儿童心导管术血管穿刺相关并发症危险因素分析

Risk factors of complications related to vascular puncture during cardiac catheterization in children

目的探讨心导管术血管穿刺相关并发症发生和预后的影响因素。方法回顾分析2019年1月至12月1488例行心导管术患儿的临床资料。结果共74例(5.0%)患儿在心导管术后出现血管穿刺相关并发症,其中男39例、女35例,中位年龄60.0(25.0~108.0)月;包括穿刺处血肿64例、股动静脉瘘5例、假性动脉瘤3例、血栓2例。与无并发症组相比,并发症组的年龄和体质量较大,身长(高)较高,穿刺血管为动脉、术前抗凝、使用大导管鞘以及先天性心脏病术后的比例较高,差异均有统计学意义(P<0.05)。结论儿童接受心导管术后血管穿刺相关并发症的发生率为5%。术前接受抗凝治疗、术中穿刺动脉血管、置入大导管鞘以及既往接受先心病手术患儿更易导致并发症的发生。

Objective To explore the occurrence,prognosis and influencing factors of vascular puncture-related complications during cardiac catheterization.Method The clinical data of 1488 children undergoing cardiac catheterization from January to December 2019 was retrospectively analyzed.Results The vascular puncture related complications after cardiac catheterization happened in a total of 74 children(5.0%)including 39 boys and 35 girls with a median age of 60.0(25.0-108.0)months.There were 64 cases of hematoma at the puncture site,5 cases of femoral arteriovenous fistula,3 cases of pseudoaneurysm and 2 cases of thrombosis.Compared with the non-complication group,the age,weight and length(height)of the complication group were higher;the proportions of artery puncture,preoperative anticoagulation,use of large catheter sheath and postoperative congenital heart disease were also higher.The differences were statistically significant(P<0.05).Conclusions The incidence of vascular puncture related complications after cardiac catheterization in children was 5%.Preoperative anticoagulant therapy,intraoperative puncture of arterial vessels,implantation of large catheter sheath and previous history of congenital heart disease surgery are more likely to lead to complications.