中西医结合治疗颅脑外伤后微小意识状态

A Case Report of Integrated Traditional Chinese and Western Medicine in Treating Patients with Minuscule Consciousness State after Craniocerebral Trauma

微小意识状态(MCS)是重度意识障碍的表现形式之一,表现为意识内容缺失,觉醒程度降低,常见于脑血管病以及颅脑外伤患者。笔者所在科室在西医常规治疗及康复手法的基础上,根据颅脑外伤意识障碍患者长期卧床,气机不畅,酿生痰湿,郁而化热以及外伤后瘀滞于脑,经络不畅,清窍失养的辨证特点,分阶段予涤痰汤涤痰开窍、益气扶正或麝香四黄汤清热豁痰、逐瘀通经、开窍醒神。该患者前期体质较弱,不能耐受攻伐,以化痰通络、益气扶正为主,经过一段时间治疗后,原发症及营养状况极大改善且伴有郁热之象,以清热豁痰、醒脑开窍、祛瘀通络为治疗原则。最终使微小意识状态半年之久的患者意识障碍显著好转,并恢复一定自理能力。

Microconsciousness(MCS)is one of the manifestations of severe disturbance of consciousness,which is mainly manifested by significant loss of consciousness content and decreased degree of awakening.It is common in patients with cerebrovascular diseases and craniocerebral trauma.On the basis of conventional Western medicine treatment and rehabilitation techniques,according to the dialectical characteristics of patients with traumatic brain injury with“long-term bed rest,qi obstruction,phlegm-induced dampness,stagnation and heat,and post-traumatic stasis in the brain,meridians obstruction,clearing and losing nourishing”,the department of the author gave Ditan decoction for clearing and clearing,supplementing qi and strengthening the body resistance or Shexiang Sihuang decoction for clearing and clearing phlegm,expelling stasis and channeling,clearing and awakening.The patient's physique was weak in the early stage,and she could not tolerate the attack,mainly therapies are dissolve phlegm and dredge collaterals,invigorate qi mainly.After a period of rehabilitation treatment,the original complications and nutritional status were greatly improved,accompanied by symptoms of stagnation and fever.The principle of treatment is clearing heat and phlegm,waking the brain and opening the orifices,removing blood stasis and dredging collaterals.Finally,the consciousness of the patients who had been in a state of minor consciousness for half a year was significantly improved,and some self-care ability was restored.