膿胸的中西醫結合治療病例報告

Control Empyema by Integrated Chinese and Western Medicine-Case Report

許堯欽(Yao-Chin Hsu) ； 郭世芳(Shih-Fang Kuo) ； 江國華(Kuo-Hwa Chiang) ； 張晉民(Gin-Ming Chang) ； 楊惠珍(Hui-Chen Yang)

《中西整合醫學雜誌》 4卷1期 (2002/12) Pp. 7-16

https://doi.org/10.29613/JICWM.200212.0002

摘要

本病例爲86歲的老年男性病患，罹患左側膿胸，經抗生素及胸管引流積極治療一個月，病情未見進展，每日膿液引流量仍大於300亳升。之後因併發急性呼吸衰竭而轉入加護病房。90/5/7中醫會診時患者依賴呼吸器治療，尿量少，四肢水腫，排便色褐質軟日多行，護理時由氣切抽吸痰黃稠量多，胸管每日引流出多量膿液。舌質乾紅，舌苔淡黃厚滑膩。診脈見右關沉滑寸短，沉取無力。中醫辨證爲脾肺氣虛，痰熱未淨。治則採補土生金法以固護脾胃內托元氣，配合清熱化痰法以瀉肺排膿。協同西蕎呼吸器、胸管引流及其他支持性療法。結果，在中醫藥介入之後患者膿胸病情逐漸改善，至第二十二天(90/5/29)順利移除胸管，開始接受脫離呼吸器的訓練。第五十二天(90/6/29)患者順利脫離呼吸器，轉出至一般病房。90/8/7病情穩定出院，後續性復情況良好。中西醫結合治療成功的控制了這個膿胸的案例。

關鍵字

膿胸 ； 呼吸衰竭 ； 胸管引流 ； 脾肺氣虛

並列摘要

An 86-year-old male with empyema showed no improvement after the antibiotics and chest tube treatment for one month. The daily prurullent drainage remained greater than 300 ml. The accompanying acute respiratory failure caused him to be transferred to the intensive care unit. During Chinese medicine consultation on May 7(superscript th), 2001, the condition was ventilator-dependent with little urine output, edematous extremities, and frequent daily brown stool. A large amount of both yellow sputum drained out through the tracheostomy and daily pus drainage on nursing appeared. The tongue was dry and red with its thick, smooth and light yellow coating. The pulses of the bar on the right are deep and smooth, which is weak while pressed, and the inch is short. The Chinese differentiation of the symptom-complex is「Insufficiency of Qi of the spleen and the lung, and uncleanness of phlegm and heat.」The methods for treatment are: 1. To invigorate vital energy by administering tonifying drug. 2. To clear up heat and resolving phlegm is also performed for removing evil heat from the lungs and draining pus. The two ways with the ventilators usage, chest tube drainage and other supportive treatment of western medicine are utilized. After the intervention of Chinese medicine, the empyema was improved gradually and chest tube was removed smoothly with the onset of the ventilator-independent training on May 29(superscript th) 2001. The ventilator was no longer employed, and the patient was transferred to the ordinary ward on June 29th, 2001. He was stable and discharged on August, 7(superscript th) 2001, with subsequent follow-ups until now. We controlled empyema successfully with the combination of Chinese and Western medicine in this case.

並列關鍵字

Empyema ； Respiratoty failure ； Chest tube drainage ； Insufficiency of Qi of the spleen and the lung