基于中医经典理论指导的分期辨证协同治疗黄疸出血型重症钩体病案例
增强出版Case Analysis of Integrated Traditional Chinese and Western Medicine for Severe Leptospirosis with Jaundice Haemorrhaging
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1.佛山市中医院肝病科,广东 佛山 528000
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谢悠青, 蒋开平. 基于中医经典理论指导的分期辨证协同治疗黄疸出血型重症钩体病案例[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=32156517&Fpath=home&index=0
XIE Youqing, JIANG Kaiping. Case Analysis of Integrated Traditional Chinese and Western Medicine for Severe Leptospirosis with Jaundice Haemorrhaging[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=32156517&Fpath=home&index=0
谢悠青, 蒋开平. 基于中医经典理论指导的分期辨证协同治疗黄疸出血型重症钩体病案例[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=32156517&Fpath=home&index=0 DOI:
XIE Youqing, JIANG Kaiping. Case Analysis of Integrated Traditional Chinese and Western Medicine for Severe Leptospirosis with Jaundice Haemorrhaging[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=32156517&Fpath=home&index=0 DOI:
病史摘要,2,患者因“反复发热1周”于2018年9月22日收入我院急诊科住院部。患者1周前无明显诱因下出现发热,热峰39.8℃,伴畏寒,肌肉酸痛,少许头痛,少许咳嗽咯痰,痰黄白,口干,腹胀,至当地医院诊治后(具体用药不详)后发热可退,症状反复,入院当日再次发热,热峰39.7 ℃。入院症见:神清,精神稍倦,身黄、目黄、尿黄,无发热,肌肉酸痛,少许咳嗽咯痰,黄白痰,口干,腹胀,胃纳及睡眠尚可,大便正常。体格检查:神志清醒,全身皮肤巩膜重度黄染,全身皮肤未见皮疹、焦痂,双下肢皮肤见散在暗红色出血点。双肺呼吸音清,未闻及干湿性啰音。心律齐,未闻及病理性杂音。腹平软,上腹部轻压痛,肝脾未触及,Murphy征阴性,肝区无叩痛,双肾区无叩痛,移动性浊音阴性,肠鸣音正常。舌暗红,苔黄稍腻,脉浮数。入院后完善相关检查,积极治疗后患者黄疸仍持续加重,且出现气促、便血、尿血、皮下出血加重等症状,考虑为多器官功能衰竭而转ICU重症监护治疗,监护治疗期间出现神志烦躁、尿量减少,遂请蒋开平主任中医师指导中医诊疗。中医诊断 黄疸病(瘀热内结证)西医诊断 钩端螺旋体病(重症黄疸出血型)干预措施 西医予抗感染、护肝、退黄、肾替代治疗等对症支持治疗。中医药治疗根据患者疾病进展的不同时期,分别以泻热逐瘀、养阴清热、清热利湿为法分期辨证施治。疗效转归 患者得以成功救治。
Summary of case history ,The patient was admitted to the Emergency Department of our hospital on September 22, 2018 due to recurrent fever for one week. The patient developed fever without obvious inducement 1 week ago, with a heat peak of 39.8 ℃, accompanied by chills, muscle soreness, a little headache, a little cough with sputum, yellow and white sputum, dry mouth, and abdominal distension. After diagnosis and treatment in the local hospital (the specific medication is unknown), the fever could be resolved, and the symptoms were repeated. On the day of admission, the patient had fever again with a heat peak of 39.7℃.Symptoms of admission: slightly tired, yellow body, yellow eyes, yellow urine, no fever, muscle soreness, a little cough withyellow white sputum, dry mouth, abdominal distension, stomach appetite and sleep is OK, normal stool. Physical examination: He was conscious, with severe yellow staining on the skin and sclera of the whole body, no rash or eschar on the skin of the whole body, and scattered dark red bleeding spots on the skin of both lower limbs. Breath sounds in both lungs were clear, and no wet or dry rales were heard. Rhythm is uniform. No pathological murmurs. The abdomen was flat and soft, the upper abdomen was light and tender, the liver and spleen were not palpable, Murphy's sign was negative, there was no tapping pain in the liver area, there was no tapping pain in the bilateral kidney area, there was no mobility dullness, and the bowel sounds were normal. Tongue dark red, slightly greasy yellow moss, pulse floating number. After admission to the related inspection andactive treatment in patients, Butjaundice continues to increase, and shortness of breath, bloody, bloody urine, the symptom such as subcutaneous hemorrhage is aggravating, considering multiple organ failure and ICU intensive care, monitoring during treatment in mind agitated, reduced the volume of urine, hence please kai-ping jiang, director of the TCM doctor to guide diagnosis and treatment.,TCM diagnosis ,Jaundice (internal stasis and heat syndrome),Western medicine diagnosis, Leptospirosis (severe jaundice),Therapeutic methods ,Western medicine gives symptomatic and supportive treatment such as anti-infection, liver protection, Relieve cholestasis and renal replacement therapy. According to the different stages of disease progression, TCM treatment is divided into syndrome differentiation and treatment by eliminating heat and removing blood stasis, nourishing Yin and clearing heat and removing dampness.,Clinical outcomes ,The patient was successfully treated.
中西医结合黄疸分期辨证钩端螺旋体病
Integrated traditional Chinese and western medicine1Jaundice2Stage differentiation3Leptospirosis4.
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