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Guillain-Barré Syndrome (GBS) — パス

Ascending flaccid paralysis + areflexia + CSF albuminocytologic dissociation; IVIG/plasma exchange, serial FVC monitoring to prevent respiratory failure.

根拠：Merck / AMBOSS。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。

ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。

ステップ 1 · Respiratory/bulbar involvement?
Acute ascending flaccid paralysis — respiratory/bulbar involvement or rapid progression?
💡 Acute immune-mediated polyradiculoneuropathy, ~65% with an antecedent infection (1–3 weeks before). Bilateral ascending flaccid paralysis, areflexia ± sensory symptoms; may involve respiratory/bulbar/facial muscles, autonomic (arrhythmia, BP swings). Clinical diagnosis (Asbury), supported by CSF albuminocytologic dissociation (high protein, normal cell count; may take up to 1 week to appear, ~10% negative) + EMG. An emergency, ICU monitoring.

パス全体像

  1. 【判断】Respiratory/bulbar involvement?
    Acute ascending flaccid paralysis — respiratory/bulbar involvement or rapid progression?（Acute immune-mediated polyradiculoneuropathy, ~65% with an antecedent infection (1–3 weeks before). Bilateral ascending flaccid paralysis, areflexia ± sensory symptoms; may involve respiratory/bulbar/facial muscles, autonomic (arrhythmia, BP swings). Clinical diagnosis (Asbury), supported by CSF albuminocytologic dissociation (high protein, normal cell count; may take up to 1 week to appear, ~10% negative) + EMG. An emergency, ICU monitoring.）
    • Respiratory/bulbar involvement or rapid progression → Respiratory/bulbar involvement → ICU
    • Mild, stable, no respiratory involvement → Mild · monitor + immunotherapy
  2. 【終点】Mild · monitor + immunotherapy
    Ambulatory, no respiratory/bulbar involvement: 入院に対し密な監視 — serial forced vital capacity (FVC)・negative inspiratory force (NIF) (q6–8h), cardiac monitoring (autonomic); most 中等症–重症 cases need immunotherapy (IVIG 2 g/kg over 5 daysまたはplasma exchange, equivalent, do not combine, ステロイド ineffective). VTE prophylaxis, rehabilitation. Escalateの場合progressing.
  3. 【終点】Respiratory/bulbar involvement → ICU
    ICU. 1) Immunotherapy: IVIG 2 g/kg over 5 daysまたはplasma exchange (as early as possible, equivalent, do not combine; corticoステロイド are ineffective). 2) Respiratory monitoring: serial FVC/NIF — FVC <15–20 mL/kg, declining NIFまたはbulbar weakness 〜あり aspiration risk → 挿管・人工呼吸 (do not waitに対しblood gasesへdeteriorate). 3) Autonomic: cardiac monitoring, manage arrhythmia/BP swings. 4) VTE prophylaxis, pain management, nutrition, rehabilitation.

よくある質問

Guillain-Barré Syndrome (GBS) — パスはどの臨床課題を扱う診療パスですか？
Ascending flaccid paralysis + areflexia + CSF albuminocytologic dissociation; IVIG/plasma exchange, serial FVC monitoring to prevent respiratory failure.
Guillain-Barré Syndrome (GBS) — パスの主要な意思決定ステップは何ですか？
Respiratory/bulbar involvement?
Guillain-Barré Syndrome (GBS) — パスはどのような対応方針を示しますか？
Mild · monitor + immunotherapy：Ambulatory, no respiratory/bulbar involvement: 入院に対し密な監視 — serial forced vital capacity (FVC)・negative inspiratory force (NIF) (q6–8h), cardiac monitoring (autonomic); most 中等症–重症 cases need immunotherapy (IVIG 2 g/kg over 5 daysまたはplasma exchange, equivalent, do not combine, ステロイド ineffective). VTE prophylaxis, rehabilitation. Escalateの場合progressing.；Respiratory/bulbar involvement → ICU：ICU. 1) Immunotherapy: IVIG 2 g/kg over 5 daysまたはplasma exchange (as early as possible, equivalent, do not combine; corticoステロイド are ineffective). 2) Respiratory monitoring: serial FVC/NIF — FVC <15–20 mL/kg, declining NIFまたはbulbar weakness 〜あり aspiration risk → 挿管・人工呼吸 (do no…
Guillain-Barré Syndrome (GBS) — パスのうち直ちに対応が必要な状況はどれですか？
Respiratory/bulbar involvement → ICU：ICU. 1) Immunotherapy: IVIG 2 g/kg over 5 daysまたはplasma exchange (as early as possible, equivalent, do not combine; corticoステロイド are ineffective). 2) Respiratory monitoring: serial FVC/NIF — FVC <15–20 mL/kg, declining NIFまたはbulbar weakness 〜あり aspiration risk → 挿管・人工呼吸 (do not waitに対しblood gasesへdeteriorate). 3) Autonomic: cardiac monitoring, manage arrhythmia/BP swings. 4) VTE prophylaxis, pain management, nutrition, rehabilitation.
Guillain-Barré Syndrome (GBS) — パスはどのガイドラインに基づいていますか？
Guillain-Barré syndrome (Merck Manual; AMBOSS); Asbury diagnostic criteria · 準拠：Merck / AMBOSS

出典

  • Guillain-Barré syndrome (Merck Manual; AMBOSS); Asbury diagnostic criteria

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