理学療法ジャーナル54巻1号

2020年01月発行

Close-up PICS

PICSと理学療法

著者： 笹沼直樹¹

所属機関： ¹兵庫医科大学病院リハビリテーション部

ページ範囲：P.72 - P.77

理学療法の効果

　集中治療後症候群（post intensive care syndrome：PICS）に対する理学療法の効果の検討に先立ち，PICSの発症および増悪因子について確認する．PICSがもたらす主な障害と発症・増悪の危険因子について表1に示す．PICSがもたらす代表的な身体運動機能障害は筋力低下であるが，単に廃用に由来する筋量減少，筋力弱化のみでなく，高血糖，全身性炎症反応症候群，敗血症および多臓器不全などの重症病態に伴う異化亢進が背景にある．これらの病因によりもたらされる全身性の筋力低下は人工呼吸の遷延に関与する．経口挿管による人工呼吸器の遷延は長期間の苦痛をもたらし，せん妄や認知機能の低下に関与すると同時に鎮痛・鎮静薬の長期投与が必要となる．

　PICS患者の多くが有するこれらの病態に基づき，集中治療期および集中治療を経て一般病床や在宅の転帰を得た症例に対する理学療法の有効性を検討した2編のシステマティックレビュー^2,3）に含まれる報告（表2^4〜7），表3^8〜13））から，PICSに対する理学療法の効果について検討する．

参考文献

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