腰椎変性すべり症術後に急性呼吸不全を来したGuillain–Barré症候群の1例(Guillain–Barré syndrome with acute respiratory failure after surgery for lumbar degenerative spondylolisthesis: a case report)

要旨 Guillain–Barré 症候群（以下GBS）の先行イベントとして，感染やワクチン接種，外傷，手術などが報告されているが，本邦において，術後発症の報告はわずかしかない。今回，腰椎変性すべり症術後にGBSを発症した1例を経験したので報告する。症例は70歳代の女性で，腰椎変性すべり症に対して椎体間固定術を施行した。術後10日目より四肢脱力が出現し，術後15日目より急性呼吸不全による意識障害を来したため，人工呼吸管理を行った。意識障害改善後の神経学的評価では呼吸筋の低下，対称性四肢麻痺，下肢腱反射の低下を認めた。臨床経過，脳脊髄液検査の蛋白細胞解離所見，神経伝導検査での末梢神経障害所見，抗ガングリオシド抗体陽性所見よりGBSの診断に至った。ICU入室後2日目より隔日で血漿交換療法を計5回施行し，呼吸筋および四肢筋力は緩徐な回復を示した。ICU入室後37日目に人工呼吸器を離脱した。リハビリテーションを継続し，独歩可能な状態まで回復した。術後患者で進行性四肢麻痺や呼吸不全を呈する患者では，本疾患を念頭におき，早期治療介入を検討する必要がある。 ABSTRACT Infection, vaccination, trauma, and surgery can trigger the development of the Guillain–Barré syndrome (GBS). However, there have been few reports on postoperative GBS in Japan. We report a case of a woman in her 70s woman who developed GBS after interbody fusion for lumbar degenerative spondylolisthesis. The patient developed weakness of all extremities and experienced syncope due to acute respiratory failure on the 10th and 15th postoperative days, respectively, and underwent mechanical ventilation. Neurological evaluation after she recovered consciousness showed respiratory muscle weakness, symmetrical limb paralysis, and depressed lower limb tendon reflexes. GBS was diagnosed based on the clinical course and the detections of albuminocytologic dissociation on cerebrospinal fluid analysis, peripheral neuropathy in the nerve conduction study, and antiganglioside antibody. Plasmapheresis was performed five times every other day from the 2nd day of ICU. The respiratory and limb muscles gradually regained strength, and the patient was weaned off the ventilator 37 days after ICU admission. Rehabilitative therapy was continued until the patient recovered enough to walk independently. In postoperative patients with progressive paralysis or respiratory failure and a suspected diagnosis of GBS, early intervention should be considered.