2024 年 41 巻 3 号 p. 324-327
Communicating the diagnosis of ALS to patients and their families and introducing tracheostomy ventilation (TIV) is mentally burdensome not only for the patients but also for the medical staff. The diagnosis of ALS is generally confirmed by the fulfillment of various diagnostic criteria, but the sensitivity and specificity vary depending on the diagnostic criteria used. The decision to introduce TIV should not be made hastily, and it is important to take time to support the decision–making process by multidisciplinary staff. It is also necessary to simulate the care and financial burden after the introduction of TIV.
Percutaneous endoscopic gastrostomy under local anesthesia is a necessary surgical procedure for ALS patients. It is recommended for weight stabilization, but there are reports of a shorter prognosis if the procedure is performed in patients with reduced lung capacity. When the patient's lung capacity is less than about 50%, gastrostomy should be performed safely with noninvasive artificial ventilation. If surgery requiring general anesthesia is necessary, more careful judgment is required because of the risk of not being able to extubate the patient due to decreased respiratory function. It has been reported that nearly 90% of patients with spondylolisthesis, which is a differential disease of ALS, do not improve after surgery and survival is not prolonged. Therefore, even if surgery is indicated, conservative treatment should be chosen as much as possible.
