多發性肌炎之物理治療-病例報告

Physical Therapy for Polymyositis: A Case Report

劉美惠(Mei-Hui Liu) ； 吳英黛(Ying-Tai Wu)

《中華民國物理治療學會雜誌》 23卷1期 (1998/01) Pp. 61-68

https://doi.org/10.29616/JPTAROC.199801.0007

摘要

多發性肌炎(polymyositis)是一種不明原因，發炎性之骨骼肌肌肉病變，好發於中年人，年齡愈大者，預後愈差；主要臨床症狀為漸進式雙側近端肢體無力、肌肉及關節疼痛、疲勞、吞嚥困難、呼吸肌無力，有些病患之心肺功能亦會受影響；且需經由酵素血清檢查、肌電圖、肌肉切片來證實此一診斷。此類病患主要是使用藥物來控制發炎反應。本文個素是一位76歲的多發性肌炎確定診斷之患者，臨床上表現出雙側近端肢體無力、吞嚥困難、關節攣縮、肺部清潔度不足、體能差；物理治療在病人接受內科治療一個月後，肌酸燐酸激素值接近正常時介入，著重在改善肺部清潔，增加關節活動度和軟組織柔軟度，加強軀幹和四肢肌力，以及功能活動能力與一般體能。雖然本病例最後是因急性肝衰竭、腎衰竭和膽道炎合併敗血症逝世，但藉由此機會，深入暸解急性多肌炎之診斷、治療及不同時期的復健方式，以助於日後對此類病患之因應。

關鍵字

多發性肌炎 ； 物理治療

並列摘要

Polymyositis is an idiopathic inflammatory myopathy. It is characterized by diffuse inflammation of skeletal muscles which is frequently accompanied by degeneration and necrosis of muscle fibers. The clinical symptoms and signs include progressive and symmetric weakness of proximal muscles, muscle pain, fatigue, dysphagia, respiratory muscle weakness, and cardiopulmonary dysfunction. The diagnosis of polymyositis has to be based on data of serum enzyme, electromyography, and muscle biopsies. It can be usually controlled by antiinflammatory drugs and corticosteroids. The reported case is a 76-year old female patient with definite diagnosis of polymyositis. She had some other medical problems which were under control before this diagnosis. She presented general weakness and dysphagia initially and then progressed to multiple joint contractures, insufficient lung hygiene, poor functional status and physical fitness. Physical therapy started when her serum enzyme CPK level returned to normal which was about one month after medical treatment. in spite of her multiple medical complaints, she improved in lung hygiene, flexibility of soft tissues, range of motions, muscle strength of trunk and four limbs, functional abilities, and general fitness. Unfortunately, this case expired four months after the initial presentation of symptoms and diagnosis because of some other medical problems. In addition to discussing the clinical manifestation and the disease course of polymyositis, we share our experiences in the physical therapy evaluation and management.

並列關鍵字

Polymyositis ； Physical therapy