Case Report J Sasang Constitut Med 2016;28(4):403-411 https://doi.org/10.7730/jscm.2016.28.4.403 Abstract A Case Report of a Soeumin Patient with Dyspnea Induced by Neuromuscular Disease Sung-Pil Yang Jin-Young Kim Ji-won Lee Byung-Hee Koh Eui-Ju Lee Dept. of Sasang Constitutional Medicine, Kyung Hee University, Korean Medical Center Objectives Dyspnea due to neuromuscular disease is very rare in the complementary medicine field. The purpose of this study is to report a case which showed sypmtoms improvement after treatment with Sohaphyang-won. Methods To evaluate the results of this treatment, number of days which the patient had dyspnea, results of an Arterial blood gas analysis, and the patient`s lab reports were measured. Results The patient who suffered from severe sudden dyspnea and applying mechanical ventilator, was treated by Sohaphyang-won and acupuncture therapy for about 2 months. He had been diagnosed as dyspnea caused by neuromuscular disease, which in Western medicine there was no specific treatment. But after treated with Sohaphyang-won and acupuncture, his frequency of dyspnea decreased. Conclusions This study suggests that using Sasang constitutuional medical treatment is effective for Soeumin patient with dyspnea induced by neuromuscular disease. Key Words : Soeumin, Dyspnea, Neuromuscular disease, Sohaphyang-won Received November 23, 2016 Revised November 30, 2016 Accepted December 19, 2016 Corresponding Author Eui-Ju Lee Dep. of Sasang Constitutional Medicine, Kyunghee University Korean Medicine Hospital. Seoul. Korea Tel: +82-2-958-9230 Fax: +82-2-958-9230 E-mail: sasangin@daum.net The Society of Sasang Constitutional Medicine. All rights reserved. This is an open acess article distributed under the terms of the Creative Commons attribution Non-commercial License (http:// creativecommons.org/licenses/by-nc/3.0/)
404 A Case Report of a Soeumin Patient with Dyspnea Induced by Neuromuscular Disease Ⅰ. 緖論 (Amyotrophic Lateral Sclerosis, ALS) 1869 Jean Martin Charcot, 1933 (motor neuron disease, MND) PMA, PBP, PLS, ALS. 1939 Lou Gehrig ALS Lou Gehrig 1. ALS (upper motor neuron, UMN) (lower motor neuron, LMN).,,,, (bulbar).,,, 3-5 2. 3 2004, 4 5. (ALS). Ⅱ. 證例 1. : (M/74yr) 2. 발병일 : 2015 4 3. 치료기간 : 2016 7 25 ~2016 10 28 (96 ) 4. 진단명 :. 5. 주소증 1) 호흡곤란 2) 불안 6. 과거력 1) Sigmoid colon cancer(lung meta 2007 ) 2) Spinal stenosis(l4-5, S1) 3) Hypertension 7. 사회력 1) 음주력 : 2) 흡연력 : (+) 40 8. 가족력 : (colon cancer) 9. 현병력 : 2007. s-colon cancer lung meta. 2014 51, 2012.6 colon polyp colon polypectomy 2014. spinal stenosis(l4-5, S1), 2015 4 2015.7-2016.3 2016.3-2016.5 2016.5-2016.7 2016.7.
