Ishida Takuto, Katagiri Takeshi, Uchida Hiroyuki, Takeuchi Hiroyoshi, Sakurai Hitoshi, Watanabe Koichiro, Mimura Masaru
Department of Psychiatry, Sakuragaoka Memorial Hospital, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Department of Psychiatry, Sakuragaoka Memorial Hospital, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Psychosomatics. 2014 Jan-Feb;55(1):69-75. doi: 10.1016/j.psym.2013.04.001. Epub 2013 Jul 9.
Although physical restraint is still used in psychiatric inpatient settings, it sometimes causes serious side effects, including deep vein thrombosis (DVT) and resulting pulmonary embolism.
The aim of this study was to investigate the incidence of the DVT in restrained patients who were receiving routine prophylaxis and to identify the risk factors of this condition.
This study was conducted at Sakuragaoka Memorial Hospital, Japan from December 2008 to September 2010. Inpatients who were restrained during the study period were included. All restrained patients wore graduated compression stockings and were recommended to receive subcutaneous injection of unfractionated heparin during the period of restraint unless it was contraindicated. When plasma d-dimer level at the time of removal of restraint was ≥ 0.50μg/dL, the patients underwent a Doppler ultrasound scanning of their lower extremities to examine the presence of DVT. A multiple logistic regression model was used to examine the effects of demographic and clinical characteristics on the incidence of DVT.
A total of 181 patients (98 men; mean ± standard deviation age, 47.8 ± 17.0y) were included; DVT was detected in 21 patients (11.6%). A longer duration of restraint (odds ratio = 9.77, 95% confidence interval = 1.56-61.03, p = 0.015), excessive sedation (odds ratio = 4.90, 95% confidence interval = 1.33-18.02, p = 0.017), lower antipsychotic dosage (odds ratio = 0.05, 95% confidence interval = 0.005-0.57, p = 0.016), and recent medical hospitalization (odds ratio = 11.44, 95% confidence interval = 2.13-61.47, p = 0.004) were significantly associated with the incidence of DVT.
The incidence of DVT in restrained psychiatric patients was not low in spite of prophylaxis. These findings emphasize the importance of regular screening of and thorough assessments of DVT, especially in restrained psychiatric patients.
尽管身体约束仍用于精神科住院患者，但有时会导致严重的副作用，包括深静脉血栓形成（DVT）及由此引发的肺栓塞。
本研究旨在调查接受常规预防措施的受约束患者中DVT的发生率，并确定该病症的危险因素。
本研究于2008年12月至2010年9月在日本樱之丘纪念医院进行。纳入研究期间接受约束的住院患者。所有受约束患者均穿着分级压力弹力袜，除非有禁忌证，在约束期间建议接受皮下注射普通肝素。当解除约束时血浆D - 二聚体水平≥0.50μg/dL时，患者接受下肢多普勒超声扫描以检查是否存在DVT。采用多元逻辑回归模型来检验人口统计学和临床特征对DVT发生率的影响。
共纳入181例患者（98例男性；平均±标准差年龄，47.8±17.0岁）；21例患者（11.6%）检测到DVT。约束时间较长（比值比=9.77，95%置信区间=1.56 - 61.03，p = 0.015）、过度镇静（比值比=4.90，95%置信区间=1.33 - 18.02，p = 0.017）、抗精神病药物剂量较低（比值比=0.05，95%置信区间=0.005 - 0.57，p = 0.016）以及近期住院治疗（比值比=11.44，95%置信区间=2.13 - 61.47，p = 0.004）与DVT的发生率显著相关。
尽管采取了预防措施，但受约束的精神科患者中DVT的发生率并不低。这些发现强调了定期筛查和全面评估DVT的重要性，尤其是在受约束的精神科患者中。
