慢性呼吸衰竭患者脫離呼吸器的中醫會診病例報告

Clinical Thinking Process of Successfully Weaning in Chronic Respiratory Failure Patients by Integration of Traditional and Western Medicine

楊育書(Yu-Shu Yang) ； 田莒昌(Chu-Chang Tyan) ； 陳建仲(Jian-Jung Chen)

《台灣中醫臨床醫學雜誌》 16卷1期 (2010/03) Pp. 32-41

https://doi.org/10.6968/TJCCM.201003.0032

摘要

慢性呼吸衰竭患者脫離呼吸器的議題，在住院會診中醫的病人當中，一直是重要的課題。本例爲肺結核反種感染併發呼吸衰竭的患者，在中西醫團隊合作的治療下，不僅可讓患者在呼吸訓練期間的不適獲得最佳緩解，甚至可更順利地脫離呼吸器。此病例以中醫辨證系統診斷有疾熱壅肺、氣滯血瘀之標實證，及肺氣陰兩虛之本虛證，故以標本兼治之法，先著重於治標，一則採宣肺豁痰法使邪有出路，二則採清熱解毒法直接攻邪，兼以益氣養陰法培本貫穿整個治療過程，在準備移除氣管內管前後酌加利咽消腫、化瘀散結之品，如川七、地龍、射干、釘地蜈蚣、黛蛤散等，最後終於得以順利脫離呼吸器，使患者得以順利出院。

關鍵字

慢性呼吸衰竭 ； 肺結核 ； 氣喘 ； 呼吸器 ； 中醫

並列摘要

The issue of weaning from a ventilator plays an important role in the consultation of Chinese Medical division at hospital. We report this patient who was persistent tuberculosis with chronic respiratory failure. With combination of Western medicine and Traditional Chinese medicine, patient's discomforts are more relieved during respiratory training course and have more successful weaning chance. We present a case with both manifestative syndromes of phlegm-heat obstructing lung and qi stagnation with blood stasis, and root cause of both qi and yin deficiency. We use dispersing lung qi with dissipating phlegm and clearing heat-toxin for symptomatic treatment in acute condition, and also benefiting qi with nourishing yin through the whole treating course. Befor removing the endotracheal tube, drugs with benefits of clearing heat for detumescence from throat and removing blood stasis and resolving static blood are added, such as Sanchi (Panax pseudoginseng), Eearthworm (Perichaeta communissma G and H), She gan (Belamcanda chinensis), Taiwan wishbone flower (Torenia concolor Lindley var. formosana Yamazaki, and daige powder. Finally, he weans successfully after two months hospitalization and recovery very well after discharged.

並列關鍵字

chronic respiratory failure ； tuberculosis ； asthma ； ventilator ； Traditional Chinese TCM