頸椎間盤疾患伴脊髓病變之居家中西醫整合照護－病例報告

Integrated Home Medical Care with Traditional Chinese Medicine for Severe Spinal Cord Compression with Quadriplegia: A Case Report

李維哲(Wei-Che Lee) ； 謝芳郁(Fang-Yu Hsieh) ； 許恒壹(Heng-Yi Hsu)

《北市醫學雜誌》 預刊文章 Pp. 1-15

https://doi.org/10.6200/TCMJ.202201/PP.0014

摘要

本篇個案報告描述一位89歲高齡女性患者，因泌尿道感染與頸椎第四及五節椎間盤突出嚴重壓迫脊髓造成四肢癱瘓、嚴重下肢肌肉痙攣住院治療，出院後經跨團隊中西醫整合性的居家醫療照護經驗。患者於2018年6月29日從醫院出院後，因考量年紀已大及行動不便，7月開始即由神經內科醫師、藥師及居家護理師組成居家醫療團隊定時訪視，並更換導尿管，泌尿道感染及肢體疼痛因而漸獲得控制，但四肢仍無力；經神經內科評估後，於2019年7月照會中醫科，一起加入居家醫療照護團隊。在半年多的針灸治療後，雙上肢肌力明顯進步，由2分進步到4分，止痛藥及肌肉鬆弛劑也逐漸減量，肌力與疼痛的控制逐步改善中。藉由本例成功的中西醫居家整合照護經驗，提供後續照護神經肌肉相關問題個案之參考。

關鍵字

頸椎椎間盤病變 ； 四肢癱瘓 ； 肌肉痙攣 ； 居家照護 ； 中西醫整合治療 ； 傳統中醫 ； 針灸

並列摘要

This report describes the cross-team integrated home medical care experience on an 89-year-old female patient hospitalized because of urinary tract infections and severe spinal cord compression at cervical 4-5 level with quadriplegia and severe muscle cramps at lower limbs. Concerning her elder age and physical inconvenience, the home medical team composed of neurologists, pharmacists, and home care nurses began regular visits and changed her catheters in July after she was discharged on June 29, 2018. Her urinary tract infections and muscle cramps were gradually controlled, but the limbs were still weak. After neurology evaluation, the Chinese medicine department, which soon joined the home medical care team, was consulted in July 2019. After a half-year more of acupuncture treatment, muscle strength of both of her upper limbs improved significantly, from grade 2 to grade 4. The analgesics and muscle relaxants were gradually reduced while the pain was gradually controlled and the muscle strength improved. This successful integrated home care experience of Chinese and Western medicine informs management of neuromuscular disease-related problems in future cases.

並列關鍵字

cervical disk disorders ； home medical care ； integrated Chinese and Western medicine ； traditional Chinese medicine ； acupuncture