出血性腦中風急性期併C反應性蛋白（CRP）升高之針灸治療一例

Applying Acupuncture to the Acute Stage of Intracranial Hemorrhage with C-Reactive Protein (CRP) Elevated: A Case Report

劉宗翰(Liu Tsung-Han)

《北台灣中醫醫學雜誌》 13卷1期 (2021/03) Pp. 45-56

摘要

一位68歲的男性，右側殼核（putamen nuclei）區域出血性腦中風發作後，左側肢體無力併吞嚥困難和失語症。中風第8天，右腦的血塊擴大併意識改變，昏迷指數Glasgow Coma Scale（GCS）從14降到11。第11天，C-Reactive Protein（CRP）升高至22.14mg/dL，當日針灸取穴：太衝（LR-3），內庭（ST-44），陰陵泉（SP-9），三陰交（SP-6），合谷（LI-4），曲池（LI-11）。3天後，CRP降為7.65 mg/dL，但患者肝指數呈現升高情形（AST=130 U/L，ALT=164 U/L），繼續維持「瀉太衝、內庭，補陰陵泉、三陰交」的治療模式，又3天後，CRP降為1.56 mg/dL，AST=58 U/L，ALT=109 U/L，患者意識清楚，GCS回到15，後續配合復健和繼續針灸治療，中風第31天拔除鼻胃管，可由口進食且語言表達可溝通理解。

關鍵字

腦出血 ； 中風急性期 ； 針灸 ； C-Reactive Protein（CRP）

並列摘要

A 68 year-old male, onset intracranial hemorrhage (ICH) at right putamen nuclei region with left hemiplegia, dysphagia and aphasia. On the 8^(th) day of onset, CT showed a mild progression of right thalamic ICH with mild midline shift, with Glasgow Coma Scale (GCS) score changed from 14(E4V4M6) to 11(E3V3M5). On the 11^(th) day, C-Reactive Protein (CRP) raised to 22.14mg/dL, then we applied traditional acupuncture on the acupoints: LR-3, ST-44, SP-9, SP-6, LI-4, and LI-11. Three days after acupuncture, CRP lowered to 7.65 mg/dL however AST/ALT raised to 130/164 U/ L. We kept the same acupuncture protocols, with 3 sessions per week. Another 3 days later, CRP lowered to 1.56 mg/dL and AST/ ALT lowered to 58/109 U/L with a GCS score of 15(E4V5M6). The patient kept acupuncture sessions and regular rehabilitation programs, on the 31^(st) day of onset, the nasogastric tube was removed, and the patient's swallow and verbal function was generally recovered.

並列關鍵字

intracranial hemorrhage ； CVA acute stage ； acupuncture ； C-Reactive Protein (CRP)

參考文獻

Di Napoli M, Slevin M, Popa-Wagner A, Singh P, Lattanzi S, Divani AA. Monomeric C-Reactive Protein and Cerebral Hemorrhage: From Bench to Bedside. Front. Immunol., 9:1921, 2018.

Ovbiagele B, Nguyen-Huynh MN. Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy. Neurotherapeutics, 8:319-329, 2011.

Wei YC, Sun MF, Chang KC, Chang CJ, Hung YC, Lin YJ, Chiu HH. Pilot scheme of health policy in stroke adjuvant acupuncture therapy for acute and subacute ischemic stroke in Taiwan. Evid Based Complement Alternat Med., 10: 1155, 2011.

Guo AS, Li AH, Chen X, Chen WG, Sun L. Effect of acupoint catgut embedding on motor function and serum high sensitivity C-reactive protein and IL-6 levels in patients with acute cerebral infarction. Zhen Ci Yan Jiu, 38(3):224-228, 2013.

王奐 之，2015， 出血 性中 風簡 介，https://www.hch.gov.tw/hch/MedicalTeams/HealthEducationDetail.aspx?MNO=C004&ID=6411 ，搜尋日期：2021 年 4 月 7 日。