儿童导管相关性静脉血栓的发生情况与危险因素

The incidence and risk factorfocathete- related thrombosiin children

目的通过回顾性收集分析首都医科大学附属北京儿童医院内科系统住院患儿中导管相关性静脉血栓（CRT）的临床资料，了解我国儿童CRT发生情况。方法回顾性收集2010年11月至2013年11月首都医科大学附属北京儿童医院内科系统住院CRT患儿病例资料，分析其发生的原因、临床表现、诊断、治疗及预后。结果共42例CRT患儿，男女比例为1．0：0．5，男女年龄分布差异无统计学意义（P=0．862）；发病年龄中位数7岁4个月（2个月-15岁6个月），〈1岁占16．7％（7／42例），其次为13～14岁占11．9％（5／42例）；CRT发生距置管间隔时间的中位数为9d（范围1～81d），置管后0～10d为发生CRT高峰期（52．5％，21／40例），其次为10～20d（35．0％，14／40例）；原发病以血液肿瘤疾病、‘肾脏疾病及深部真菌感染居多。发生血栓位置右侧置管（57．1％，24／42例）稍多于左侧（38．1％，18／42例）；病例均经B超检查获得确诊，其中无症状者占28．6％（12／42例）。确诊后7．1％（3／42例）采用患肢制动、热敷等保守治疗，7．1％（3／42例）行导管拔除，33．3％（14／42例）在拔管基础上使用抗凝剂和／或溶栓剂。1周后共22例复查B超，其中血栓较前缩小54．5％（12／22例），且均为干预病例；血栓较前增长22．7％（5／22例）；血栓无明显变化22．7％（5／22例）。3例在发生CRT拔出导管后因病情需要重新置管，且3例均再次复发，复发率为100％。结论儿童CRT以婴儿及年长儿多见；多发生在置管20d以内；常发生于患有血液肿瘤、肾脏疾病及深部真菌感染的患儿；对放置导管的患儿应进行常规超声检查，监测血栓的发生；发生CRT时及时应用抗凝、溶栓治疗，必要时拔出导管治疗有效，重新放置导管有CRT复发的可能。

Objective To study the currenstatuof cathete- related thrombosi（CRT） in Chinese children through retrospective analysiof the inpatientin the Departmenof Medicine, Beijing Children＇Hospital Affiliated to Capital Medical University. MethodThe clinical datof the inpatientwith Crfrom Novembe2010 to Novembe2013 were collected retrospectively, and the causes, clinical symptoms, diagnosis, treatmenand prognosiwere ana- lyzed. ResultThere were 42 caseof children with Crin Beijing Children＇Hospital Affiliated to Capital Medical University. Among the cases,the male to female ratio wa1.0 - 0.5 ;the median age of onsewa88 （2 -186） monthwith 〈 1 yeaold counted fo16.7% （7/42 cases） and 13 -14 yearold counted fo11.9% （5/42 cases） ;the distribution differencebetween the male and the female age were nosignificant（ P = 0. 826）. The median time from cathe- terization to CRonsewa9 （ 1 - 81 ） days,0 - 10 dayaftecatheterization wathe peak of onse（52.5% ,21/40 ca- se） followed by 10 -20 day（35.0% , 14/40 cases）. The protopathy wausually hematologitumor, kidney disease odeep fungal infection. Slightly more casedeveloped Cron the righside （57.1% ,24/42 cases） than on the lefside （38.1%, 18/42 cases）. All casewere diagnosed by using -ultrasound, of whom 28.6% （12/42 cases） were symp- tom -free. Aftebeing diagnosed ,7.1% （3/42 cases） were treated with conservative methodsuch aimmobilization of the affected limband hocompres;7.1% （3/42 cases） had catheteremoved;anticoagulanand/othrombolyticaftecatheteremoval used in 33.3% patient（ 14/42 cases）. Afte1 week, 22 casewere reviewed, of whom 54.5% （12/22 cases） had thrombosireduced （all with intervention） ,thrombosigrowing in 22.7% patient（5/22 cases）, and thrombosidid nochange in 22.7% patients（5-22 cases）. Three caseneeded re -catheterization aftecatheteremoval, and all of 3 casehad Crrecurrence（ 100% ）. ConclusionCRimore common among infantand seniochildren. Crusually developwithin 20 dayaftecatheterization. Children with hematologitumor, kidneydisease odeep fungal infection are more likely to have CRT. Routine uhrasound tesshould be conducted to monitoCRin catheterized children. Once Cridiagnosed,patientneed to be treated with anticoagulantand/othrombo- lytics. Catheteshould also be removed if necessary. Recatheterization can resulin Crrecurrence.