- 期刊
術後麻痺性腸阻塞合併困難拔管：中醫會診病例報告
Chinese Medicine Inpatient Consultation for Relieving Postoperative Ileus-A Case Report
摘要
術後腸阻塞（Postoperative ileus, POI）是手術併發症之一，一般認為術後四日仍未恢復正常的腸道生理功能，則為病理性術後腸阻塞，除了增加患者不適、不利術後恢復、延長住院時間及浪費醫療資源外，甚至產生諸多併發症而危及患者生命。本病例為一70歲女性，過去有高血壓、高膽固醇血症、第二型糖尿病伴腎病變病史，此次因車禍入院，影像學檢查顯示肝臟撕裂傷伴隨腹膜腔積血、肢體多處骨折，經歷7小時的開放性復位及內固定術（Open Reduction and Internal Fixation, ORIF），手術隔日開始腹脹便秘，西醫診斷為麻痺性腸阻塞，經鼻胃管低位引流及33天靜脈營養的保守治療後，雖恢復腸道營養，但仍存在嚴重的腹脹及便秘，腹脹影響呼吸而困難拔管，又後期意識差，遂尋求中醫幫助。中醫診察後辨證為脾虛濕滯、腑氣不通、宗氣不足，以香砂六君子湯加減治療，初期配合行氣導滯、宣肅肺氣藥物，並搭配針灸運行氣血，後期加強補益氣血以幫助患者脫離呼吸器，經過二十餘日的中醫治療，消化功能改善並意識恢復，也成功脫離呼吸器、下轉一般病房，最終返家接受門診復健及追蹤。
並列摘要
Postoperative ileus (POI), one of the postoperative complications, not only increases patient discomfort, slows patient recovery, prolongs hospital stay, wastes medical resources, but also causes complications that can be life-threatening. In this case, a 66-year-old woman presented to our emergency department following a car accident. A liver laceration accompanied with hemoperitoneum and multiple extremity fractures was found and Open Reduction Internal Fixation surgery was performed smoothly. However, the absence of stool passage and abdominal distention was observed in our intensive care unit the next day, with radiologic confirmation, paralytic ileus was diagnosed. Conservative therapy of nasogastric decompression with 33 days of peripheral nutrition was administered. Eventually, she could tolerate the oral diet, but still had constipation and severe abdominal distension, which affected her breathing and made it difficult to extubate. Moreover, deterioration in the level of consciousness was observed in the latter period, so her family sought the help of traditional Chinese Medicine. Diagnosed with qi deficiency and stagnation, addition of Xiang Sha Liu Jun Zi Tang and acupuncture was prescribed. After twenty or so days of shared TCM care, the patient not only digestion improved and consciousness clear, but was extubated smoothly. Here are the medical records for one month providing a reference of the treatment of postoperative ileus with Chinese medicine.