儿童脑外血管栓塞29例临床特点  

Clinical features of 29 cases of children with extracranial cerebral embolism

作　　者：韩青[1] 史彧[1] 周凯[2] 唐文伟[3] 赵德育[1] 

机构地区：[1]南京医科大学附属南京儿童医院呼吸科,210008 [2]南京医科大学附属南京儿童医院感染科,210008 [3]南京医科大学附属南京儿童医院放射科,210008

出　　处：《中华实用儿科临床杂志》2016年第24期1889-1893,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的通过病例分析，提高对儿童脑外血管栓塞性疾病（VED）的认识。方法总结2011年1月至2015年12月南京医科大学附属南京儿童医院收治的29例VED患儿的临床资料，回顾性分析儿童VED的发病趋势、易栓因素、临床特点、治疗及预后等。结果2011年1月至2015年12月VED的年诊断率由0／万升至1．49／万。29例中男20例，女9例，平均年龄6．03岁（2h-13．83岁）。婴儿期占比〉20％（6／29例）。女性、非感染组、风湿性疾病组、静脉栓塞组的平均年龄虽分别高于男性、感染组、非风湿性疾病组、动脉栓塞组，但差异均无统计学意义（P均〉0．05）。易栓症依次为感染、心脏疾病、肾病综合征、风湿性疾病、肿瘤、双胎栓塞综合征，易栓因素为静脉置管、制动、脱水、使用糖皮质激素等。心脏疾病主要引起非血栓性动脉栓塞，其他易栓疾病主要引起血栓性静脉栓塞。肺栓塞主要见于重症肺炎特别是肺炎支原体肺炎（MPP）。年龄越大临床表现越典型，D二聚体、纤维蛋白／纤维蛋白原降解产物显著升高有一定提示意义。治疗视危险程度而定。动脉栓塞中〈1岁占37．50％（3／8例）、病死率为25．00％（2／8例），分别高于静脉栓塞的17．65％（3／17例）、11．76％（2／17例）。结论心脏疾病主要引起动脉栓塞，感染、肾病综合征、风湿性疾病主要引起静脉栓塞。肺栓塞主要见于重症肺炎特别是MPP。动脉栓塞的危险性高于静脉栓塞。Objective Through the analysis of cases, to improve the cognition of clinicians on extracranial vas- cular embolism diseases（VED） in children. Methods The clinical information included incidence trend, thrombophi- lia, clinical features, treatment and prognosis of 29 children with VED,who were admitted from January 2011 to Decem- ber 2015 in Nanjing Children＇s Hospital Affiliated to Nanjing Medical University, and retrospectively analyzed. Results The annual rate of VED increased from 0 to 1.49 per 10 000 hospital admissions from January 2011 to December 2015. In 29 cases,there were 20 male and 9 female,with an average age of 6.03 years old （2 h - 13.83 years old）. In- fants accounted for 〉 20% （6/29 cases）. The average age of the female, non infected group, rheumatic disease group and venous thrombosis group was higher than that of the male, the infection group, the non rheumatic disease group and the arterial embolization group, but there was no significant difference（ all P 〉 0.05 ）. Thrombophilia were as follows：in- fection disease,heart disease,kidney disease syndrome, rheumatoid disease, tumor, and twins embolization syndrome. Risk factors included central venous line, immobility, dehydration, glucocorticoids use, etc. Heart disease was the leading cause of non thrombotic embolism,while other thrombophilic diseases resulted in thrombotic embolism. Pulmonary em- bolism was mainly seen in patients with severe pneumonia, especially mycoplasma pneumoniae pneumonia （ MPP ）. The older the age,the more typical clinical manifestations, and significantly elevated D dimer, fibrin/fibrinogen degradation products tips VED. Treatment depends on the degree of risk. Thirty - seven point five percent （3/8 cases） of children with arterial embolism were less than 1 year old, and the mortality 25.00% （ 2/8 cases） was significantly higher than that of venous thrombosis 17.65% （3/17 cases） and 11.76% （2/17 cases）. Conclusion Heart disease mainly cause arterial embolism and infection,

关 键 词：动脉栓塞 静脉栓塞 肺栓塞 儿童 

分 类 号：R726.5[医药卫生—儿科]