SP Yang et al. 405 10. 1) 165cm, 50kg. 2) 容貌詞氣, tracheostomy,. 3) 性質材幹. 4) 素症 (1) : 5-6 1-2. 1. (2) 食慾, 消化 : 1/2~1. (3) 口渴, 飮水 :. (4) 大便 : 3~4 1,. (5) 小便 :. (6) 汗出, 寒熱 :. (7) 舌, 脈 :,,. 5) QSCCⅡ 결과 : 11. 주요검사소견 1) Chest CT 소견 (2016 년 5월 11일 ) Possible aspiration pneumonia with multiple mucus secretions. a/w multiple centrilobular nodules on both lungs, r/o bronchiolitis. No change of several nodules in both lungs. --> r/o benign nodule such as granuloma. Improved pneumonia on RML and RLL. R/O mild combined pulmonary edema. Tb sequeale on RUL, no change. 2) 심전도결과 - 2016 7 18 Normal sinus rhythm Right bundle branch block Abnormal ECG 3) 복부초음파소견 (2016 년 7월 28일 ) Normally placed foley catheter in UB. Multiple urinary bladder stones Table 1. Progress of Lab Results 5/11 5/23 6/7 6/22 7/13 8/2 8/19 9/15 10/4 10/26 BUN (8~23 mg/dl) 18 19 19 27 16 14 14 15 11 15 Creatinine (0.6~1.2 mg/dl) 0.4 0.3 0.3 0.3 0.3 0.3 0.4 0.2 0.3 0.3 AST (0~40 U/L) 46 52 52 47 31-40 47 29 - ALT (0~40 U/L) 37 39 64 50 29-44 51 29 - CRP (0~0.3 mg/dl) 4.52 0.59 8.93 2.46 4.97 5.34 0.61 1.50 4.55 2.19 Na (135~145 mmol/l) 135 137 136 137 138 140 140 139 138 135 K (3.5~5.0 mmol/l) 3.7 3.4 3.3 3.6 3.5 3.6 3.8 3.5 3.4 3.8 WBC (4.0~10.0 103/ul) 4.59 3.92 3.01 1.98 2.51 2.92 3.09 5.50 5.59 5.83 Hemoglobin (13~17 g/dl) 9.1 9.6 9.2 7.9 9.0 8.7 9.0 9.8 8.8 10.2 Bun : Blood urea nitrogen ; AST : Aspartare aminotransferase ; ALT : Alanine aminotransferase ; CRP : C-Reactive Protein ; Na : Sodium ; K : Potassium ; WBC : White blood cell
406 A Case Report of a Soeumin Patient with Dyspnea Induced by Neuromuscular Disease 4) 결과 : Table 1. Ⅲ. 治療및經過 1. 방법 1) 한약치료 2016 7 25 2016 10 28. 2016 7 25 2016 8 2 2 3 100cc 10, 15, 20, 2016 8 4 2016 8 11 1 15, 2016 8 12 2016 10 28 2 10, 20 (Table 2). 2) 침구치료 1 1,,,,,, 20. 1 stainless 0.20mm 30mm( ). 3) 양방치료, consult. (1) 및주사처치 2016 7 25 ~ 2016 10 28 10% + 1000ml 2016 7 29 ~ 2016 8 5 Finibax 0.25g q 8hrs/ 100ml mix 2016 8 5 ~ 2016 8 24 Table 2. The Prescription of Herbal Medicine Herbal name Pharmaceutical Name Atractylodis Rhizoma Alba 4 * 150 Agastachis Herba 2 150 Ginseng Radix 12 Astragali Radix 12 Zingiberis Rhizoma Crudus 6 Zizyphi Fructus 6 Angelicae Gigantis Radix 4 Citri Unshius Pericarpium 4 Glycyrrhizae Radix et Rhizoma 4 Perillae Folium 2 Cyperi Rhizoma 150 Aucklandiae Radix 150 Aquilariae Lignum 150 Piperis Longi Fructus 150 Syzygii Flos 150 Foeniculi Fructus 150 Pterocarpus Indicus 150 Cinnamomi Cortex 150 Benzoinum 150 Chubulae Fructus 150 Trogopterorum Faeces 75 Corydalis Tuber 75 *Dose: g
