7．周術期管理—広範囲・重症熱傷特有の病態を意識した術後管理

Perioperative management of patients with severe burns

広範囲・重症熱傷患者の周術期管理の要諦は，集中治療医自らが行う積極的な創部の観察，焼痂切除術（デブリードマン）から植皮術に至る一連の手術戦略の十分な理解，そして，長期に及ぶ手術戦略の一環としての周術期管理の実践である。

　急性期から繰り返される手術の術後管理，長期人工呼吸器管理に伴う気道管理の選択，感染症との長い闘い，難渋する鎮痛・鎮静，どれも集中治療医の腕の見せどころである。

　本稿では，広範囲・重症熱傷患者に対する超急性期のデブリードマンから植皮術の完了までの周術期管理，とりわけ形成外科医や救急医などの術者が集中治療医に期待する広範囲・重症熱傷特有の病態を意識した術後管理についてまとめた。

In the management of patients with severe burns, it is important for the intensive care physician to actively observe the wounds, to fully understand the series of surgical strategies from debridement to skin grafting, which involves multiple operations, and to be aware of perioperative management as part of the overall surgical strategy. Postoperative management of repeated operations from the acute stage, selection of airway management with long-term ventilator management, prevention and management of infections, complex severe pain management and sedation are all opportunities to apply the skills of the intensive care physician. This article summarizes perioperative management from debridement to skin grafting in the hyperacute stage of patients with severe burns, especially postoperative management with an awareness of the specific pathophysiology of severe burns expected from intensive care physicians by members of the care team such as plastic surgeons and emergency physicians.