儿童肺栓塞的诊治进展

Advances in the diagnosis and treatment of pulmonary embolism in children

儿童肺栓塞发病率低,但死亡率高。儿童肺栓塞的发生与高危因素密切相关,常见于先天性心脏病(尤其合并感染性心内膜炎时)、使用中心静脉导管和感染患儿。儿童肺栓塞临床表现不典型,与呼吸道感染症状难以区分,且常被基础疾病所掩盖,需要更多检查协助诊断。近年来,CT肺血管造影已取代肺动脉造影,成为确诊肺栓塞的首选检查方法。目前儿童肺栓塞的治疗建议主要来自成人临床试验和一些小样本儿科临床资料。治疗方式包括抗凝、溶栓、血栓切除等。该文对儿童肺栓塞的诊断及治疗进展进行综述,以便于儿科临床工作者更好地了解该疾病,及时对患儿做出正确的诊断和治疗。

The incidence of pulmonary embolism in children is low,but the mortality rate is high.In children,pulmonary embolism(PE)is characteristically seen in combination with serious underlying medical disorders,most commonly in children with congenital heart disease,central venous catheters,and infection.The clinical manifestations of pulmonary embolism in children are atypical and difficult to distinguish from respiratory infections.Diagnostic test is necessary,especially with the lack of clinical prediction rules.In recent years,CT pulmonary angiography has replaced pulmonary angiography and become the first choice for the diagnosis of pulmonary embolism in children.Because of the lack of large sample studies in children,therapy recommendations are obtained from adult clinical trials and a few smaller pediatric studies.Treatment methods include anticoagulation,thrombolysis and surgical thrombectomy.This article reviews the high-risk factors,diagnosis and treatment of children with pulmonary embolism.