機械による咳介助と体位ドレナージにより無気肺の治癒と動的肺コンプライアンスが有意に増加した重症心身障がい者の症例
〔目的〕右中・下葉および左下葉の無気肺を呈している重症心身障がい者（重症者）に対して，機械による咳介助（MI-E）と体位ドレナージ（PDT）で右中・下葉の無気肺が治癒し，動的肺コンプライアンス（Cdyn）が有意に増加した症例を報告する．〔対象と方法〕37歳男性．気管切開下の人工呼吸器管理（TPPV）．四肢麻痺．Cobb角92.8°の側弯．右中・下葉の無気肺にはMI-EとPDTを実施した．左下葉には重度側弯により不十分なPDT下でのMI-Eを実施した．〔結果〕右中・下葉の無気肺は治癒したが，左下葉の無気肺は治癒しなかった．Cdynは介入6週間後に有意に改善した．〔結語〕重度側弯な重症者にはMI-...
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| Published in | Rigaku ryoho kagaku Vol. 34; no. 1; pp. 143 - 147 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Tokyo
理学療法科学学会
01.01.2019
Japan Science and Technology Agency |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1341-1667 2434-2807 |
| DOI | 10.1589/rika.34.143 |
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| Abstract | 〔目的〕右中・下葉および左下葉の無気肺を呈している重症心身障がい者（重症者）に対して，機械による咳介助（MI-E）と体位ドレナージ（PDT）で右中・下葉の無気肺が治癒し，動的肺コンプライアンス（Cdyn）が有意に増加した症例を報告する．〔対象と方法〕37歳男性．気管切開下の人工呼吸器管理（TPPV）．四肢麻痺．Cobb角92.8°の側弯．右中・下葉の無気肺にはMI-EとPDTを実施した．左下葉には重度側弯により不十分なPDT下でのMI-Eを実施した．〔結果〕右中・下葉の無気肺は治癒したが，左下葉の無気肺は治癒しなかった．Cdynは介入6週間後に有意に改善した．〔結語〕重度側弯な重症者にはMI-Eと最適なPDTが必要である． |
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| AbstractList | 要旨: 〔目的〕右中・下葉および左下葉の無気肺を呈している重症心身障がい者(重症者)に対して, 機械による咳介助(MI-E)と体位ドレナージ(PDT)で右中・下葉の無気肺が治癒し, 動的肺コンプライアンス(Cdyn)が有意に増加した症例を報告する. 〔対象と方法〕37歳男性. 気管切開下の人工呼吸器管理(TPPV). 四肢麻痺. Cobb角92.8°の側弯. 右中・下葉の無気肺にはMI-EとPDTを実施した. 左下葉には重度側弯により不十分なPDT下でのMI-Eを実施した. 〔結果〕右中・下葉の無気肺は治癒したが, 左下葉の無気肺は治癒しなかった. Cdynは介入6週間後に有意に改善した. 〔結語〕重度側弯な重症者にはMI-Eと最適なPDTが必要である. 〔目的〕右中・下葉および左下葉の無気肺を呈している重症心身障がい者（重症者）に対して，機械による咳介助（MI-E）と体位ドレナージ（PDT）で右中・下葉の無気肺が治癒し，動的肺コンプライアンス（Cdyn）が有意に増加した症例を報告する．〔対象と方法〕37歳男性．気管切開下の人工呼吸器管理（TPPV）．四肢麻痺．Cobb角92.8°の側弯．右中・下葉の無気肺にはMI-EとPDTを実施した．左下葉には重度側弯により不十分なPDT下でのMI-Eを実施した．〔結果〕右中・下葉の無気肺は治癒したが，左下葉の無気肺は治癒しなかった．Cdynは介入6週間後に有意に改善した．〔結語〕重度側弯な重症者にはMI-Eと最適なPDTが必要である． [Purpose] Mechanical insufflation-exsufflation (MI-E) significantly improved atelectasis of the right medial lobe, lower lobe and lower left lobe, and thoracic compliance (Cdyn) in a subject with severe motor and intellectual disabilities (SMID). [Participant and Methods] The subject was a 30-year-old with SMID. Ventilator management under tracheotomy for quadriplegia, scoliosis with Cobb angle 92.8°, and passive right lateral decubitus posture was incomplete. Postural drainage + MI-E was performed for atelectasis of the right middle lobe and the lower lobe. Due to the severity of scoliosis, insufficient postural drainage + MI-E was performed on the lower left lobe. [Results] Atelectasis of the middle and lower lobes of the right lung disappeared, but partial atelectasis of the left lower lobe did not improve. Cdyn improved significantly after 6 weeks of intervention. [Conclusion] Insufficient postural drainage did not improve atelectasis. It took one month to improve Cdyn. |
| Author | 佐竹, 將宏 木元, 裕介 岩澤, 里美 菊地, 和人 白崎, 和也 |
