重度格林—巴利綜合徵的中西醫結合治療病例報告

Gase Report–The Treatment of Guillain-Barre' Syndrome with the Intergrated Chinese and Western Medicine

許堯欽(Yao-Chin Hsu) ； 陳彥行(Yen-Hsing Chen) ； 陳延年(Yan-Nian Chen)

《臺灣中醫醫學雜誌》 3卷1期 (2004/03) Pp. 51-67

摘要

本病例為79歲的老年男性病患，於92年2月16日出現感冒症狀，而後逐漸發展至四肢癱瘓無力，無法活動，深部肌腱反射消失，呼吸衰竭住進加護病房，Hughes功能等級評估屬於5級，臨床診斷為格林–巴利綜合徵（Guillain-Barre’Syndrome GBS），在接受血漿置換術後療效依舊不彰。3月14日會診中醫，依臨床見症，診斷為“痿證”，辨證為“風邪與濕痰阻絡，清陽不達四肢”，治療從脾胃論治，採健脾益氣法，化濁開竅，處方以補中益氣湯為主。服用中藥三帖後，患者肌力明顯增加，手可以握物，足可以抬高；服至第10日，除手足肌力明顯恢復外，已可脫離呼吸器自主呼吸，第12日移除鼻胃管自行進食。第14日轉入一般病房，第21日已可獨立步行5公尺以上，順利出院。一週後自已步行回中醫門診追踪，四肢活動自如，生活起居順利。而後至10/2電話隨訪，患者生活起居可自行處理，並能參與登山健行活動不需他人輔助。
在這個案例中，我們發現於西醫血漿置換術與加護維生治療中加入中醫藥，可以明顯加速重度格林–巴利綜合徵病患的功能恢復，包括全身肌力提升，脫離呼吸器的使用，提高獨立步行與恢復生活功能。中西醫結合提供了重度格林–巴利綜合徵一個新的治療希望。

關鍵字

呼吸衰竭 ； 格林-巴利綜合徵 ； 血漿置換術 ； 補中益氣湯

並列摘要

This 79 years old male patient had suffered from upper respiratory infection 3 weeks before he was admitted. Gradual paralysis of extremities developed into respiratory failure, the Hughe’s functional class is grade 5. Then he was sent into the intensive care unit on 7 March, the Diagnosis is Guillain-Barre’ syndrome. Although serum plasma exchange, no significant improvement was noted. So the Family ask for the consultation of Chinese Medicine.
We approached the patient first on 14 March, the Chinese medical diagnosis is “Illness of consumption”, and the differentiation of symptom complex is “Block of the Channels by the Wind and phlegm, the hypo functional Yang didn’t warm the extremities.” The therapeutic principle is “Replenish vital energy of the spleen and clearing off phlegm to cause resuscitation.” The Main Prescription is Decoction of 「Bu Zhong Yi Qi 」.
After taking the herb drugs, the patient showed much improvement in muscular strength he could crasp with the hands and elevate the legs independently on the 3rd day, respired spontaneously without the support of the mechanical ventilator on the 10th day and stand and along as far than 5 meters without any support on the 21th days. As the condition improvement smoothly, he was discharged. And he went back to the Chinese outpatient ward with a spiritual status and can manage in everything around his life independently
According to this experience, we noted that the combination of Chinese medicine with serum plasma exchange and life-supporting machine accelerated the recovery of Guillain-Barre' syndrome, include the regain of muscle power, remove from the mechanical ventilator, to walk independently and the early recovery of life-quality. The Integrated Chinese and Western medicine afford an effective therapeutic choice for Guillain-Barre' syndrome.

並列關鍵字

Respiratory failure ； Guillain-Barre' Syndrome ； Serum plasma exchange ； Decoction of 「Bu Zhong Yi Qi」