出血性腦中風的中西醫結合治療病例報告

Management of Hemorrhagic Stroke by Integrated Chinese and Western Medicine: A Case Report

許堯欽(Yao-Chin Hsu) ； 葉昭宏(Chao-Hung Yen) ； 游榮聖(Jung-Sheng Yu) ； 陳延年(Yan-Nian Chen)

《臺灣中醫醫學雜誌》 4卷2期 (2005/09) Pp. 22-37

https://doi.org/10.30032/TJCM.200509.0004

摘要

這是一位53歲男性病患，94年1月8日早晨突發意識不清並發生嘔吐，被送入本院急診，到院時意識昏迷，GCS:E1VeM4，右側手足無力，腦部電腦斷層顯示左側大腦的被核丘腦出血(Left putamino-thalamic hemorrhage)，積血破裂進入腦室。1月9日施行緊急減壓開顱術取出血塊，術後病患持續呈現重度昏迷，又發生呼吸衰竭，故會診中醫治療。1月14日中醫會診時病患證見昏迷不醒，GCS:E1VeM2，發燒、血壓高。手足四肢腫脹拘緊，對按壓疼痛無反應；痰黃量多，大便秘。舌苔白舌質紅，脈來弦滑。診斷為中風，中臟腑，痰火內閉。經投以清熱化痰合通腑瀉下中藥，服藥後患者高熱漸退，黃痰減，血壓緩降，大便得通，四肢氣腫消失。至第十帖時病患意識甦醒，兩眼可自行張開，眼球隨聲音而轉動。而後病患因感染再度發高燒，血壓上升，配合抗生素我們隨證加以平肝潛陽藥，終於逐漸控制感染與血壓，病人得於2月3日脫離呼吸器，轉至一般病房。此後處方以健脾益氣養陰類中藥為主，固護元氣，再配合電針治療。病患的體能逐漸好轉，手足肌力進步，可自己手拿餅乾由口腔進食。於2月18日接受顱骨重置術，並順利於2月28日出院。

關鍵字

大腦被核丘腦出血 ； 痰火內閉 ； 清熱化痰 ； 通腑瀉下

並列摘要

This is a case of 53 years old male patient. Episodic vomiting followed by disorientation happened, then he was sent to our Emergency Departmtnt on the morning of January 8, 2005. He had suffered from coma and right side hemiplegia, Glasgow Coma Scale revealed E1VeM4, the Brain Computered Tomography showed Left putamino-thalamic hemorrhage and ruptured into the ventricle. Decompressive Craniectomy was performed to remove intracerebral hematoma on January 9. But the patient was still in deep comatose state after the surgical operation. So the family asked for the combined treatment of Chinese Medicine.
We first visited the patient on January 14, he was comatose with those following symptoms coordinated with the diagnosis of 「Stroke; Wind evil invading the organs; Spirit obstructed by phlegm-fire」。: Glasgow Coma Scale E1eM2、high fever、hypertention、tightness of extremities without any reaction to pain、productive purulent sputum、constipation、reddish tongue with whittish fur、string and slippery pulse. According to the rule of 「Diagnosis and treatment based on overall analysis of symptoms and signs, we prescribed the formula consisted of herbs 「Clearing heat and Transforming phlegm、Precipiting gastrointestinal heat-bind」。After medication, the fever subsided, sputum decreased, blood pressure subsided, stool passage patent and subcutaneous emphysema disappeared. The patient's had regained his consciousness on January 24, opened his eyelids and turned eyeballs smoothly.
Unfortunately, high fever and hypertention recurred according to respiratory and urinary infection. But we controlled the infection with the combined of antibiotics and herbs which can 「Subduing Yang of the Liver」 and 「Bezoar Resurrection Pills」. Then the ventilator was removed smoothly and rehabilitation started. Accu-puncture and herbs to 「reinforce the vital energy and invigorate the function of the spleen」 was arranged. The patient's spiritual and physical condition got better and better gradually. He had discharged on February 282005.
According to the Integrated Chinese and Western Medicine, we survived the patients from a critical status.

並列關鍵字

Cerebral putamino-thalamic hemorrhage ； Mental obstruction due to phlegm and fire ； removed heat and dispelled the phlegm ； relieve constipation and clear stagnation