儿童下肢深静脉血栓形成的病因及治疗

目的 探讨儿童下肢深静脉血栓形成(DVT)的病因和治疗措施.方法 回顾性分析中山大学附属第一医院1989至2009年12例儿童DVT患者的临床资料.结果 1989至1999年间,儿童DVT患者在住院儿童患者的发生率为万分之0.52;2000至2009年间,发生率为万分之3.18.尽管其发生率不高,但近10年来,呈上升趋势.12例儿童DVT患者中,感染和创伤所致的儿童DVT各占3例,是儿童DVT的主要病因.静脉导管置入所致为2例.其他病因包括肾病综合征,肿瘤,系统性红斑狼疮,和先天性血浆蛋白C缺乏各1例.2例患者合并肺梗塞,1例新生儿因患核黄疸,最终因多系统器官功能衰竭死亡.抗凝是治疗儿童DVT的主要方法,尤其在新生儿DVT患者中,仅抗凝治疗可达到良好效果.9例儿童DVT患者同时接受经外周静脉溶栓治疗.治疗过程中无严重出血并发症发生.结论 由于儿童DVT发生率的不断升高和治疗的特殊性,临床上应引起对该疾病诊断和治疗的重视.

Risk factors and therapeutic management of deep venous thrombosis in hospitalized children

Objective The incidence and treatment regimen for deep venous thrombosis(DVT)in hospitalized children in China are rarely reported.This report was to assess the incidence,risk factors and treatment strategy for deep venous thrombosis(DVT)among hospitalized children admitted to the First Affiliated Hospital,Sun Yat-sen University,a single tertiary-care hospital.Methods In twenty years between 1989 and 2009,12 DVTs in hospitalized children(＜17 years old)were identified in this hospital.Clinical data were retrospectively reviewed.Results The incidence of DVT in hospitalized children was low,however,it demonstrated increasing trend from 0.52 per 10 000 admissions between 1989 and 1999 to 3.18 per 10 000 admissions between 2000 and 2009 in this hospital Infection and trauma were the mostly frequent causes of DVT in hospitalized children.The catheter-related DVT was increasingly prevalent cause for DVT in hospitalized children.The other causes included nephritic syndrome,tumor,systemic lupus,and congenital plasma C protein deficiency.Two patients were complicated with pulmonary embolism.Only one neonate died due to kernicterus.Anticoagulation therapy was the first recommended treatment choice in hospitalized children with DVT,especially more low-molecular-weight heparin in recent 10 years.Antithrombotic treatment was used in 9 children older than 30 days through peripheral venous access,its application should be meticulously cautious in dosage.No bleeding occurred in all the patients.Conclusions Cautions should be given to DVT among hospitalized children due to its increasing incidence and special treatment pattern compared with adult patients.