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| References | 9) Siriwat R, Deerojanawong J, Sritippayawan S, et al.: Mechanical Insufflation-exsufflation versus conventional chest physiotherapy in children with cerebral palsy. Respir Care, 2018, 63: 187-193. 2) 水野勇司，高松美紀，曳野晃子：重症心身障害児（者）における無気肺の発生要因の検討と気管支鏡による治療の有効性．脳と発達，2004, 36: 304-310. 6) 村上知恵，鈴木聖子，河野義恭・他：重症心身障害者におけるインエクスサフレータの長期有用性の検討．日重症心身障害誌，2011, 36: 113-117. 15) Bott J, Blumenthal S, Buxton M, et al. British Thoracic Society Physiotherapy Guideline Development Group: Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 2009, 64: i1-i51. 12) Bushby K, Finkel R, Birnkrant DJ, et al. DMD Care Considerations Working Group: Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol, 2010, 9: 177-189. 16) Brüssel T, Hachenberg T, Roos N, et al.: Mechanical ventilation in the prone position for acute respiratory failure after cardiac surgery. J Cardiothorac Vasc Anesth, 1993, 7: 541-546. 3) 日本リハビリテーション医学会脳性麻痺リハビリテーションガイドライン策定委員会：脳性麻痺リハビリテーションガイドライン，第2版．金原出版，東京，2014，pp203-205 13) Miller RG, Jackson CE, Kasarskis EJ, et al. Quality Standards Subcommittee of the American Academy of Neurology: Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2009, 73: 1227-1233. 7) 行山頌人，藤本智久，西村暁子・他：人工呼吸器管理中の児に対するMecanically Assisted Coughingの効果．姫路赤十字病院雑誌，2016, 40: 59-62. 10) 横山仁志，森尾裕志，平木幸治：人工呼吸器装着下における肺コンプライアンス測定の再現性．高知リハビリテーション学院紀要，2008, 9: 17-21. 11) Birnkrant DJ, Bushby KM, Amin RS, et al.: The respiratory management of patients with duchenne muscular dystrophy: a DMD care considerations working group specialty article. Pediatr Pulmonol, 2010, 45: 739-748. 17) Bach JR: Noninvasive respiratory management of patients with neuromuscular disease. Ann Rehabil Med, 2017, 41: 519-538. 4) Strickland SL, Rubin BK, Haas CF, et al.: AARC Clinical Practice Guideline: effectiveness of pharmacologic airway clearance therapies in hospitalized patients. Respir Care, 2015, 60: 1071-1077. 14) McCool FD, Rosen MJ: Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129: 250S-259S. 5) Homnick DN: Mechanical insufflation-exsufflation for airway mucus clearance. Respir Care, 2007, 52: 1296-1305, discussion 1306-1307. 1) Winfild NR, Barker NJ, Turner ER, et al.: Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay. Cochrane Database Syst Rev, 2014, 10: 1-69. 8) He YL, Liao DL, Kang HY, et al.: Comparison of mechanical insufflation-exsufflation and percussors in the treatment of lung infections for children with cerebral palsy. J Pediatr Resp Dis, 2013, 9: 40-47. |
| References_xml | – reference: 2) 水野勇司，高松美紀，曳野晃子：重症心身障害児（者）における無気肺の発生要因の検討と気管支鏡による治療の有効性．脳と発達，2004, 36: 304-310. – reference: 9) Siriwat R, Deerojanawong J, Sritippayawan S, et al.: Mechanical Insufflation-exsufflation versus conventional chest physiotherapy in children with cerebral palsy. Respir Care, 2018, 63: 187-193. – reference: 4) Strickland SL, Rubin BK, Haas CF, et al.: AARC Clinical Practice Guideline: effectiveness of pharmacologic airway clearance therapies in hospitalized patients. Respir Care, 2015, 60: 1071-1077. – reference: 6) 村上知恵，鈴木聖子，河野義恭・他：重症心身障害者におけるインエクスサフレータの長期有用性の検討．