儿童左心导管插入术后股动脉血栓形成的溶栓治疗。

Thrombolytic therapy for femoral artery thrombosis after left cardiac catheterization in children.

作者信息

Liu Qiong, Yan Chao-wu, Zhao Shi-hua, Jiang Shi-liang, Xu Zhong-ying, Huang Lian-jun, Ling Jian, Zheng Hong, Wang Yun

机构信息

Department of Radiology, Cardiovascular Institute, Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China.

出版信息

Chin Med J (Engl). 2009 Apr 20;122(8):931-4.

PMID:19493417

Abstract

BACKGROUND

Femoral artery thrombosis is one of the most common complications of catheterizations in infants and young children. This study was conducted to investigate the feasibility and effectiveness of thrombolytic therapy for femoral artery thrombosis after left cardiac catheterization in children.

METHODS

Thrombolytic therapy with urokinase was carried out in children with femoral artery thrombosis after left cardiac catheterization. Each patient was given a bolus injection of heparin (100 U/kg). A bolus of urokinase (30,000 - 100,000 U) was injected intravenously, and then a continuous infusion of 10 000 - 50 000 U/h was administered. Transcatheter thrombolysis was performed once previous procedures failed.

RESULTS

Eight patients (aged (3.1 +/- 2.3) years (8 months to 7 years), body weight (13.1 +/- 4.2) kg (7 to 20 kg)) presented lower limbs ischemia after left cardiac catheterizations was performed. Seven patients accepted thrombolytic therapy with urokinase. In 5 patients, peripheral intravenous thrombolysis was successful with restoration of a normal pulse. In the other 3 cases, peripheral intravenous thrombolysis failed, followed by successful transcatheter thrombolysis. The average duration of therapy was (7.25 +/- 5.31) hours (1 - 17 hours). The average doses of heparin and urokinase were (1600 +/- 723) U (800 - 3000 U) and (268 571 +/- 177 240) U (50 000 - 500 000 U), respectively. There were no statistically significant differences in partial thromboplastin time before and during urokinase therapy ((40.6 +/- 22.3) to (49.9 +/- 39.2) seconds). However, the prothrombin time was significantly longer ((12.7 +/- 2.58) to (48.1 +/- 18.6) seconds, P < 0.05). Patency of the target vessel was evaluated in all the patients for 2 weeks and no occlusion recurred.

CONCLUSION

Thrombolytic therapy with urokinase is a safe and useful modality in children with femoral artery thrombosis after left cardiac catheterization.

摘要

背景

股动脉血栓形成是婴幼儿导管插入术最常见的并发症之一。本研究旨在探讨溶栓治疗小儿左心导管插入术后股动脉血栓形成的可行性和有效性。

方法

对左心导管插入术后发生股动脉血栓形成的患儿采用尿激酶进行溶栓治疗。每位患者先静脉推注肝素（100 U/kg）。静脉推注尿激酶（30,000 - 100,000 U），然后以10 000 - 50 000 U/h的速度持续输注。若先前的治疗方法失败，则进行经导管溶栓。

结果

8例患者（年龄（3.1±2.3）岁（8个月至7岁），体重（13.1±4.2）kg（7至20 kg））在左心导管插入术后出现下肢缺血。7例患者接受了尿激酶溶栓治疗。5例患者经外周静脉溶栓成功，恢复了正常脉搏。另外3例患者外周静脉溶栓失败，随后经导管溶栓成功。平均治疗时间为（7.25±5.31）小时（1至17小时）。肝素和尿激酶的平均剂量分别为（1600±723）U（800至3000 U）和（268 571±177 240）U（50,000至500,000 U）。尿激酶治疗前后部分凝血活酶时间无统计学显著差异（（40.6±22.3）秒至（49.9±39.2）秒）。然而，凝血酶原时间显著延长（（12.7±2.58）秒至（48.1±18.6）秒，P<0.05）。对所有患者的目标血管通畅情况进行了2周的评估，未再发生闭塞。