16．熱傷・気道損傷患者のリハビリテーション—病期・病態に合わせて実施する

Rehabilitation of patients after burns and inhalation injuries

熱傷は，受傷範囲が広く深度が深いほど，重症となり入院加療を要し，リハビリテーションの必要度も高くなる。熱侵襲は炎症反応を惹起し体液，呼吸，血行動態に大きな影響を及ぼすため全身管理が求められる。さらに，感染症を合併すれば病態は複雑化し，治療は長期化する。熱傷患者のリハビリテーションの最終目標は機能回復，社会復帰であるが，治療過程において続発する呼吸・循環機能の変化，瘢痕拘縮，筋力低下，日常生活動作（ADL）の低下などに柔軟に対応する必要がある。そのためにも熱傷の病態について理解し，合併症予防，日常生活動作能力の改善に向けたリハビリテーションが重要となる。

The greater the extent and depth of a burn injury, the more severe the injury, the more likely the patient is to require hospitalization and rehabilitation. Thermal invasion induces an inflammatory response, which significantly affects fluid balance, respiration, and circulation, and systemic management is required. Infectious complications complicate the condition and prolong treatment. The ultimate goal of the rehabilitation of patients who suffered burns is functional recovery and social reintegration, but it is necessary to flexibly respond to changes in respiratory and circulatory function, scar contractures, muscle weakness, and the decreased ability to perform activities of daily living that occur during the treatment process. Therefore, it is important to understand the pathophysiology of burns and to provide rehabilitation aimed at preventing complications and improving the ability to perform activities of daily living.