儿童急性淋巴细胞白血病诱导化疗期导管相关性血栓发病及危险因素分析

The incidence and risk factors of catheter-related-thrombosis during induction chemotherapy inacute lymphocytic leukemia children

目的分析初诊急性淋巴细胞白血病（ALL）诱导化疗期外周静脉穿刺中心静脉置管（PICC）患儿导管相关性血栓（CRT）的危险因素。 方法收集2014年3月1日至2014年12月31日首都医科大学附属北京儿童医院血液肿瘤中心白血病病房行PICC置管的116例初诊ALL患儿临床资料。 结果①PICC置管后第15天33例（28.4%）患儿发生CRT（CRT组），83例患儿未发生CRT（非CRT组）。②两组在性别、年龄分布、ALL危险度、免疫表型以及置管时两组血常规、凝血功能、是否合并感染、置管静脉方面差异无统计学意义，CRT组右侧置管比例高于非CRT组[75.8%（25/33）对55.4%（46/83），P=0.043]。③CRT组患者均无临床症状，置管第15天D-二聚体高于非CRT组[0.18（0.05-2.45）mg/L对0.11（0.01-5.34）mg/L，P=0.001]。④观察期中出现3例导管相关性并发症，均为导管相关性感染，其中2例并发CRT。⑤置管第33天CRT组26例患者复查B超，19例（73.1%）血栓缩小，6例（23.1%）无明显变化，1例（3.8%）增大。 结论CRT是初诊ALL患儿诱导化疗期PICC置管的常见导管相关并发症，但症状出现较少，大部分血栓可自行缩小，右侧置管为CRT发生的危险因素；检测D-二聚体水平以及定期进行导管部位B超检查有助于及时发现CRT。

Objective To investigate the current status of catheter-related-thrombosis （CRT） and the risk factors of Chinese acute lymphocytic leukemia （ALL） children with peripherally inserted central catheter （PICC）. Methods The clinical data of the 116 inpatients preliminarily diagnosed ALL in the Leukemia Ward of Beijing Children＇s Hospital with PICC from 1st March 2014 to 3 lS＇ December 2014 were collected prospectively. Results Refer to the B-ultrasound on the 15th day after catheterization, the incidence of CRT was 28.4% （33/116 cases）, all cases were symptom-free. There were no statistical differences in terms of gender, age distribution, degree, immunotype between CRT and CRT-free groups. This study revealed no statistical differences of blood routine test items, coagulation function items, co-infection and catheterization vein between the two groups. While there was significant statistical difference of catheterization side, the frequency of right catheterization was higher in CRT group [75.8% （25/33） vs 55.4% （46/83）, P=0.043]. On the 15th day after catheterization, significant statistical difference of D-Dimer between the two groups was revealed [0.18 （0.05-2.45）mg/L vs 0.11 （0.01-5.34） mg/L, P=-0.001 ], while no statistical differences of blood routine test items and other coagulation function items. Multivariate Logistic regression analysis verified catheterization on right was a risk factor of CRT. During the observation, there were 3 cases of catheter-related complications other than CRT, all of which were CRI, 2 of them had CRT meanwhile. The B-ultrasound on the 33rd day after catheterization showedthat 73.1% of the cases had reduced thrombosis, 3.8% had growth thrombosis, 23.1% had no obvious change respectively. Conclusion CRT was a common catheter related complication among ALL children during induction chemotherapy, and CRT cases with symptoms were rare. Catheterization on right was a risk factor for CRT, and regular test of D-Dimer and B ultrasound contributed to detect CRT. Most of the CRT cases had reduced thrombosis without specific management.