早期離床を中心とした理学療法が有効であった急性肺動脈血栓塞栓症に対する外科的血栓摘除術後再灌流障害により肺出血を来した1例

Physical Therapy for a Patient in Surgical Acute Pulmonary Embolectomy Complicated by Lung Hemorrhage:A case report

要旨　外科的急性肺動脈血栓塞栓摘除術に対する早期離床中心の理学療法の有効性を検討した．患者は69歳，女性で，胸部不快感と意識混濁により救急搬送となり，急性肺動脈血栓塞栓症の診断となり，摘除術を実施した．再灌流障害により肺出血を呈し，経皮的心肺補助装置を必要とした．第5病日より呼吸理学療法を中心に理学療法を開始し，第10病日より人工呼吸器挿管管理下で座位訓練，車椅子乗車を開始した．第14病日に人工呼吸器離脱し，起立，歩行訓練を実施し，第21病日に転院に至った．その後，再発などを認めず，外来通院した．

　摘除術後の理学療法には一定した見解が得られていない．早期離床を中心とした理学療法は摘除術後の呼吸状態悪化のメカニズムを考えると理に適った方法である．本症例では明らかな術後合併症を認めず，人工呼吸器離脱から日常生活の拡大に至った．結果，摘除術後に早期離床を中心とした理学療法が有効である可能性を示すことができた．

　The purpose of this case report is to discuss the efficacy of physical therapy for a patient following acute surgical pulmonary embolectomy(SAPE)complicated by lung hemorrhage. A 69-year-old woman was admitted to our hospital following chest discomfort and unconsciousness. She was diagnosed as having acute pulmonary embolization and underwent emergency SAPE. During the operation, the complication of lung hemorrhage arose due to lung reperfusion injury, so she had to be supported by percutaneous cardiopulmonary support. On the postoperative day 5, we started respiratory physical therapy for prevention of respiratory complications and arange of motion exercises for prevention of deep venous thrombosis. On the postoperative day 10, she was able to sit on the edge of the bed and sit in a wheel chair. On the postoperative day 14, she did away with the mechanical ventilator and started standing and ambulating. On the postoperative day 21, She was transferred to another hospital. Physical therapy with early mobilization is suitable for the mechanism of respiratory dysfunction following SAPE. Her course of treatment was uneventful with regard to respiratory function and she improved ambulation and undertook activities of daily living. Physical therapy with early mobilization seems to be suitable for a patient following SAPE with lung hemorrhage.