Bairdain Sigrid, Kelly Daniel P, Tan Corinne, Dodson Brenda, Zurakowski David, Jennings Russell W, Trenor Cameron C
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
J Pediatr Surg. 2014 Feb;49(2):370-3. doi: 10.1016/j.jpedsurg.2013.09.003.
To determine the incidence of catheter-associated venous thromboembolic events (VTE) in long gap esophageal atresia (LGEA) patients treated at Boston Children's Hospital (BCH) and to identify possible risk factors associated with their development.
We performed a retrospective analysis of LGEA patients from 2005 to 2012. Symptomatic VTEs with radiographic confirmation were defined as events. Potential risk factors were assessed by univariate analysis and multivariate logistic regression. Covariates included age, weight, initial gap length, cumulative days of pharmacologic paralysis and paralytic episodes, number and type of central venous catheters (CVCs), and number of operations.
Forty-four LGEA patients were identified. The incidence of CVC associated VTE was 34%. Univariate analysis identified age at Foker 1 (P=.03), paralysis duration (P=.01), episodes of paralysis (P=.001), cumulative number of CVC (P=.007) and length of stay (P=.03) as significant. Multivariate logistic regression identified the number of paralytic episodes as the only significant independent risk factor for VTE (P<.0001).
The incidence of symptomatic VTE was 34%, significantly higher than the VTE incidence of 4.5% reported for our other hospitalized children. These data have led to multidisciplinary discussions regarding thromboprophylaxis and development of a consensus-driven protocol. Since the initiation of this protocol, no VTEs have been identified.
确定在波士顿儿童医院（BCH）接受治疗的长段食管闭锁（LGEA）患者中导管相关静脉血栓栓塞事件（VTE）的发生率，并识别与其发生相关的可能风险因素。
我们对2005年至2012年的LGEA患者进行了回顾性分析。将经影像学证实的有症状VTE定义为事件。通过单因素分析和多因素逻辑回归评估潜在风险因素。协变量包括年龄、体重、初始间隙长度、药物性麻痹的累积天数和麻痹发作次数、中心静脉导管（CVC）的数量和类型以及手术次数。
共确定了44例LGEA患者。CVC相关VTE的发生率为34%。单因素分析确定福克1期年龄（P = 0.03）、麻痹持续时间（P = 0.01）、麻痹发作次数（P = 0.001）、CVC累积数量（P = 0.007）和住院时间（P = 0.03）具有显著意义。多因素逻辑回归确定麻痹发作次数是VTE唯一显著的独立风险因素（P < 0.0001）。
有症状VTE的发生率为34%，显著高于我们报告的其他住院儿童4.5%的VTE发生率。这些数据引发了关于血栓预防的多学科讨论，并制定了一个由共识驱动的方案。自该方案启动以来，未发现VTE事件。
