儿科中心静脉导管相关性血栓的临床特点和转归

Clinical features and outcomes of pediatric central venous catheter-related thrombosis

目的探讨儿科中心静脉导管相关性血栓形成的临床特点及血栓的转归情况。方法对2011年1月至2012年9月本院各科室上报静脉治疗小组导管相关性血栓形成的21例患儿临床资料进行回顾性分析。结果肢体肿胀、大腿和(或)小腿周长增加、患肢疼痛或活动减少是血栓形成主要的临床表现;血栓发生时间为导管置入后1～10d,平均4.76d;本组17例接受了规范的静脉内溶栓治疗,16例在溶栓开始1～7d后成功溶栓,其中2例PICC患儿均溶栓成功并保留了导管,本组平均溶栓时间为3.32d,1例溶栓无效。4例未进行溶栓的患儿,1例血栓自行消失,3例血栓未溶解。结论通过临床仔细观察并结合超声多普勒检查可及时发现中心静脉导管相关性血栓形成。一旦确诊导管相关性血栓形成,除有明确溶栓禁忌证的患儿以外,应尽早进行规范溶栓治疗。

Objective To investigate the clinical features and outcomes of pediatric central venous catheter-related thrombosis. Methods The clinical data of 21 cases of pediatric central venous catheter-related thrombosis reported by intravenous teams were retrospectively analyzed. Results Limb swelling, increase in thigh circumference and/or leg circmnference, limb pain or less movement were the major clinical manifestations of thrombosis. Central venous catheter-related thrombosis was found within 1 to 10 days after intubation with an average of 4.76 days. Seventeen children received standardized intravenous thrombolytic therapy and the treatment was effective in 16 cases within 1 to 7 days after treatment. The average duration of thrombolytic therapy was 3.32 days. The thrombolytic therapy was ineffective in one case. Among the 4 children who didn＇t receive thrombolytic therapy,the thrombosis disappeared in one case. Conclusion The central venous catheter-related thrombosis can be found by careful clinical observation combined with Ultrasonic Doppler examination. Once the catheter-related thrombosis was found,formal thrombolytic therapy should start as soon as possible unless with definitely contraindications.