先天性心脏病介入治疗并发股动脉血栓形成的病因

Etiopathogenisis of Femoral Artery Thrombosis during Interventional Therapy for Congenital Heart Disease

目的探讨小儿先天性心脏病(CHD)介入治疗并发股动脉血栓形成的原因及防治措施。方法选择2004年5月-2006年8月在河北医科大学第一医院行介入治疗的CHD患儿962例,均根据其临床表现,并经X线、心电图、心脏彩超等检查确诊,符合介入治疗指征,介入治疗后发生股动脉血栓6例,男4例,女2例,均予溶栓治疗,对其临床资料进行分析。结果962例患儿中6例术后发生股动脉血栓(发生率为0.63%),均予早期静脉溶栓治疗,其中3例早期静脉溶栓成功,2例早期静脉溶栓未成功者随即予经导管局部溶栓治疗成功。该5例患儿出院1个月复查均无异常。另1例早期静脉溶栓未成功者继续予静脉溶栓治疗及抗凝治疗1周,复查其超声发现代偿性侧支循环建立,直径为对侧股深动脉内径的20%,出院1、6、12个月复查其超声,右侧代偿的侧支血管直径分别为对侧股深动脉内径的40%、70%和80%,左侧足背动脉搏动及皮温恢复正常。6例均未发生肢体坏死。结论早期静脉溶栓及经导管局部溶栓治疗小儿CHD介入术后股动脉血栓形成效果较好;积极做好围术期处理,严格控制危险因素可降低其股动脉血栓形成发生率。

Objective To explore the cause and prevention measure of femoral artery thrombosis during interventional therapy for con- genital heart disease （CHD） in children. Methods From May. 2004 to Aug. 2006,in the First Hospital of Hebei Medical University, interven- fional procedures were performed in 962 children with CHD. All of the 962 subjects accorded with interventional indication and 6 of them（4 male and 2 female） who suffered from femoral artery thrombosis after transcatheter closure were given thrombolysis therapy. The data of the 6 cases were analyzed. Results Femoral artery thrombosis were found in 6 cases （0.63%） and all of them were dealt with intravenous throm- bolysis early. The early intravenous thrombolysis therapy was succeeded in 3 cases. For the 3 cases unsueeeeded, local transeatheter closure thrombolysis was performed in 2 cases and succeeded, intravenous thrombolysis and anticoagulant therapy were lasted in the other case and collateral circulation compensation was found by ultrasonography 1 week later. The diameter was respectively 40% ,70% ,80% of contralateral femoral deep artery after postoperation 1 month,6 months and 12 months. Left dorsalis pedis arteries skin temperature and pulsation was nor- real after postoperation 1 month. The other 5 cases recovered well. No limb necrosis happened. Conclusions Early intravenous thrombolysis and local transcatheter closure thrombolysis therapy on femoral artery thrombosis during interventional therapy for CHD in children is efficient. Positive perioperative management and strict dangerous factors control may be reduce the incidence of femoral artery thrombosis.