儿童华法林用药指征与指南推荐的对比分析  

Comparative Analysis of Indications and Guidelines for Warfarin Use in Children

作　　者：岑菡婧 李晓君 郭芷君 何艳玲 Cen Hanjing;Li Xiaojun;Guo Zhijun;He Yanling(Guangzhou Women and Children's Medical Center,Guangdong Guangzhou 510623,China;Souhern Medical Universily,Guangdong Guangzhou 510515,China)

机构地区：[1]广州市妇女儿童医疗中心,广东广州510623 [2]南方医科大学,广东广州510515

出　　处：《儿科药学杂志》2020年第10期36-40,共5页Journal of Pediatric Pharmacy

基　　金：广州市医药卫生科技项目,编号20171A011254;广东省医院药学研究基金,编号2016A25。

摘　　要：目的:分析儿童华法林用药指征分布特点,总结指南推荐意见,为儿科临床合理使用华法林提供参考。方法:回顾分析广州市妇女儿童医疗中心儿科华法林的用药情况,查阅患儿诊断、手术及病程记录明确华法林用药目的。分析美国胸科医师协会、美国血液学协会、美国心脏协会、中华医学会等目前美国及国内较权威的相关指南与共识,对华法林用药指征的指南推荐进行总结。结果:共纳入248例患儿,其中男173例,女75例,平均年龄5岁。门静脉海绵样变Meso-Rex术后、肝移植术后预防血栓形成、完全肺静脉异位引流矫治术等用药指征未见儿童及成人相关指南推荐信息。部分用药指征,如间歇性跛行、外周动脉植入支架后预防血栓及外周动脉栓塞,指南不推荐使用华法林。结论:儿童华法林的用药指征分布具有其特殊性,且部分用药指征的循证证据级别不高,需加强针对儿童用药的相关研究。Objective: To analyze the distribution characteristics of indications of warfarin in children,and to summarize the recommendations of the guidelines,so as to provide reference for the rational use of warfarin in pediatrics. Methods: Retrospective analysis was performed on warfarin use in pediatrics in Guangzhou Women and Children’s Medical Center. The diagnosis,operation and course of disease records of children were reviewed to determine the purpose of warfarin use. Recommendations of different indications in authoritative guidelines or expert consensuses drafted by the American College of Chest Physicians,American Society of Hematology,American Heart Association or Chinese Medical Association were analyzed and viewed. Results: A total of 248 children were enrolled,including 173 males and 75 females,with an average age of 5 years. There was no recommendations of anticoagulant selection for the indications such as Meso-Rex procedure for cavernous transformation of portal vein,thromboprophylaxis after liver transplantation and thromboprophylaxis of surgical correction of total anomalous pulmonary venous connection. And the guidelines did not recommend warfarin for indications including intermittent claudication,thromboprophylaxis for stent placement of peripheral artery and peripheral arterial embolism. Conclusion: The distribution characteristics of indications of warfarin use in children is special and the level of evidences for some indications is relatively low,therefore,more related researches for children are needed.

关 键 词：儿童 华法林 用药指征 指南 

分 类 号：R969.3[医药卫生—药理学]