血栓性肺栓塞八例临床特征分析

目的分析儿童血栓性肺栓塞(PTE)临床特征以提高对该病的认识和诊治能力。方法回顾性分析浙江大学医学院附属儿童医院2014年3月至2019年3月收治的8例PTE患儿(男4例、女4例)的临床表现、实验室检查、影像学特点和诊治情况。结果8例PTE患儿年龄9小时龄~14岁10月龄。发热4例、咳嗽加剧4例、气促3例、胸痛2例、腹痛和背痛1例、咯血2例、发绀1例、下肢水肿2例。肺部局部呼吸音降低2例、痰鸣音3例、胸膜摩擦音1例。超声发现胸腔积液5例。6例血浆D-二聚体水平升高(0.66~9.96 mg/L),5例超敏C反应蛋白升高(10.78~78.00 mg/L)。胸部增强CT提示肺动脉或静脉充盈缺损,其中肺动脉栓塞7例、肺静脉栓塞1例。原发病包括肺炎支原体肺炎4例、肾炎2例和先天性心脏病术后2例。7例患儿接受抗凝治疗后痊愈,1例因家长拒绝进一步治疗自动出院。结论对于有肺炎支原体肺炎、免疫紊乱、长期激素治疗、心血管有创操作等高危因素的患儿,出现发热、咳嗽加重、呼吸急促、胸痛和腹背痛伴胸腔积液等,要注意PTE可能,尽早行胸部增强CT检查以确诊。抗凝可以作为儿童PTE首选治疗方法。

Clinical features of pulmonary thromboembolism of eight children

Objective To improve the diagnosis and therapy of childhood pulmonary thromboembolism(PTE)by analyzing the clinical features of this rare condition.Methods A total of 8 pediatric patients(4 males,4 females)with PTE diagnosed in the Children′s Hospital of Zhejiang University School of Medicine from March,2014 to March,2019 were enrolled.The clinical manifestation,laboratory results,imaging findings,diagnosis and treatment were summarized.Results Among these 8 cases,aged from 9 hours to 14 years and 10 months.Fever was found in 4 cases,cough aggravation in 4,short of breath in 3,chest pain in 2,abdominal and back pain in one,hemoptysis in 2,cyanosis in 1,and edema of lower extremities in 2.Physical examination found decreased breath sound in 2 cases,phlegm rale in 3,and pleural friction rub in one.Pleural effusion was found in 5 cases by ultrasound.Plasma D-dimer increased in 6 cases(0.66-9.96 mg/L)and hypersensitive C-reactive protein elevated in 5 cases(10.78-78.00 mg/L).Chest enhanced CT showed pulmonary artery or venous filling defects,including pulmonary artery embolism in 7 cases and pulmonary vein embolism in one.The primary disease of these patients included Mycoplasma Pneumoniae pneumonia in 4 cases,nephritis in 2 and postoperative congenital heart disease in 2.Apart from one case who withdrew the treatment and was discharged,the other 7 patients received anticoagulant treatment had good outcome.Conclusions For children with Mycoplasma pneumoniae pneumonia,immune disorders,long-term hormone therapy,cardiovascular invasive operation or other high-risk factors,PTE should be considered when fever,cough aggravation,short of breath,chest and back pain with pleural effusion are present.Chest enhanced CT scan should be performed as soon as possible,and anticoagulation should be started once the diagnosis is confirmed.