パフォーマンスステータス良好な知的障害者の膿胸の2例

Treatment for Empyema in Patients with Intellectual Disabilities That Have Good Performance Status：Report of Two Cases

はじめに　膿胸では胸腔ドレナージのみでは改善せずに手術が必要なことが多い．ただし知的障害者，特にパフォーマンスステータス（PS）がよい場合は手術のタイミングやドレーンの管理，四肢の抑制，元の施設への退院など課題がある．われわれはPS良好な知的障害者の膿胸の2例を経験したので，若干の文献的考察を含めて報告する．

Case 1 involved a 64-year-old man with severe intellectual disability and an Eastern Cooperative Oncology Group （ECOG） performance status （PS） of 1. On the second day after admission, we performed decortication and drainage of the left thoracic cavity without using a chest tube. A chest drainage tube was carefully attached to the patient’s body. The chest drain was removed on the 3rd postoperative day, and the patient was discharged from the intensive care unit the day after. The patient was discharged from the hospital on the 29th postoperative day.

Case 2 involved a 22-year-old man with intellectual disabilities and attention deficit hyperactivity disorder, with an ECOG PS of 0. On the day of admission, we performed decortication and drainage of the left thoracic cavity using video-assisted thoracoscopic surgery without chest tube drainage. The chest drain was removed on the 3rd postoperative day. The patient’s sputum required reintubation and extubation three times due to difficulty with sputum expectoration. Eventually, a tracheostomy was performed. The patient needed to have his trunk and limbs restrained. He was transferred from the intensive care unit to the psychiatric ward on the 27th postoperative day, and to a different hospital on the 42nd postoperative day. The patient was discharged on the 81st postoperative day.

When considering surgery for empyema in patients with intellectual disabilities with good PS, problems in areas such as operation timing, management of chest drains and discharge are encountered.