大陷胸湯合四逆湯治療呼吸衰竭中西結合病例報告

患者為81歲女性，素有慢性阻塞性肺病與肥厚性阻塞性心肌症，因肺炎合併呼吸衰竭轉入加護病房，因家屬與患者始終拒絕插管與氣切，經加護病房照護後病情稍穩定，轉入胸腔內科，患者仍覺心悸，胸口悶，咳嗽，痰多黏稠難以咳出且難以抽出，自覺痰液積在胸口與心下部位。家屬希望能以中西結合治療。會診時，患者意識清楚，以鼻胃管餵食，小便不利使用導尿管，胸部X-ray發現雙側肺葉浸潤、心臟擴大、肺炎、肋膜積水，給予氧氣補給、抽胸水、抽痰、抗生素等控制感染。會診一周後，患者病進，呼吸困難、血氧下降、肺水腫、心房顫動、全身水腫、大小便不通，西醫以類固醇、血漿、抗凝血劑、利尿劑、抗生素等加以治療，雙向正壓呼吸器勉強維持血中氧飽和度，中醫切診為脈浮滑寸浮關沉，腹診從心下至少腹硬滿痛不可近，短氣煩躁，心中懊憹，證屬大陷胸湯證，危急之際，以仲景大陷胸湯蕩滌水飲四逆湯回陽救逆，患者在中西醫照護下，病情穩定後順利出院。

關鍵字

肺炎；呼吸衰竭；肺水腫；大陷胸湯；四逆湯

並列摘要

The patient is an 81-year-old female with chronic COPD and Hypertrophic Obstructive Cardiomyopathy. She was transferred to ICU due to complication of pneumonia and respiratory failure. The patient and her family refused to receive intubation and tracheostomy, she was transferred to Pulmonology department after her condition became stable. The patient still feels palpitation, tight chest and cough with sticky phlegm. The patient's family wants her to receive integrated Chinese medicine and Western medicine treatment. During conference, the patient is conscious, wears feeding tube and catheter. Her chest X-ray shows lobe infiltration, enlarged heart, pneumonia and pleural effusion. She was treated with oxygen, intercostal drain and antibiotics to control the infection. After one week, the patient became worse with difficult breathing, dropping blood oxygen, pleural edema, atrial fibrillation, edema, urine and stool barrier. Western doctor prescribed steroid, plasma, anti-coagulant, diuretics and antibiotic with Bilevel Postive Airway Pressure to maintain blood oxygen; Chinese Medicine doctors diagnosed the patient's syndrome DaXianXiongTang syndrome with floating and slippery pulse, painful abdomen, short of breath and agitation, so DaXianXiongTang is applied with SiNiTang to resurrect Yang. The patient was discharged after overall condition become stable.

並列關鍵字

pneumonia ； respiratory failure ； pleural edema ； DaXianXiongTang ； SiNiTang

國際替代計量

大陷胸湯合四逆湯治療呼吸衰竭中西結合病例報告

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