重型血友病A经外周置入中心静脉导管现状分析

Analysis of peripherally inserted central catheters in children with severe hemophilia A

目的探索和总结经外周静脉置入中心静脉置管(PICC)在重型血友病治疗中的经验。方法回顾性收集2020年1月-2023年12月在首都医科大学附属北京儿童医院接受PICC的重型血友病A儿童的基本信息,电话询问其目前治疗现状及PICC并发症情况。结果共纳入76例重型血友病A患儿,中位年龄4.2(2.3-5.8)岁,共安装123次PICC。安装PICC前,有17.1%(13/76)的患儿开展了家庭治疗;安装后,84.2%(64/76)的患儿进行了家庭治疗。有7.9%(6/76)的患儿出现导管位置改变,10.5%(8/76)出现导管阻塞,39.5%(30/76)出现贴膜下以及贴膜周围皮肤皮疹,2例患儿出现导管相关血栓,5例自行将PICC导管拔除,7例出现导管相关感染。结论重型血友病A患儿PICC置入后,置管局部皮疹、导管堵塞、导管滑脱、导管血栓及导管相关感染等并发症较常发生,应充分考虑多种因素,为其建立最适合的血管通路。

Objective To explore and summarize the real experience of Peripherally Inserted Central Venous Catheters(PICC)in treating children with severe hemophilia.Methods Basic information on children with severe hemophilia A who were treated with PICC at Beijing Children′s Hospital of Capital Medical University from January 2020 to December 2023 was retrospectively collected.The current treatment status of these children and data on PICC-related complications were obtained through telephone interviews and other methods.Results Seventy-six children with severe haemophilia A were enrolled in this study,with a median age of 4.2(2.3,5.8)years.123 PICCs were installed in 76 children,and in 54 children with inhibitors.Before PICC installation,17.1%(13/76)of the children were treated at home.After PICC installation,84.2%(64/76)of the children underwent home treatment.7.9%(6/76)of the children had a change in catheter position,10.5%(8/76)had catheter obstruction,39.5%(30/76)had a rash of the skin under the patch and around the patch,2 children had catheter-related thrombosis,5 children removed the PICC on their own,and 7 children removed the catheter on their own.Catheters were removed in 5 children,and 7 children developed catheter-related infections.Conclusions PICC placement is a practical and safe option for children with severe haemophilia A with inhibitors during ITI treatment.However,there are still deficiencies in PICC placement,such as complications such as local rash,catheter blockage,catheter slippage,catheter thrombosis and catheter-related infections still occur more frequently.The most suitable vascular access should be established for individual children with severe haemophilia.