Nishio Akihiro, Gotoh Taro M, Ueki Hirofumi
Department of Psychopathology, Division of Neuroscience, Gifu University Graduate School of Medicine.
Seishin Shinkeigaku Zasshi. 2007;109(11):998-1007.
Pulmonary thromboembolism induced by deep vein thrombosis (DVT), which is known as economy-class syndrome, is one of sudden death in psychiatric patients under physical restraint. (1) A decrease in venous blood flow, (2) damage to vessel walls, and (3) the enhancement of blood clotting are the major risk factors for DVT (Virchow triad). It has been speculated that physical restraint inhibits venous blood flow, and that antipsychotic drugs facilitate blood clotting. In order to prevent sudden death due to DVT, prophylactic measures and early diagnosis are crucial. Whereas Doppler ultrasonography and contrast venography are the gold standards for the diagnosis of DVT, more simplified methods are now under development. Of those, D-dimer measurement, which can be conducted with a small blood sample, is the most potent candidate for the biochemical diagnosis of DVT. Although there are many prophylactic measures, including anticoagulant medications and physical therapies, it is not clear which is the most effective and suitable in psychiatric practice. Psychiatric professionals should pay closer attention to DVT in psychiatric patients under physical restraint.
由深静脉血栓形成（DVT）引起的肺血栓栓塞，即所谓的经济舱综合征，是身体受约束的精神科患者猝死原因之一。（1）静脉血流减少、（2）血管壁损伤和（3）血液凝固增强是DVT的主要危险因素（维勒三联征）。据推测，身体约束会抑制静脉血流，而抗精神病药物会促进血液凝固。为预防因DVT导致的猝死，预防措施和早期诊断至关重要。虽然多普勒超声检查和静脉造影是诊断DVT的金标准，但目前正在开发更简化的方法。其中，可用少量血样进行检测的D - 二聚体测量是DVT生化诊断最有力的候选方法。尽管有许多预防措施，包括抗凝药物和物理治疗，但在精神科实践中哪种措施最有效且最合适尚不清楚。精神科专业人员应更加关注身体受约束的精神科患者中的DVT。
