- 期刊
針灸治療造成氣胸之處理
Management of Pneumothorax Following Acupuncture
摘要
目的 探討針刺導致氣胸的處理方式，並提出避免針刺氣胸的探討。 方法 由病歷紀錄的追蹤，回顧了從1987年到2002年這5年當中，因針灸治療而造成氣胸的7個案例。 結果 7例當中，男性1例，女性6例，年齡由17歲到53歲 (平均31.2歲)。其中，6例因罹患慢性背痛、頸部僵硬和肩痛，1例因上肢肌肉萎縮，而接受針灸治療。這些個案下針的穴道(膏肓、頸華佗夾脊、肩井穴、肩外俞、肩貞、天 )，都接近在後上背部的位置。針灸治療後，7例都因有胸痛和呼吸困難的主訴而尋求治療。經胸部X光檢查，7例都顯示有氣胸。在臨床處置上，2例僅在門診做臨床觀察，皆在1星期後氣胸獲得改善；4例需接受pigtail導管引流治療，3例在2天後、1例在3天後拔管出院；另外1例因肺臟塌陷而實施胸腔鏡手術，在手術後4天出院。 結論 針灸治療可能造成氣胸，若能及時處理，對於小量氣胸，可以臨床觀察，大量氣胸，則須放置pigtail導管引流。若導管引流失敗，可考慮以胸腔鏡手術，達到治癒的目的。若能加強針灸醫師對於病人的安全觀念，並做好預防措施，將可避免氣胸的發生。
並列摘要
Objectives. Iatrogenic penumothorax is rarely caused by acupuncture. However, we have encountered 7 patients in the past 5 years who developed this condition. In this article, we discuss the management and prevention of pneumothorax caused by acupuncture. Methods. We reviewed 7 consecutive patients who sought traditional acupuncture to treat chronic back pain, neck stiffness and shoulder joint pain. All patients developed penumothorax after acupuncture was performed at two acupoints, BL-43 (膏肓 Gaohuang) and GB-21 (肩井Jianjing) within the past 5 years. Results. There were 6 females and 1 male (age range, 17 to 53 years; average, 31.2 years) One of the patients required video-assisted thoracoscopic surgery for wedge resection of leak site and vigorous pleurodesis due to persistant air leak and collapse of lung. Four patients required pig-tail drainage. Two patients fully recovered without intervention. Conclusions. Pneumothorax following acupuncture does occur but usually can be attributed to insufficient basic medical anatomical knowledge, low hygienic standards and inadequate acupuncture training.