エコノミークラス症候群の治療について、お話したいと思います。
軽症例では、血流を改善するための薬や血栓溶解剤を服用する薬物療法がおこなわれます。
重症例では、病状が急変して呼吸、心停止をきたすことがあるので、まずは救命のための救命処置が行われます。
治療には、血液の循環や心臓の動きを保つため、肺動脈につまった血栓を溶かす治療
- Heparin
- Warfarin
- Thrombin inhibitors
血栓溶解薬、抗凝固薬が投与されます。
肺動脈の血栓により循環を保つことができない場合は、体外循環装置（ECMO、またはPCPS）を用いて、一時的に人工心肺装置で生命を維持する必要があります。
さらに、IVRあるいは手術で血栓除去術を行うこともあります。
下肢静脈に広範囲の血栓ができている場合で命に別状ない場合は、下肢血栓が下大静脈から肺動脈にとぶことを予防するため、IVRにて下大静脈フィルターというネットを留置します。
エコノミークラス症候群の予防策としては、
常日頃から運動する習慣をもつ、
長時間座りっぱなしのとき、足首や膝の運動を時々行って脚の血流を保つ、
脱水を防ぐため、こまめに水分をとるなどがあります。
長時間の手術の際には、弾性ストッキングを行うなどで予防することができます。
English translation by Bard:
Treatment of Economy Class Syndrome
In mild cases, economy class syndrome (ECS) is treated with medication to improve blood flow and dissolve blood clots. Medications that may be used include:
- Heparin
- Warfarin
- Thrombin inhibitors
In severe cases, ECS can progress rapidly and lead to respiratory failure or cardiac arrest. In these cases, emergency care is necessary to stabilize the patient. Treatment may include:
- Oxygen therapy
- Pain medication
- Fluids
In addition to these measures, blood clots in the pulmonary artery may be dissolved with thrombolytic therapy. Thrombolytic therapy uses drugs to break down blood clots. Anticoagulant therapy, which uses drugs to prevent blood clots from forming, may also be used.
If the blood clot in the pulmonary artery is too large to be dissolved with medication, surgery may be necessary to remove it. Surgery may involve inserting a catheter into the vein to remove the clot or performing open surgery to open the blocked artery.
In some cases, it may be necessary to insert a filter into the inferior vena cava (IVC) to prevent blood clots from traveling from the legs to the lungs. This is typically done in patients with large blood clots in the legs who are not at risk of death from ECS.
Prevention of Economy Class Syndrome
The best way to prevent ECS is to avoid sitting for long periods of time. If you must sit for long periods of time, it is important to get up and move around regularly. Other preventive measures include:
- Staying hydrated by drinking plenty of fluids
- Avoiding alcohol and tobacco
- Wearing loose-fitting clothing
- Elevating your legs when sitting for long periods of time
ECS is a serious condition that can be fatal. However, by being aware of the risk factors and taking preventive measures, you can help protect yourself.
Here is a more detailed explanation of each treatment option:
Medication
Medication is the most common treatment for ECS. In mild cases, medication may be enough to dissolve the blood clot and prevent further complications. In severe cases, medication may be used in combination with other treatments, such as surgery or blood clot removal.
The types of medication that may be used to treat ECS include:
- Heparin: Heparin is a blood thinner that helps to prevent blood clots from forming. It is typically given by injection or infusion.
- Warfarin: Warfarin is a long-term blood thinner that helps to prevent blood clots from forming. It is typically taken by mouth.
- Thrombin inhibitors: Thrombin inhibitors are drugs that work by blocking the action of thrombin, an enzyme that helps to form blood clots. They may be given by injection or infusion.
Thrombolytic therapy
Thrombolytic therapy is a procedure that uses drugs to break down blood clots. It is typically used in severe cases of ECS when the blood clot is blocking the flow of blood to the lungs.
Thrombolytic therapy is a high-risk procedure that can cause bleeding. It is important to discuss the risks and benefits of thrombolytic therapy with your doctor before undergoing the procedure.
Anticoagulant therapy
Anticoagulant therapy is a type of medication that helps to prevent blood clots from forming. It is typically used after thrombolytic therapy to prevent the blood clot from reforming.
Anticoagulant therapy may also be used in patients with a high risk of ECS, such as those who have a history of blood clots or who are undergoing surgery.
Surgery
Surgery may be necessary to remove a blood clot in the pulmonary artery in severe cases of ECS.
The type of surgery that is performed will depend on the location of the blood clot. In some cases, a catheter may be inserted into the vein to remove the clot. In other cases, open surgery may be necessary to open the blocked artery.
Inferior vena cava filter
An inferior vena cava (IVC) filter is a small, metal net that is inserted into the IVC to prevent blood clots from traveling from the legs to the lungs.
An IVC filter may be inserted in patients with large blood clots in the legs who are not at risk of death from ECS.