矽肺症合併肺泡蛋白沉積症接受右肺移植之物理治療早期介入：個案報告

Right Lung Transplant for Silicosis With Pulmonary Alveolar Proteinosis and Early Physical Therapy Intervention: A Case Report

蕭琬蓁(Wan-Chen Hsiao) ； 林哲玄(Che-Hsuan Lin)

《物理治療》 48卷1期 (2023/03) Pp. 49-57

https://doi.org/10.6215/FJPT.202303_48(1).0004

摘要

矽肺症為暴露在矽塵後產生的肺部疾病，除了造成呼吸困難或全身性症狀外，可由於其毒性影響肺泡中巨噬細胞功能而引起繼發型肺泡蛋白沉積症（pulmonary alveolar proteinosis, PAP），為一種肺泡表面活性劑平衡遭破壞的罕見疾病。主要治療方式為支持性治療、類固醇藥物及全肺灌洗治療，進展為末期肺病則需接受肺臟移植。本文應用個案處理模式介紹一位曾於石材工廠工作8年的34歲男性，診斷為矽肺症合併肺泡蛋白沉積症，2019年起歷經數次肋膜沾黏術及全肺灌洗治療，病情於2021年6月惡化而於同年8月7日接受右肺移植。個案接受術後早期物理治療介入成效良好：運動頻率為每日2回每週7日，強度為休息心跳加30下以內，自覺用力係數13（有點吃力），伯格氏呼吸困難指數4（有點嚴重），血氧維持在88%以上，運動形式及時間為跑步機加腳踏車有氧訓練每回共30分鐘。六分鐘行走測試距離由255m增加至399m；一分鐘坐到站次數由18次增加至27次。術後約一個月於9月9日順利出院返家，並將持續於門診進行為期一年的物理治療訓練。

關鍵字

矽肺症 ； 肺泡蛋白沉積症 ； 肺臟移植 ； 物理治療

並列摘要

Silicosis is the pulmonary disease caused by silica inhalation, and can lead to dyspnea and systematic symptoms. Further, the dysfunction of macrophages in alveoli induced by toxicity of silica dust will result in secondary pulmonary alveolar proteinosis (PAP), a pulmonary surfactant homeostasis disorder. Supportive care, steroid medication, and whole lung lavage are the major treatments of silicosis and PAP. Nevertheless, while progressing to end-stage lung disease, lung transplantation is the only intervention. This article presented a 34 year-old male working in a stone processing factory for eight years, diagnosed as silicosis complicated with PAP. He received several times of pleurodesis and whole lung lavage during 2019 and 2020, but the conditions worsen since June 2021. Then, he received right lung transplant on Aug. 7th 2021. During hospitalization, he undergone aerobic exercises (treadmill and stationary bike for 30 minutes) 2 times a day, 7 days per week. Target heart rate < resting heart rate + 30, rating of perceived exertion (RPE) 13 (somewhat hard), Borg dyspnea scale 4 (somewhat hard), and SpO_2 > 88% were the parameters of exercise intensity. This case had impressive outcomes after early physical therapy intervention including: six-minute walking distance from 255 m to 399 m, and 1-minute sit to stand from 18 to 27 repetitions. He had been discharged from our hospital on Sep. 9th 2021 and will keep outpatient training for 1 year.

並列關鍵字

Silicosis ； Pulmonary alveolar proteinosis ； Lung transplant ； Physical therapy