下肢严重创伤患儿深静脉血栓和肺栓塞的筛查

Screening and diagnosis of severe trauma of the lower limbs in children

目的探讨创伤患儿静脉血栓和肺栓塞的特点及其相关的筛查、预防及诊断治疗策略。方法2010年1月1日至2015年12月30日,唐山市第二医院小儿骨科共收治3214例创伤患儿,其中下肢创伤1635例,对部分高危患儿进行深静脉血栓(deep venous thrombosis,DVT)诊断性筛查。通过动态监测D-二聚体及双下肢深静脉彩超,必要时静脉CT成像等检查手段确诊下肢DVT患儿14例。并对高危患儿采取基本预防、物理预防及药物预防等措施,所有确诊患儿采取抗凝治疗。结果创伤患儿DVT的发生率为0.44%,下肢创伤后DVT发生率为0.86%,发生的时间于伤后1~6天,年龄7~16岁,平均14.5岁,无一例肺栓塞发生。所有确诊的DVT患儿均为下肢创伤或严重多发伤。儿童DVT具有持续时间短、血栓消失快、治疗方法简单、疗程较成人短、血栓复发率及血栓后遗综合征发生率低的特点。结论儿童DVT/PE在流行病学特点、病理、生理方面均不同于成人,因此在诊断和治疗方面也具有明显的个性化。其发生率虽明显低于成人,但近年来有增加的趋势,故对高危儿童及下肢严重创伤的儿童要重视DVT的筛查,作好DVT的诊断、预防及治疗工作,减少静脉血栓栓塞症的发生。

Objective To investigate the characteristics of post-trauma deep venous thrombosis（ DVT） and pulmonary embolism（ PE） in children, including screening, prevention, diagnosis and treatment strategies. Methods From January 1 st, 2010 to December 30 th, 2015, 3214 pediatric patients（ 1635 lower extremities） were confirmed by Color Doppler ultrasound, Dynamic monitoring of D-dimer, and CT examination of intravenous contrast. Fourteen cases with DVT were found. For those with high-risk of DVT, basic prevention, physical prevention and drug prevention measures were conducted. All patients received anticoagulant treatment. Results The incidence rate of DVT was 0.44% in post-trauma children, while 0.86% in children with lower extremity trauma. It occurred 1-6 days after the injury with the mean age of 14.5 years（ range： 7-16 years）. No pulmonary embolism occurred. All diagnosed DVT children were of lower extremity trauma or severe multiple injuries. Characteristics of DVT in children included short duration, quick disappearance, simple treatment, shorter course of treatment than that in adults, lower rate of recurrence and thrombus syndrome sequel. Conclusions DVT and PE in children are different comparing with adults in epidemiology, pathology, and physiology. So diagnosis and treatment should be individualized. In recent years, the morbidity has increased although it is lower than that in adults. Vigilance should be increased for at-risk children, especially for those with severe trauma of the lower limbs. Effective diagnosis, prevention and treatment of DVT are conducive to reduce the occurrence of venous thromboembolism.