先天性心脏病患儿术后下肢静脉血栓形成的危险因素分析

Kaiyuan Wu, Bin Li, Y. Hua, Taibing Fan
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Hua, Taibing Fan","doi":"10.3760/CMA.J.CN101070-20190217-00105","DOIUrl":null,"url":null,"abstract":"Objective \nTo explore the risk factors of puncture- or catheter-related lower extremity venous thrombosis after surgery for congenital heart disease(CHD). \n \n \nMethods \nA retrospective analysis was performed on 683 children with venipuncture or venous catheterization in the lower extremities who underwent surgery for CHD in Children′s Heart Center Intensive Care Unit, Henan Provincial People′s Hospital from January 2017 to December 2018, and there were 55 children suspected thrombosis, among whom, 26 cases of thrombosis confirmed by ultrasound were included in the thrombosis group, and 29 cases without thrombosis seen by ultrasound were assigned to the control group.A comparative analysis was carried out to see whether there were statistical differences in the possible risk factors between the 2 groups, and the risk factors of puncture- or catheter-related lower extremity venous thrombosis after operation of CHD. \n \n \nResults \nThe incidence of puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD was 3.81% (26/683 cases). The differences between the thrombosis group and the control group in age (62 d vs.92 d), weight [(3.92±0.66) kg vs.(4.61±0.86) kg], CHD postoperative critical score (Vasoactive-Ventilation-Renal score, VVR)[(29.58±15.50) scores vs.(22.14±11.72) scores], peak blood lactate within 24 hours after surgery [(3.59±0.66) mmol/L vs.(1.71±1.13) mmol/L], postoperative blood transfusion[76.9%(20/26 cases) vs.34.5%(10/29 cases)], co-infection[53.8%(14/26 cases) vs.24.1%(7/29 cases)], cyanotic congenital heart disease [84.6%(22/26 cases) vs.34.5%(10/29 cases)] and puncture difficulty[69.2%(18/26 cases) vs.17.2%(5/29 cases)] were statistically significant(all P<0.05). 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引用次数: 0

