Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital / Academic Medical Center, Amsterdam, Netherlands.
JPEN J Parenter Enteral Nutr. 2012 Jul;36(4):456-62. doi: 10.1177/0148607111416482. Epub 2012 Jan 12.
Home parenteral nutrition (PN) has improved the survival of children with intestinal failure. Important complications include catheter-related thrombosis, occlusion, and infection. This study evaluated the efficacy and safety of prophylactic anticoagulation in the prevention of these complications.
Medical records were retrospectively reviewed of all children (0-18 years) with PN between January 1994 and March 2007 in 1 tertiary center. After introduction of prophylactic low molecular weight heparin or vitamin K antagonists in March 2007, all patients were prospectively followed until March 2010.
In sum, 14 patients did not receive prophylaxis; 13 switched from no prophylaxis to prophylaxis in March 2007; and 5 directly received prophylaxis. Median age of PN onset was 4 months (range, 0.1-202) in the nonprophylaxis group (n = 27) and 25 (range, 2-167) in the prophylaxis group (n = 18); 16 children received low molecular weight heparin and 2, vitamin K antagonists. Catheter-related thrombosis developed in 9 patients with no prophylaxis (33%) and 1 with prophylaxis (6%) (P = .034). Cumulative 5-year thrombosis-free survival was 48% and 93% in the nonprophylaxis and prophylaxis groups, respectively (P = .047). Per 1,000 PN days, the nonprophylaxis and prophylaxis groups had 2.6 and 0.1 occlusions (P = .04) and 4.6 and 2.1 infections (P = .06), respectively. Cumulative infection-free survival after 3 years was 19% and 46% in the nonprophylaxis and prophylaxis groups, respectively (P = .03). Bleeding complications did not occur.
Thromboprophylaxis significantly decreased catheter-related thrombosis and occlusion in children with PN without complications.
家庭肠外营养（PN）提高了肠衰竭患儿的生存率。重要的并发症包括导管相关血栓形成、阻塞和感染。本研究评估了预防性抗凝在预防这些并发症中的疗效和安全性。
回顾性分析了 1994 年 1 月至 2007 年 3 月在 1 家三级中心接受 PN 的所有儿童（0-18 岁）的病历。2007 年 3 月引入预防性低分子肝素或维生素 K 拮抗剂后，所有患者均前瞻性随访至 2010 年 3 月。
共有 14 名患者未接受预防治疗；13 名患者于 2007 年 3 月由未预防转为预防治疗；5 名患者直接接受预防治疗。无预防组（n=27）的 PN 起始中位年龄为 4 个月（范围，0.1-202），预防组（n=18）的 PN 起始中位年龄为 25 个月（范围，2-167）；16 名儿童接受低分子肝素治疗，2 名儿童接受维生素 K 拮抗剂治疗。无预防组发生导管相关血栓形成 9 例（33%），预防组发生 1 例（6%）（P=0.034）。无预防组和预防组的 5 年血栓无形成存率分别为 48%和 93%（P=0.047）。每 1000 天 PN 天数，无预防组和预防组的阻塞发生率分别为 2.6 和 0.1（P=0.04），感染发生率分别为 4.6 和 2.1（P=0.06）。无预防组和预防组的 3 年后感染无形成存率分别为 19%和 46%（P=0.03）。无出血并发症发生。
在接受 PN 的儿童中，预防性抗凝可显著降低导管相关血栓形成和阻塞，且无并发症发生。
Zotero 插件