造血幹細胞移植後閉塞性細気管支炎に対し脳死両肺移植術後，リハビリテーション実施に難渋した小児患者の経験

抄録

[Introduction] We report our experience in the rehabilitation of a pediatric patient who underwent brain-dead double lung transplantation for bronchiolitis obliterans after hematopoietic stem cell transplantation.

[Patient] A teenaged boy had developed B-progenitor cell acute lymphoblastic leukemia X−7 years before. Although he achieved remission with multidrug chemotherapy, it relapsed in X−6 years, and he underwent bone marrow transplantation and was in remission. The patient developed obstructive bronchiolitis in X−3 years, was listed for lung transplantation in X−2 years, underwent brain-dead bilateral lung transplantation, and underwent tracheostomy on the 12th postoperative day (POD12).

[Results] When rehabilitation was started on POD6, we observed severe limitations of range of motion in the extremities and thorax, as well as significant muscle weakness (manual muscle strength test (MMT) 2). During intubation, the patient was encouraged to sit on the edge (POD7), stand (POD11), sit in a wheelchair (POD13), and get out of bed; however, it was difficult to perform rehabilitation due to breathing difficulties and decreased motivation. We shared information across multiple professions and considered a program that would motivate the child to have fun and implemented a program that included hiding his favorite action figures in the hospital ward and making the child move around using lower-limb wheelchairs to search for the action figures. After he was transferred to the general floor on POD48, his muscle strength and physical strength improved, and his general condition including breathing improved, so that he was able to work cooperatively on rehabilitation. When he was transferred to a previous hospital for rehabilitation on POD98, his muscle strength had improved to MMT 3-4, and he was able to walk 60 m in a walker and drive a lower-limb wheelchair 120 m.

[Conclusion] Postoperative rehabilitation of patients who were in poor general condition before transplantation is often difficult to implement. Rehabilitation of pediatric patients requires the introduction of programs that include play that children can enjoy and the setting of goals, and it is important to continue rehabilitation patiently.