顱腦外傷昏迷會診中醫病例報告

A Case Report on Treating Comatose Patient after Traumatic Brain Injury with Chinese Medicine

孫筱茹(Hsiao-Ju Sun) ； 陳有昱(Yu-Yu Chen) ； 江佩蓉(Pei-Jung Chiang)

《中醫藥研究論叢》 24卷4期 (2021/12) Pp. 89-104

https://doi.org/10.6516/TJTCM.202112_24(4).0008

摘要

顱腦損傷是指頭部受損後產生顱骨骨折、腦損、腦震盪等現象，輕症可能產生暫時的意識喪失、失憶、嘔吐，但重症則可能陷入昏迷或死亡。入院格拉斯哥昏迷指數（Glasgow Coma Scale, GCS）分數越低，年齡越高，外傷嚴重度分數（Injury Severity Score, ISS）越高，則癒後較差。在台灣的年長者中，有一半的損傷患者有顱內出血，而在顱內出血病例中，有27.1%屬重度傷害，13.5%死亡。中醫輔助治療顱腦損傷的住院患者已有多時，多項研究指出針刺及中藥治療可以改善顱腦損傷患者的意識、認知、語言和行為表現，減少損傷後發熱，改善顱腦損傷後的生活品質，減少便秘，改善憂鬱情緒，減少顱腦損傷後併發中風的風險。本案例為一66歲男性跌仆後發現顱骨骨折，急性SDH、SAH及ICH，入院時GCS=3，ISS=16分，屬嚴重外傷，在經過手術清除血塊後斷續發燒，意識不清，肢體無力，解便困難半個月，會診中醫以活血化瘀，調補肺氣，疏肝理氣，通腑降氣之法，使用水煎劑和針刺治療，有效改善其意識、肌力、發燒頻率和排便。

關鍵字

顱腦損傷 ； 意識不清 ； 針刺 ； 中醫藥

並列摘要

Traumatic brain injury refers to skull fracture, brain damage, concussion after head damages. In mild cases, symptoms include temporary loss of consciousness, memory loss, and vomiting. In severe cases, the injury may lead to coma or death. Recovery is worse for elderly patients, those with low GCS scores, or high trauma severity scores (ISS score). In Taiwan, 1/3 of all cases of traumatic brain injury involve the elderly with moderate and severe injuries. Half of the patients suffer from intracranial hemorrhage, of which 27.1% belong to severe injuries and 13.5% of them died. Chinese medicine has long been an adjuvant treatment in patients with traumatic brain injury. A number of studies on patients of traumatic brain injury found benefits from acupuncture and traditional Chinese medication on improving consciousness, cognition, language and behavior. Such treatment reduces the symptom of fever and improves life quality, constipation, and depression. In addition, it lowers the risk of stroke. In this case, a 66-year-old man presented with a skull fracture after a falling incident. He suffered from acute SDH, SAH, and ICH. At the time of hospital admission, his GCS was=3, and ISS=16. After receiving a surgical operation to remove his blood clots, he remained unconscious. For the next half month, the patient had intermittent fever, limb weakness, and constipation. Doctors from the traditional Chinese medicine department had been consulted, and acupuncture and Chinese herb decoction were prescribed. With the promotion of blood circulation and the removal of blood stasis, adjusting and nourishing lung qi, regulating liver qi, his consciousness and muscle strength gradually improved. Fever finally subsided and he experienced no constipation. Following two weeks of treatment, he was discharged from the hospital.

並列關鍵字

Traumatic Brain Injury ； Coma Status ； Traditional Chinese Medicine ； Acupuncture

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