251.8 41 歲多次早產史孕婦中醫安胎之病例報告
TJ TCM.25(1) : 99-112, 2022
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41 歲多次早產史孕婦中醫安胎之病例報告
Combined Treatment of Chinese Medicine
and Western Medicine in Pregnant Women with Preterm Labor: A Case Report
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黃家瑩1 陳光偉1 瞿瑞瑩1*
1 馬偕紀念醫院中醫部，台北，台灣
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【摘要】
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41 歲女性，過去曾有四次早產史G6P4A1（AA），前四胎皆住院完全臥床安胎分別至34、35、29、34 週自然生產。此次於懷孕18 週開始有腹部下墜感。口服安胎藥物Ritodrine 下腹下墜緊繃感仍明顯並增加，於懷孕18+1 週至本院急診就醫，診斷早產收縮（preterm contraction），於2018/6/10（GA：18+1 週）收入院安胎。
安胎住院前兩個月完全臥床， 過程中使用Ritodrine、Nifedipine、Atosiban、Indomethacin 等安胎藥物，藥物使用劑量與頻率提高後，仍持續感覺下腹下墜感與下腹緊繃收縮感，並開始出現喘、心悸、心跳上升（HR：100-110 次/ 分）等現象，於2018/8/16（GA：27+5 週）首次會診中醫。
經診察，診斷證型以脾腎氣虛為本，以氣鬱化熱為標。治則為補脾益腎、理氣清熱和中。經中西合併治療後，宮縮減緩，西藥安胎藥物劑量逐步下調，並於懷孕31 週時可以下床自由活動，安胎針劑改為口服劑型，於懷孕34 週出院，在懷孕36+1 週自然產下一3352 克健康男嬰。
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【關鍵詞】安胎、中西醫結合治療、先兆早產、胎漏
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Chia-Ying Huang1Jui-Ying Chu1*Kuan-Wei Chen1
1Department of Chinese Medicine of MacKay Memorial Hospital, Taipei, Taiwan
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【Summary】
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A 41-year-old pregnant woman with history of preterm delivery consulting Chinese Medical Department for frequent uterine contraction. Pressure sensation in the pelvic and irregular contraction without cervical dilation were found in the gestational age of 18th week, clinical diagnosis was preterm contraction thus the patient was hospitalized for tocolysis.
After 2-month administration of tocolytic agents (Ritodrine, Nifedipine, Atosiban, Indomethacin) and total bed rest, the contraction persisted accompanying with signs of palpitation, tachycardia, shortness of breath, flushing, and diaphoresis. Chinese medical doctor was consulted at the gestational age of 27+5th week.
After receiving Chinese medicine and western medicine treatment together, the frequency of contraction decreased, dose of tocolytic drug was tapered down and total bed rest was no longer needed. Patient was discharged at the gestational age of 34th week and delivered a healthy 3352g baby. This report aims to provide an effective clinical case for the treatment of preterm labor for Chinese medical practitioners.
【Keywords】Preterm Labor; Tocolysis; Combination of Chinese and Western Medicine
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