病例04(2024):新生儿肢体动脉血栓溶栓治疗2例  

Case 04(2024):Two cases of neonatal limb arterial thrombosis with thrombolytic therapy

作　　者：孙梦泽 张莹[1] 王来栓 陈正[3] 王华 丁欣[5] 王秋实[6] 胡海地 侯阿娜[1] Sun Mengze;Zhang Ying;Wang Laishuan;Chen Zheng;Wang Hua;Ding Xin;Wang Qiushi;Hu Haidi;Hou Ana(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Neonatology,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Neonatology,Children's Hospital,Zhejiang University,Hangzhou 310003,China;Department of Neonatology,West China Second University Hospital,Sichuan University,Chengdu 610044,China;Department of Neonatology,Children's Hospital of Soochow University,Suzhou 215025,China;Department of Blood Transfusion,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Vascular Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿科,沈阳110004 [2]复旦大学附属儿科医院新生儿科,上海201102 [3]浙江大学附属儿童医院新生儿科,杭州310003 [4]四川大学华西第二医院新生儿科,成都610044 [5]苏州大学附属儿童医院新生儿科,苏州215025 [6]中国医科大学附属盛京医院输血科,沈阳110004 [7]中国医科大学附属盛京医院血管外科,沈阳110004

出　　处：《中华围产医学杂志》2024年第8期688-694,共7页Chinese Journal of Perinatal Medicine

摘　　要：本文报道中国医科大学附属盛京医院分别于2023年4月和2022年8月收治的2例局部留置针后发生腋动脉血栓形成的超低/极低出生体重儿。病例1行坏死性小肠结肠炎手术治疗前于左侧腋下留置动脉留置针1枚,当日出现左上肢皮肤青紫和桡动脉搏动减弱,超声检查明确左侧腋动脉血栓形成。予皮下注射低分子量肝素和输注血浆后血液循环仍未改善,并出现左上肢活动减少和桡动脉搏动消失,予重组组织型纤溶酶原激活剂溶栓治疗。开始溶栓后6 h可触及桡动脉搏动,停止溶栓,继续低分子量肝素抗凝2周。患儿1岁8月龄时左手握持力较右侧减弱,功能基本保留。病例2患儿生后17 d发生晚发型败血症,留置腋动脉留置针1枚,次日出现左上肢肤色苍白和肱动脉及桡动脉搏动消失,血管超声提示左侧腋动脉血栓形成。予低分子量肝素皮下注射抗凝治疗,加用尿激酶溶栓。溶栓后第6天超声检查未见血栓样回声。患儿1岁8月龄时患侧上肢发育及运动未见明显异常。This article reported two cases of axillary artery thrombosis in extremely low/very low birth weight infants following the placement of a local arterial catheter,who hospitalized in Shengjing Hospital of China Medical Universityin in April 2023 and August 2022,respectively.Case 1:Before surgery for necrotizing enterocolitis,an arterial catheter was placed in the left axilla of the infant.On the same day,the infant developed cyanosis of the left upper limb and weakened radial artery pulse.Ultrasound examination confirmed the presence of left axillary artery thrombosis.Despite subcutaneous injection of low molecular weight heparin(LMWH)and plasma infusion,there was no improvement in blood circulation.The infant also exhibited reduced movement in the left upper limb and loss of radial artery pulse.Thrombolytic therapy with recombinant tissue-type plasminogen activator was administered.Six hours after the treatment,the radial artery pulse became palpable.Thrombolysis was then terminated,and anticoagulation with LMWH was supplied for two weeks.At one year and eight months of age,the infant had a weaker left-hand grip strength compared to the right,but the overall functionality was largely preserved.Case 2:The infant developed late-onset sepsis at 17 days old and had an arterial catheter placed in the axilla.Pale left upper limb was observed in the following day,and the brachial and radial artery pulses were absent.Vascular ultrasound indicated the presence of left axillary artery thrombosis.Anticoagulation therapy with subcutaneous injection of LMWH was provided,along with thrombolysis using urokinase.On the sixth day after thrombolysis,an ultrasound examination showed no thrombus-like echoes.At one year and eight months of age,the development and movement of the affected upper limb became normal.

关 键 词：早产儿 新生儿 动脉栓塞 溶栓 

分 类 号：R722.1[医药卫生—儿科]