生活自理，且到院前心跳停止的患者在住院之後，病情大都不穩定，入院後的第一週往往成為是否存活的關鍵時期。本文探討一則心跳停止到院前死亡的病患，大腦缺血導致細胞壞死等一連串的病理機轉，中醫將其過程及產物視其為氣血兩虛，因虛致實，形成痰濕而鬱阻化熱，最終讓腦部供血更形惡化。在這裡的關鍵是，將缺血性細胞壞死的病理產物視為痰濕，在現代醫療環境維持其生命徵象與中西結合的高度信任之下，中醫團隊得以在病發非常初期即介入共同照護，以祛痰化瘀法為主軸，才有超乎預期的療效。

【關鍵詞】到院前心跳停止、缺氧性腦病變、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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