兒童發熱性嗜中性白血球低下症的中西共同照護模式－病例報告

A Western-Chinese Medicine Integrated Care Model for Pediatric Febrile Neutropenia: A Case Report

顏嫚萱(Man-Hsuan Yen) ； 吳亞儒(Ya-Ju Wu) ； 游舜傑(Shun-Chieh Yu) ； 黃義鈞(Yi-Chun Huang)

《北市醫學雜誌》 預刊文章 Pp. 1-8

https://doi.org/10.6200/TCMJ.202201/PP.0024

摘要

目的：在現行化療後出現白血球低下症伴隨發燒的中醫理論依據下，依照患者病程特點的轉變，提出初步對應治則與方藥，可作為日後進一步研究方向參考。方法：15歲男性患者，因急性骨髓性白血病，化療後出現嗜中性球低下伴隨發燒且出現菌血症。西醫使用多種抗生素後，出現嘔吐、腹瀉等腸胃症狀，辨證後屬於邪毒內蘊，氣血虧虛。介入方式以科學中藥為主，輔以雷射針灸。急性發熱期，中藥以養陰透熱為主，佐以健脾、引火歸源之法助西藥袪邪之際兼顧護脾胃；餘熱未清時採用養陰清熱，益氣和胃之法；熱勢已退後改為補氣健脾法。結果：治療期間約兩週餘，患者恢復進食，恢復體力，最後順利出院。討論：現行已有許多文獻探討白血病的中醫治療，亦探討白血球低下發熱的病因病機與相關治療，本文以症狀分期論治，非以傳統證型分治或以腫瘤治療前、中、後分期論治，可以作為此疾病不同面向之探討。

關鍵字

白血球低下 ； 抗生素 ； 發燒 ； 食慾不振 ； 腹瀉 ； 中醫 ； 雷射針灸

並列摘要

Purpose: Proposing preliminary treatment principles and remedies according to disease progression in febrile neutropenia appearing after chemotherapy under the traditional Chinese medicine (TCM) theory framework according to disease progression for future research. Method: A 15-year-old male patient with acute myeloid leukemia presented febrile neutropenia and bacteremia after chemotherapy. After treating with multiple antibiotics, he manifested vomiting and diarrhea symptoms. Judgment by symptom differentiation demonstrated a pattern of toxin accumulated internally and Qi and blood deficiency. Interventions were TCM granules supplemented with laser acupuncture. During the acute pyrexia, the treatment aimed to nourish Yin and clear heat, accompanied by spleen strengthening and leading the fire back to its origin, to preserve the spleen/stomach while assisting the western medicine in depleting the toxin. The principles of Yin nourishing and heat eliminating and Qi toning and stomach harmonizing were adopted to manage the residual heat. In the condition that heat was degraded, the principle of Qi augmenting and spleen strengthening was adopted. Result: After two weeks of treatment, the patient started food intake and recovered his physical strength, and was discharged smoothly. Discussion: Ample literature has been attributed to discussing leukemia treatment using TCM and exploring the mechanisms and treatments of febrile neutropenia. The current article discusses the management according to symptoms, specific management for non-traditional symptom patterns, and specific management before, during, and after tumor treatment to explore different perspectives of this disease.

並列關鍵字

febrile neutropenia ； antibiotics ； fever ； poor appetite ； diarrhea ； traditional chinese medicine ； laser acupuncture