SP Yang et al. 407 Tazolactam 4500mg q 8hrs/ 100ml mix Vancomycin HCl 750mg q 12hrs/ 100ml mix 2016 9 1 ~ 2016 9 19 Maxipime 2g q 8hrs/ 100ml mix 2016 9 29 ~ 2016 10 5 Tazolactam 4500mg q 8hrs/ 100ml mix 2016 9 29 ~ 2016 10 5 Unasyn 2g q 6hrs/ 100ml mix (2) 약물처치 2016 7 25 ~2016 10 28 lansoprazole 30mg 1T#1, pseudoephedrine hydrochloride 60 /triprolidine hydrochloride 2.5 1T#1, nortryptiline 10mg 0.5T#2, clopidogrel 75mg 1T#1 (3) 흡입분무처치 2016 7 25 ~2016 10 28 : mucomyst=2:1 6 4) 치료 Covidien Puritan bennett 560 home ventilator. -mode: P A/C -Pi: 5cm H2O -PEEP: 6cm H2O -Rise time: 2 -Rate: 28bpm -Voulume total target: 350ml. 2) (Arterial blood gas analysis, ABGA) ph, po2, pco2. 3) 혈액검사상의변화. 3. 치료경과 1) 호흡곤란횟수의변화 (2016 년 5월 11일 ~2016 년 10월 28일 ) (1) 2016년 5월 11일 ~ 2016년 8월 3일 ( 소합원투여전 ) 5/11, 5/17, 5/18, 5/26, 5/30, 6/5, 6/14, 6/20, 6/21, 6/30, 7/5, 7/30, 8/2(85 13 ). (2) 2016년 8월 4일 ~ 2016년 10월 28일 ( 소합원투여후 ) 8/8, 8/31, 9/24, 10/1(86 4 )(Figure 1). 2. 방법 1) 호흡곤란횟수 spo2 monitor 90% 30. 7/25 Figure 1. Changes of the dyspnea ratio
408 A Case Report of a Soeumin Patient with Dyspnea Induced by Neuromuscular Disease Table 3. Progress of Arterial Blood Gas Analysis Results ph (7.38~7.46) pco2 (32~46 mmhg) po2 (74~108 mmhg) 5/15 6/1 6/7 6/14 6/22 7/6 7/29 8/3 8/19 8/24 9/16 10/1 10/15 10/27 7.357 7.553 7.633 7.737 7.590 7.593 7.516 7.424 7.442 7.451 7.439 7.475 7.449 7.434 55.9 27.4 26.2 17.4 24.7 25.2 33.8 44.8 36.2 36.1 43.0 37.7 37.9 43.4 43.6 133.4 91.7 86.1 65.6 111.4 84.6 54.6 100.5 102.0 80.9 87.1 88.1 100.8 2) (Arterial blood gas analysis, ABGA) 2016 5 11 ~2016 10 28 (Table 3). 3) 혈액검사상의변화 2016 5 11 ~2016 10 28 (Table 1). Ⅳ. 考察 ALS 10 2, 10 7 1. 50 70, 85 6. ALS UMN LMN. (UMN),,,,,,. UMN,,, 7. (LMN),,. Split hand,.,,,.,,, 8. (bulbar palsy),.,,,, 9.,. 2016 5 11 chest CT. Percutaneous endoscopic gastrostomy tube( PEG tube),., 30,.,
SP Yang et al. 409. Brain CT, Brain MRI, Electromyogram(EMG), Electonystagmogram (ENG),. Brain CT Brain MRI, EMG ENG motor-neuron disease, (Amyotrophic lateral sclerosis, ALS) ALS (Neuromuscular disease). 10,. ambu-bagging,..,,.,.,.,.. PEG tube. (Table 3). 11 12,,.,,,,,,,,,,,,, 13. ALS, 14. PEG tube.
410 A Case Report of a Soeumin Patient with Dyspnea Induced by Neuromuscular Disease, 85 13 (15%) 86 4 (5%). (ABGA) ph, pco2, po2. AST, ALT CRP. ALS, ALS.,,,. 2~3,.,...,. 3~6., (ventilator-induced lung injury),, 15.,. rivotril alprazolam,.,.... Ⅴ. 結論,.
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