儿童下肢导管相关深静脉血栓有关临床因素

Clinical factors of catheter-related lower limbs deep venous thrombosis in children

目的观察儿童下肢导管相关深静脉血栓(CRDVT)有关临床因素。方法回顾性分析57例股静脉置管后超声检出下肢CRDVT患儿,记录其年龄、原发病等临床资料,以及血栓类型、部位、距置管时间、治疗及预后等。结果57例年龄36.0(6.8,96.5)个月,其中28例(28/57,49.12%)0~3岁、5例(5/57,8.77%)3~6岁、12例(12/57,21.05%)6~9岁、12例(12/57,21.05%)>9岁;25例(25/57,43.86%)原发病为血液及肿瘤性疾病,9例(9/57,15.79%)为感染性疾病,7例(7/57,12.28%)先天性心脏病(CHD)外科矫治术后,16例(16/57,28.07%)为癫痫、外伤后等。39例(39/57,68.42%)下肢CRDVT为不完全性血栓、18例(18/57,31.58%)为完全性血栓;31例(31/57,54.39%)血栓位于股总静脉及髂外静脉,20例(20/57,35.09%)仅见于股总静脉,4例(4/57,7.02%)仅见于髂外静脉,2例(2/57,3.51%)同时累及股浅静脉及股总静脉;检出下肢CRDVT时间为置管后11.0(7.0,18.0)天,其中44例(44/57,77.19%)距置管2~20天。对39例(39/57,68.42%)行抗凝及溶栓治疗、3例(3/57,5.26%)予拔管、抗凝及溶栓治疗,对13例(13/57,22.81%)未予治疗,2例(2/57,3.51%)记录不详。治疗后36例(36/57,63.16%)下肢CRDVT完全溶解、14例(14/57,24.56%)部分溶解,7例(7/57,12.28%)血栓机化并阻塞血管。结论股静脉置管后下肢CRDVT与患儿年龄、原发疾病及置管时间等因素相关。

Objective To explore the clinical factors of lower limb catheter-related deep venous thrombosis(CRDVT)in children.Methods Data of 57 children with lower limb CRDVT found with ultrasound after femoral vein catheterization were retrospectively reviewed,and the clinical factors,status of thromboses(thrombi type,location and time from catheterization),as well as treatment and prognosis were recorded and analyzed.Results Twenty-eight children aged 0—3 years(28/57,49.12%),5 aged 3—6 years(5/57,8.77%),12 aged 6—9 years(12/57,21.05%)and 12>9 years(12/57,21.05%),with the mean age of 36.0(6.8,96.5)months.The primary diseases included hematologic or neoplastic diseases in 25 cases(25/57,43.86%),infectious diseases in 9 cases(9/57,15.79%),congenital heart disease(CHD)after surgery in 7 cases(7/57,12.28%),also epilepsy or post-traumatic diseases,etc.in 16 cases(16/57,28.07%).Incomplete thromboses of lower limb were detected in 39 cases(39/57,68.42%),while complete thromboses were found in 18 cases(18/57,31.58%).Thrombi in both common femoral vein and external iliac vein were observed in 31 cases(31/57,54.39%),only in common femoral vein in 20 cases(20/57,35.09%),only in external iliac vein in 4 cases(4/57,7.02%),in both superficial femoral vein and common femoral vein in 2 cases(2/57,3.51%).The time interval of lower limb CRDVT and femoral vein catheterization of all 57 cases was 11.0(7.0,18.0)days,while of 44 cases(44/57,77.19%)was 0—20 days.Among 57 cases,anticoagulation and thrombolysis were performed in 39 cases(39/57,68.42%),extraction of catheter and anticoagulation as well as thrombolysis were used in 3 cases(3/57,5.26%),while 13 cases(13/57,22.81%)were not treated and 2 cases(2/57,3.51%)had no treatment information.After treatment,CRDVT were completely dissolved in 36 cases(36/57,63.16%)while partially dissolved in 14 cases(14/57,24.56%),while thrombi mechanization and blood vessel occlusion occurred in 7 cases(7/57,12.28%).Conclusion Lower limb CRDVT after femoral vein catheterization in children related to age,primary disease and catheterization time.