多發性肌炎併肺炎呼吸衰竭之中西醫結合治療病案與病機推演

多發性肌炎是侵犯肌肉為主的自體免疫疾病，臨床症狀以肌肉無力、肌肉痠痛為表現，常侵犯近端骨絡肌肉，如：上臂、提肩胛肌、大腿等處。多發性肌炎常併發肺部疾患造成呼吸衰竭，而呼吸衰竭是顯示預後不佳的因素之一，患者常因肺炎併發敗血性休克而死亡。多發性肌炎屬中醫痿證之範疇。本病案是一位34歲女性患者，過去曾患有甲狀腺亢進，接受過甲狀腺手術治療後，甲亢病情獲得改善。近三年逐漸出現上臂、大腿肌肉無力、痠痛的症狀，症狀隨時間加劇，有數次因喘促、呼吸困難導致意識昏迷而住院，一年前患者由台北某醫學中心診斷為多發性肌炎併發急性呼吸衰竭，2011年5月因肺炎再度住院接受西醫類固醇及靜脈免疫球蛋白注射治療，但因治療效果不佳，始終無法順利脫離呼吸器，故轉至本院中醫治療。經中醫臟腑病機四要素分析：肝鬱化火、脾虛痰凝，肺熱津傷為引發多發性肌炎的主要病機。復因外感邪氣，導致肺熱葉焦，腎不納氣，而併發肺炎、呼吸衰竭。而給予導痰湯合黃連解毒湯化裁治療一個多月後順利脫離呼吸器並出院，後續追蹤血液學檢查發現肌酸磷化酶（CPK）指數已由13000U/L降至180U/L。

關鍵字

多發性肌炎；呼吸衰竭；肺痿

並列摘要

Polymyositis is an autoimmune disease which invades mainly muscle tissue, clinical symptoms included muscle weakness, muscle aches, and violations of the proximal skeletal muscles such as: upper arm, levanter scapulae muscles, and thighs etc. Polymyositis often complicated lung disease and respiratory failure which is one of poor prognosis factors. Patients died of pneumonia and complicated septic shock. Polymyositis is the content of wilting pattern in Traditional Chinese Medicine (TCM).This is a 34 years old female patient who had hyperthyroidism in the past. And her illness was better post- thyroidectomy. In recent three years, weakness and sour- pain symptoms of the upper aRM and thigh muscle were gradually severe. Even she was sent to hospitalization be caused dyspnea and loss of consciousness. One year ago, she was diagnosed polymyositis with acute respiratory failure at one of Taipei Medical Center. She suffered from pneumonia and re-admitted hospital received steroid and immunoglobulin treatment at May in 2011. She was tried to wean from the ventilator but in vain. Therefore, she was transferred our hospital expected integration of TCM treatment.Depressed liver qi transforming fire, spleen vacuity with congealing phlegm, and lung heat with fluids damage were the main patho-mechanism of polymyositis. The polymyositis case complicated pneumonia and respiratory failure which the law of pathogenesis was externally contracted evil qi caused lung heat scorching the lobes and kidney failing to absorb qi. The patient was administered the modified decoction from Dao-tan tang and Huang-lian-jie-du tang. After treatment for one more month, she successfully weaned from the ventilator and discharged from hospital. Follow-up blood examination demonstrated that the creatine phosphokinase (CPK) index from 13000 U / L decreased to 180 U / L.

並列關鍵字

Polymyositis ； Respiratory failure ； Lung wilting

國際替代計量

多發性肌炎併肺炎呼吸衰竭之中西醫結合治療病案與病機推演

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