摘要

目的探讨先天性心脏病(CHD)术后与穿刺或导管相关的下肢静脉血栓形成的危险因素。方法回顾性分析2017年1月至2018年12月在河南省人民医院儿童心脏中心重症监护病房行冠心病手术的下肢静脉穿刺或静脉置管患儿683例,其中疑似血栓患儿55例,其中超声确诊血栓26例为血栓组;29例超声未见血栓形成者作为对照组。比较分析两组患者可能的危险因素,以及冠心病术后穿刺或导管相关下肢静脉血栓形成的危险因素是否有统计学差异。结果冠心病术后与穿刺、导管相关的下肢静脉血栓发生率为3.81%(26/683)。血栓组与对照组在年龄(62 d vs.92 d)、体重((3.92±0.66)kg vs(4.61±0.86)kg)、冠心病术后临界评分(血管活性-通气-肾评分,VVR)[(29.58±15.50)分vs(22.14±11.72)分]、术后24小时血乳酸峰值[(3.59±0.66)mmol/L vs(1.71±1.13)mmol/L]、术后输血[76.9%(20/26例)vs.34.5%(10/29例)]、合并感染[53.8%(14/26例)vs.24.1%(7/29例)]、青紫型先天性心脏病[84.6%(22/26例)比34.5%(10/29例)]、穿刺困难[69.2%(18/26例)比17.2%(5/29例)]差异有统计学意义(均P<0.05)。Logistic回归分析显示,术后VVR评分(OR=0.88, 95%CI: 0.77 ~ 0.99, P=0.04)、术后24 h血乳酸峰值(OR=6.62, 95%CI: 1.35 ~ 32.46, P=0.02)、青紫型先天性心脏病(OR=0.04, 95%CI: 0.00 ~ 0.63, P=0.04)是下肢静脉血栓形成的危险因素。结论冠心病术后VVR评分高、24 h血乳酸峰值高、先天性青紫是冠心病术后穿刺或导管相关性下肢静脉血栓形成的高危因素。关键词:先天性心脏病;下肢静脉;血栓形成;婴儿
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Analysis of risk factors of lower extremity venous thrombosis in pediatric patients after surgery for congenital heart disease
Objective To explore the risk factors of puncture- or catheter-related lower extremity venous thrombosis after surgery for congenital heart disease(CHD). Methods A retrospective analysis was performed on 683 children with venipuncture or venous catheterization in the lower extremities who underwent surgery for CHD in Children′s Heart Center Intensive Care Unit, Henan Provincial People′s Hospital from January 2017 to December 2018, and there were 55 children suspected thrombosis, among whom, 26 cases of thrombosis confirmed by ultrasound were included in the thrombosis group, and 29 cases without thrombosis seen by ultrasound were assigned to the control group.A comparative analysis was carried out to see whether there were statistical differences in the possible risk factors between the 2 groups, and the risk factors of puncture- or catheter-related lower extremity venous thrombosis after operation of CHD. Results The incidence of puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD was 3.81% (26/683 cases). The differences between the thrombosis group and the control group in age (62 d vs.92 d), weight [(3.92±0.66) kg vs.(4.61±0.86) kg], CHD postoperative critical score (Vasoactive-Ventilation-Renal score, VVR)[(29.58±15.50) scores vs.(22.14±11.72) scores], peak blood lactate within 24 hours after surgery [(3.59±0.66) mmol/L vs.(1.71±1.13) mmol/L], postoperative blood transfusion[76.9%(20/26 cases) vs.34.5%(10/29 cases)], co-infection[53.8%(14/26 cases) vs.24.1%(7/29 cases)], cyanotic congenital heart disease [84.6%(22/26 cases) vs.34.5%(10/29 cases)] and puncture difficulty[69.2%(18/26 cases) vs.17.2%(5/29 cases)] were statistically significant(all P<0.05). Logistic regression analysis showed postoperative VVR score (OR=0.88, 95%CI: 0.77-0.99, P=0.04), blood lactate peak within 24 hours after surgery (OR=6.62, 95%CI: 1.35-32.46, P=0.02), and cyanotic congenital heart disease (OR=0.04, 95%CI: 0.00-0.63, P=0.04) were risk factors for venous thrombosis in the lower extremities. Conclusions High postoperative VVR score, high 24 h blood lactate peak after surgery and cyanotic congenital heart disease are high risk factors for puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD. Key words: Congenital heart disease; Lower extremity vein; Thrombosis; Infant
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来源期刊
中华实用儿科临床杂志
中华实用儿科临床杂志 Medicine-Pediatrics, Perinatology and Child Health
CiteScore
0.60
自引率
0.00%
发文量
14243
期刊介绍: Chinese Journal of Applied Clinical Pediatrics ( semi-monthly ) is a core journal of paediatrics under the supervision of China Association for Science and Technology, sponsored by Chinese Medical Association and undertaken by Xinxiang Medical College. Founded in 1986, it is openly circulated both at home and abroad. The journal has several columns, such as Expert Forum, Experimental Research and Paediatric Surgery, which are mainly for paediatric medical workers and medical researchers in hospitals. Its purpose is to reflect the new theories and technologies in paediatric medicine and scientific research at home and abroad, and to promote academic exchanges. Chinese Journal of Applied Clinical Pediatrics is a source journal of China Science Citation Database (CSCD), a core journal of Peking University, a source journal of Chinese science and technology paper statistics (China Science and Technology Core Journals), a core academic journal of RCCSE, a high-quality scientific and technical journal of China, a high-quality scientific and technical journal of China Association for Science and Technology, and a high-quality scientific and technical journal of China Biomedical Science and Technology Association. We have been published in China Biomedical Literature Database (SinoMed), China Knowledge Network, Wanfang Data Knowledge Service Platform, China Academic Journal Abstracts, Scopus Database, Chemical Abstracts (USA), Japan Science and Technology Agency (JSTA) Database, Copernicus Abstracts (Poland), Abstracts of the Centre for Agricultural and Biological Sciences (CABS) of the United Kingdom, Cambridge Scientific Abstracts ProQuest Database, WHO Medical Journal of the Western Pacific Region (WMPR), and WHO Medical Journal of the Western Pacific Region (WMPR) of the United States. We have been included in dozens of authoritative databases at home and abroad, such as WHO Western Pacific Region Index of Medicine (WPRIM), Ullrich's Guide to Periodicals, and so on.
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