Levy Michael L, Granville Robert C, Hart David, Meltzer Hal
Department of Neurosurgery, Childrens Specialists of San Diego, and University of California, San Diego, California 92123, USA.
J Neurosurg. 2004 Aug;101(1 Suppl):32-7. doi: 10.3171/ped.2004.101.2.0032.
The objective of this retrospective review was to identify patients on the pediatric neurosurgical ward with deep venous thrombosis (DVT) to develop diagnostic and treatment-related guidelines.
The authors performed a retrospective chart review of all cases of DVT presenting to the Children's Hospital between March 1986 and February 1997. Of 32 patients identified, 14 were followed by the neurosurgical service. Current records were additionally evaluated to assess follow-up condition in the patients as well as outcome. Variables included diagnosis, race, age, follow-up duration, outcome, presenting signs/symptoms, involved vessel(s), concurrent disease, diagnostic modalities, and treatment. Patient age ranged from 1 to 16 years (mean 12.6 years, median 15 years). There were five girls and nine boys. Eight DVTs were right sided and six were left sided. Presenting symptoms included swelling of the affected extremity in 11 patients, pain in five, erythema in one, and cardiopulmonary arrest in two. Comorbidities included previous orthopedic procedures in three, brain tumors in two, and sepsis, fracture, pulmonary disease, preexisting coagulation disorders, and brain abscess in one patient each. Eight patients presented with a history of trauma. Two patients had undergone chemotherapy. Diagnostic studies included ultrasonography and venography in one, venography alone in two, computerized tomography (CT) scanning and venography in one, tagged red blood cell studies in one, ultrasonography and CT scanning in one, and ultrasonography alone in eight. In one patient an inferior vena cava filter was placed and one patient was treated with oral warfarin alone. One patient with a brain tumor died while hospitalized. In four patients there was evidence of rheumatological disease in the group of patients not treated neurosurgically. Two patients suffered recurrences during the follow-up period (mean 20 months) In the entire series of 32 patients there were five total deaths. Of these, two patients experienced six recurrences each, and one other patient suffered four recurrences. Of note, none of the recurrences was observed in patients with underlying coagulation disorders.
Children with DVT can experience serious complications in the form of both morbidity and mortality. Although most thrombotic complications have been found in patients with femoral lines, prolonged treatment involving a central line has been found to be a significant predictor of DVT. Multiple treatment modalities currently exist for children with DVT. Low-molecular-weight heparin therapy has many benefits over unfractionated heparin agents and may be more appropriate for the prophylaxis or treatment of children and adolescents with DVT because of its acceptable safety and efficacy. Clinical data for neonates and young children remain incomplete.
本回顾性研究的目的是确定小儿神经外科病房中患有深静脉血栓形成（DVT）的患者，以制定诊断和治疗相关指南。
作者对1986年3月至1997年2月期间儿童医院收治的所有DVT病例进行了回顾性病历审查。在确定的32例患者中，14例由神经外科服务团队随访。另外评估了当前记录，以评估患者的随访情况以及结局。变量包括诊断、种族、年龄、随访时间、结局、出现的体征/症状、受累血管、并发疾病、诊断方式和治疗。患者年龄从1岁到16岁不等（平均12.6岁，中位数15岁）。有5名女孩和9名男孩。8例DVT发生在右侧，6例发生在左侧。出现的症状包括11例患者患侧肢体肿胀、5例疼痛、1例红斑和2例心肺骤停。合并症包括3例既往有骨科手术史、2例脑肿瘤、1例败血症、1例骨折、1例肺部疾病、1例既往有凝血障碍和1例脑脓肿。8例患者有外伤史。2例患者接受过化疗。诊断研究包括1例超声检查和静脉造影、2例仅静脉造影、1例计算机断层扫描（CT）和静脉造影、1例标记红细胞研究、1例超声检查和CT扫描以及8例仅超声检查。1例患者放置了下腔静脉滤器，1例患者仅接受口服华法林治疗。1例脑肿瘤患者住院期间死亡。在未接受神经外科治疗的患者组中，4例有风湿性疾病证据。2例患者在随访期间（平均20个月）复发。在整个32例患者系列中，共有5例死亡。其中，2例患者各复发6次，另1例患者复发4次。值得注意的是，在有潜在凝血障碍的患者中未观察到复发。
患有DVT的儿童可能会出现严重的并发症，包括发病率和死亡率。虽然大多数血栓形成并发症见于有股静脉置管的患者，但发现涉及中心静脉置管的长期治疗是DVT的重要预测因素。目前存在多种针对儿童DVT的治疗方式。低分子量肝素疗法相对于普通肝素制剂有许多优点，由于其可接受的安全性和有效性，可能更适合预防或治疗儿童和青少年的DVT。新生儿和幼儿的临床数据仍然不完整。
