One Medical Case:Integrated Traditional Chinese and Western Medicine in the Treatment of the Difficult Ventilator Weaning that the Elderly with AECOPD Had
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1.a3Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China
2.北京中医药大学脓毒症研究所,北京 100029
3.北京中医药大学东直门医院,北京 100700
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WANG Cheng-xiang. One Medical Case:Integrated Traditional Chinese and Western Medicine in the Treatment of the Difficult Ventilator Weaning that the Elderly with AECOPD Had[DB/OL].(2023-02-28)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=23220606&Fpath=home&index=0
患者李某某,女,85岁,主因“喘憋3周,拔除气管插管后8天”于2021年6月16日至外院急诊科进行气管插管、机械通气、抗感染、对症支持等治疗后于2021年6月23日拔除气管插管。因患者经口进食反复呛咳,肺部感染未彻底控制,心力衰竭反复发作,无法出院。为求彻底治疗,首次拔管8天后,家属于2021年7月2日转入我院ICU进一步治疗。四诊信息:患者少神,喘憋,息促,动则喘甚,需用呼吸机通气,间断咳嗽,咳痰难,气短乏力,纳呆呕恶,尿少浮肿,便秘,低热,舌红黯,苔少而干,脉细滑。西医诊断:1.慢性阻塞性肺病急性加重;2.肺部感染。中医诊断:1.肺胀,痰瘀互结、水凌心肺、肺肾两虚、脾失健运证;2.风温肺热病,痰热蕴肺证。干预措施:因病情反复,于2021年7月4日再予插管上机,加强抗感染、营养支持等治疗,同时采用健脾化痰、活血利水、补肺纳肾、益气养阴的生脉注射液及汤剂联合针刺足三里、三阴交、气海、关元等穴,中西医结合救治。疗效转归:患者成功脱机、拔管,避免了气管切开,顺利出院。
Medical history summary: Li, female, 85 years old, went to the ICU of the other hospital where she was treated by endotracheal intubation, invasive ventilator,antibiotic therapy and symptomatic treatment on June 16, 2021 for "Pant for 3 weeks and 8 days after extubation" and the tube was pulled out on June 23, 2021. However, the uncontrolled pulmonary infection and heart failure caused by the repeated oral-feeding choking made that she couldn’t be discharged from the hospital. For the thorough treatment, her family decided to move her to the ICU of our hospital on July 2, 2021, 8 days after her first extubation. Diagnostic information: The patient with ventilation was less conscious, wheezing, short breathing which was severe with movement. And she coughed intermittently with difficult expectoration. The appetite was bad and vomiting appeared. She had less urine, edema and constipation. The body temperature increased slightly. Her tongue was dark red with less and drier moss. And the pulse felt thin and smooth.Ddiagnosis:1. Acute exacerbation of chronic obstructive pulmonary disease; 2. Pulmonary infection.TCM diagnosis: 1. Lung Distention with Phlegm and Blood Stasis Type,Heart and Lung with the Invasion of Water Type, Deficiency of Lung and Kidney and the dysfunction of the spleen;2.Accumulation of phlegm, Heat, Blood stasis and toxin in the lung. Treatment: Due to the unstable pathogenetic condition, the invasive ventilator was given again on July 4, 2021, and we strengthened antibiotic therapy and nutritional support. At the same time, with the combination of the acupuncture into Zusanli, Sanyinjiao, Qihai and Guanyuan, the Shengmai injection and traditional Chinese medicine decoction were given, which could improve the function of the spleen, reduce phlegm, promote blood circulation and diuresis, strengthen the lung and kidney, and replenish Qi and nourish Yin.Efficacy outcome: With the comprehensive treatment of traditional Chinese and western medicine, the patient was successfully taken off the line,avoided gas resection, and discharged smoothly.Suitable Majors:Intensive Care Unit; Emergency Department; Respiratory Department;Geriatrics
Integrated Traditional Chinese and Western MedicineComprehensive TreatmentAdvanced AgeAECOPDDifficult Ventilator Weaning
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