運動減退状態で深部静脈血栓症を合併した2例―精神科領域における運動減退と血栓形成リスク

Two Cases with Deep Vein Thrombosis due to Reduced Motor Activity: The risk of thromboplastic factors due to reduced motor activity in psychiatric practice

抄録

　静脈血栓の主要な形成要因，①血流の停滞②血管壁の損傷③血液凝固の亢進のうち，精神科領域では運動減退による血流の停滞が最も重要である。運動減退状態で深部静脈血栓症（DVT）を合併した2例を報告した。

　症例M.S.：53歳男性。躁状態のため3回目の入院。入院後うつ病性亜昏迷状態となり，うつ状態になって19日目に左下肢腫脹が出現した。左総腸骨静脈血栓を確認。ヘパリンによる抗凝固療法を行ったが，二次性肺塞栓を併発した。患者は回復した。

　症例U.I.：37歳男性。非定型精神病およびてんかん。水中毒を防止するため1週間隔離したところ右下肢が腫脹，DVTを合併した。

　精神科領域では患者の精神症状や身体拘束によりしばしば運動減退が生じる。水分や食事摂取が不十分なこともある。このようなDVTの危険因子については十分注意すべきである。

Summary

　Among the principal thromboplastic factors such as ①disturbance of blood circulation, ②damage of blood vessels, ③acceleration of hemoconcentration, the disturbance of blood circulation due to reduced motor activity is the most important one in psychiatric practice.

　Two cases complicated with deep vein thrombosis (DVT) under a state of reduced motor activity were reported.

　Case M.S., a 53-year-old man was involuntarily admitted for the third time under a manic state. During his stay, his manic state was replaced by a depressive substuporous state. Nineteen days after the onset of the depressive state, swelling of his left leg was noted. The complication of deep vein thrombosis (DVT) in his left ilial vein was noticed. In spite of anticoagulation therapy by intravenous heparin, severe secondary pulmonary thromboembolism occurred. The patient was eventually revived.

　Case U.I., a 37-year-old man suffering atypical psychosis with epilepsy developed DVT in his right leg after one-week's seclusion for the prevention of water intoxication.

　Motor activity of inpatients is often reduced because of psychiatric conditions or physical restraints in psychiatric practice. In addition, intake of water and food is often insufficient. Such risk factors of DVT should be monitored carefully in psychiatric hospitals.