CAJ | 학술논문

目的：通过回顾性收集分析首都医科大学附属北京儿童医院内科系统住院患儿中导管相关性静脉血栓（CRT）的临床资料，了解我国儿童 CRT 发生情况。方法回顾性收集2010年11月至2013年11月首都医科大学附属北京儿童医院内科系统住院 CRT 患儿病例资料，分析其发生的原因、临床表现、诊断、治疗及预后。结果共42例 CRT 患儿，男女比例为1.0：0.5，男女年龄分布差异无统计学意义（P ＝0.862）；发病年龄中位数7岁4个月（2个月~15岁6个月），﹤1岁占16.7%（7/42例），其次为13~14岁占11.9%（5/42例）；CRT 发生距置管间隔时间的中位数为9 d（范围1~81 d），置管后0~10 d 为发生 CRT 高峰期（52.5%，21/40例），其次为10~20 d（35.0%，14/40例）；原发病以血液肿瘤疾病、肾脏疾病及深部真菌感染居多。发生血栓位置右侧置管（57.1%，24/42例）稍多于左侧（38.1%，18/42例）；病例均经 B 超检查获得确诊，其中无症状者占28.6%（12/42例）。确诊后7.1%（3/42例）采用患肢制动、热敷等保守治疗，7.1%（3/42例）行导管拔除，33.3%（14/42例）在拔管基础上使用抗凝剂和/或溶栓剂。1周后共22例复查 B 超，其中血栓较前缩小54.5%（12/22例），且均为干预病例；血栓较前增长22.7%（5/22例）；血栓无明显变化22.7%（5/22例）。3例在发生 CRT 拔出导管后因病情需要重新置管，且3例均再次复发，复发率为100%。结论儿童 CRT 以婴儿及年长儿多见；多发生在置管20 d 以内；常发生于患有血液肿瘤、肾脏疾病及深部真菌感染的患儿；对放置导管的患儿应进行常规超声检查，监测血栓的发生；发生 CRT 时及时应用抗凝、溶栓治疗，必要时拔出导管治疗有效，重新放置导管有 CRT 复发的可能。
목적：통과회고성수집분석수도의과대학부속북경인동의원내과계통주원환인중도관상관성정맥혈전（CRT）적림상자료，료해아국인동 CRT 발생정황。방법회고성수집2010년11월지2013년11월수도의과대학부속북경인동의원내과계통주원 CRT 환인병례자료，분석기발생적원인、림상표현、진단、치료급예후。결과공42례 CRT 환인，남녀비례위1.0：0.5，남녀년령분포차이무통계학의의（P ＝0.862）；발병년령중위수7세4개월（2개월~15세6개월），﹤1세점16.7%（7/42례），기차위13~14세점11.9%（5/42례）；CRT 발생거치관간격시간적중위수위9 d（범위1~81 d），치관후0~10 d 위발생 CRT 고봉기（52.5%，21/40례），기차위10~20 d（35.0%，14/40례）；원발병이혈액종류질병、신장질병급심부진균감염거다。발생혈전위치우측치관（57.1%，24/42례）초다우좌측（38.1%，18/42례）；병례균경 B 초검사획득학진，기중무증상자점28.6%（12/42례）。학진후7.1%（3/42례）채용환지제동、열부등보수치료，7.1%（3/42례）행도관발제，33.3%（14/42례）재발관기출상사용항응제화/혹용전제。1주후공22례복사 B 초，기중혈전교전축소54.5%（12/22례），차균위간예병례；혈전교전증장22.7%（5/22례）；혈전무명현변화22.7%（5/22례）。3례재발생 CRT 발출도관후인병정수요중신치관，차3례균재차복발，복발솔위100%。결론인동 CRT 이영인급년장인다견；다발생재치관20 d 이내；상발생우환유혈액종류、신장질병급심부진균감염적환인；대방치도관적환인응진행상규초성검사，감측혈전적발생；발생 CRT 시급시응용항응、용전치료，필요시발출도관치료유효，중신방치도관유 CRT 복발적가능。
Objective To study the current status of catheter - related thrombosis(CRT)in Chinese children through a retrospective analysis of the inpatients in the Department of Medicine,Beijing Children's Hospital Affiliated to Capital Medical University. Methods The clinical data of the inpatients with CRT from November 2010 to November 2013 were collected retrospectively,and the causes,clinical symptoms,diagnosis,treatment and prognosis were ana-lyzed. Results There were 42 cases of children with CRT in Beijing Children's Hospital Affiliated to Capital Medical University. Among the cases,the male to female ratio was 1. 0:0. 5;the median age of onset was 88(2 - 186)months with ﹤ 1 year old counted for 16. 7%(7 / 42 cases)and 13 - 14 years old counted for 11. 9%(5 / 42 cases);the distri-bution differences between the male and the female age were not significant(P = 0. 826). The median time from cathe-terization to CRT onset was 9(1 - 81)days,0 - 10 days after catheterization was the peak of onset(52. 5% ,21 / 40 ca-ses)followed by 10 - 20 days(35. 0% ,14 / 40 cases). The protopathy was usually hematologic tumor,kidney disease or deep fungal infection. Slightly more cases developed CRT on the right side(57. 1% ,24 / 42 cases)than on the left side (38. 1% ,18 / 42 cases). All cases were diagnosed by using B - ultrasound,of whom 28. 6%(12 / 42 cases)were symp-tom - free. After being diagnosed,7. 1%(3 / 42 cases)were treated with conservative methods such as immobilization of the affected limbs and hot compress;7. 1%(3 / 42 cases)had catheter removed;anticoagulant and/ or thrombolytics after catheter removal used in 33. 3% patients(14 / 42 cases). After 1 week,22 cases were reviewed,of whom 54. 5%(12 / 22 cases)had thrombosis reduced(all with intervention),thrombosis growing in 22. 7% patients(5 / 22 cases), and thrombosis did not change in 22. 7% patients(5 / 22 cases). Three cases needed re - catheterization after catheter removal,and all of 3 cases had CRT recurrences(100% ). Conclusions CRT is more common among infants and senior children. CRT usually develops within 20 days after catheterization. Children with hematologic tumor,kidney disease or deep fungal infection are more likely to have CRT. Routine ultrasound test should be conducted to monitor CRT in catheterized children. Once CRT is diagnosed,patients need to be treated with anticoagulants and/ or thrombo-lytics. Catheter should also be removed if necessary. Recatheterization can result in CRT recurrence.