29例儿童血管栓塞性疾病的临床特征分析  

Clinical characteristics of 29 children with vascular embolism

作　　者：詹瑶 谢乐云[1] 王涛[1] 余阗[1] 曾赛珍[1] Zhan Yao;Xie Leyun;Wang Tao;Yu Tian;Zeng Saizhen(The First Affiliated Hospital of Hunan Normal University,Hunan Provincial People′s Hospital,Changsha 410005,China)

机构地区：[1]湖南师范大学附属第一医院湖南省人民医院,长沙410005

出　　处：《中国小儿急救医学》2021年第5期415-419,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的总结儿童血管栓塞性疾病的临床特点,为早期识别及诊断提供临床数据。方法回顾性收集2017年1月至2020年1月在湖南师范大学附属第一医院(湖南省人民医院)儿童医学中心住院诊断血管栓塞性疾病患儿的临床资料并进行总结分析。结果共纳入29例血管栓塞性疾病患儿,男女比例为2.2∶1(20/9);年龄范围为1个月~13岁,中位年龄16(6~41)个月。其中22例为静脉栓塞,以下肢静脉栓塞常见(13/29,44.8%),其次为颅内静脉血栓形成(6/29,20.7%);6例为动脉栓塞,左心耳血栓1例。纳入患儿原发疾病以重症肺炎最为常见(19/29,65.5%),其次为心肺复苏术后(3/29,10.3%)、川崎病(3/29,10.3%)。对导管相关、长期卧床、D-二聚体升高、机械通气、静脉应用激素等血管栓塞性疾病危险因素进行统计,29例患儿中同时具有3个以上危险因素达89.2%(25/29),具有5个以上危险因素达82.8%(24/29)。结论儿童血管栓塞性疾病以深静脉血栓尤其是下肢静脉血栓较为常见,原发疾病以重症肺炎多见,对存在中心静脉置管、D-二聚体显著升高、长期卧床、重症肺炎等多重危险因素的患儿,发生血管栓塞性疾病风险较高,临床中应监测凝血功能并观察局部症状,以期早期识别。Objective To provide clinical data for early identification and diagnosis of vascular embolism in children.Methods We collected and analyzed the clinical data of children with vascular embolism diagnosed at the Children Medical Center of the First Affiliated Hospital of Hunan Normal University from January 2017 to January 2020.Results A total of 29 children with vascular embolism were included.The male to female ratio was 2.2∶1(20/9);the age range was 1 month to 13 years,and the median age(IQR)was 16(6-41)months.Among them,22 cases were diagnosed with venous thrombosis,including 13 children with lower limb venous thrombosis(13/29,44.8%),and six children with intracranial venous thrombosis(6/29,20.7%).Arterial embolism was found in six cases,and left atrial appendage thrombosis was found in one case.Severe pneumonia was the most common primary disease(19/29,65.5%),followed by cardiopulmonary resuscitation(3/29,10.3%),and Kawasaki disease(3/29,10.3%).Analysis on the risk factors of vascular embolization diseases,including catheter-related,long-term bed rest,elevated D-dimer,mechanical ventilation,and intravenous hormone administration,showed that 89.2%(25/29)had≥3 risk factors at the same time,and 82.8%(24/29)had≥5 risk factors at the same time.Conclusion In children with vascular thrombotic diseases,deep venous thrombosis,especially lower extremity venous thrombosis,are common.The severe pneumonia is more common in primary disease.Children with multiple risk factors have a higher risk of developing vascular embolism.In clinic,coagulation function should be monitored and local symptoms should be observed for early identification.

关 键 词：儿童 血管栓塞性疾病 危险因素 

分 类 号：R725.4[医药卫生—儿科]