日重症心身障害誌，2011, 36: 113-117. – reference: 7) 行山頌人，藤本智久，西村暁子・他：人工呼吸器管理中の児に対するMecanically Assisted Coughingの効果．姫路赤十字病院雑誌，2016, 40: 59-62. – reference: 13) Miller RG, Jackson CE, Kasarskis EJ, et al. Quality Standards Subcommittee of the American Academy of Neurology: Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2009, 73: 1227-1233. – reference: 16) Brüssel T, Hachenberg T, Roos N, et al.: Mechanical ventilation in the prone position for acute respiratory failure after cardiac surgery. J Cardiothorac Vasc Anesth, 1993, 7: 541-546. – reference: 10) 横山仁志，森尾裕志，平木幸治：人工呼吸器装着下における肺コンプライアンス測定の再現性．高知リハビリテーション学院紀要，2008, 9: 17-21. – reference: 12) Bushby K, Finkel R, Birnkrant DJ, et al. DMD Care Considerations Working Group: Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol, 2010, 9: 177-189. – reference: 1) Winfild NR, Barker NJ, Turner ER, et al.: Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay. Cochrane Database Syst Rev, 2014, 10: 1-69. – reference: 11) Birnkrant DJ, Bushby KM, Amin RS, et al.: The respiratory management of patients with duchenne muscular dystrophy: a DMD care considerations working group specialty article. Pediatr Pulmonol, 2010, 45: 739-748. – reference: 17) Bach JR: Noninvasive respiratory management of patients with neuromuscular disease. Ann Rehabil Med, 2017, 41: 519-538. – reference: 5) Homnick DN: Mechanical insufflation-exsufflation for airway mucus clearance. Respir Care, 2007, 52: 1296-1305, discussion 1306-1307. – reference: 14) McCool FD, Rosen MJ: Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129: 250S-259S. – reference: 3) 日本リハビリテーション医学会脳性麻痺リハビリテーションガイドライン策定委員会：脳性麻痺リハビリテーションガイドライン，第2版．金原出版，東京，2014，pp203-205． – reference: 8) He YL, Liao DL, Kang HY, et al.: Comparison of mechanical insufflation-exsufflation and percussors in the treatment of lung infections for children with cerebral palsy. J Pediatr Resp Dis, 2013, 9: 40-47. – reference: 15) Bott J, Blumenthal S, Buxton M, et al. British Thoracic Society Physiotherapy Guideline Development Group: Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 2009, 64: i1-i51. |
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| Snippet | ... 要旨: 〔目的〕右中・下葉および左下葉の無気肺を呈している重症心身障がい者(重症者)に対して, 機械による咳介助(MI-E)と体位ドレナージ(PDT)で右中・下葉の無気肺が治癒し, 動的肺コンプライアンス(Cdyn)が有意に増加した症例を報告する. 〔対象と方法〕37歳男性. 気管切開下の人工呼吸器管理(TPPV).... [Purpose] Mechanical insufflation-exsufflation (MI-E) significantly improved atelectasis of the right medial lobe, lower lobe and lower left lobe, and thoracic... |
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| SubjectTerms | Case reports Intellectual disabilities Posture Scoliosis 体位ドレナージ 機械による咳介助 重症心身障がい者 |
| Title | 機械による咳介助と体位ドレナージにより無気肺の治癒と動的肺コンプライアンスが有意に増加した重症心身障がい者の症例 |
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