Rodríguez Núñez A, Fonte M, Faustino E V S
Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
Unidade de Cuidados Intensivos Pediátricos e Servizo de Transporte Pediátrico, Hospital São João, Porto, Portugal.
An Pediatr (Barc). 2015 Mar;82(3):144-51. doi: 10.1016/j.anpedi.2014.05.001. Epub 2014 Jun 5.
Although critically ill children may be at risk from developing deep venous thrombosis (DVT), data on its incidence and effectiveness of thromboprophylaxis are lacking.
To describe the use of thromboprophylaxis in critically ill children in Spain and Portugal, and to compare the results with international data.
Secondary analysis of the multinational study PROTRACT, carried out in 59 PICUs from 7 developed countries (4 from Portugal and 6 in Spain). Data were collected from patients less than 18 years old, who did not receive therapeutic thromboprophylaxis.
A total of 308 patients in Spanish and Portuguese (Iberian) PICUS were compared with 2176 admitted to international PICUs. Risk factors such as femoral vein ( = .01), jugular vein central catheter ( < .001), cancer ( = .03), and sepsis ( < .001), were more frequent in Iberian PICUs. The percentage of patients with pharmacological thromboprophylaxis was similar in both groups (15.3% vs. 12.0%). Low molecular weight heparin was used more frequently in Iberian patients ( < .001). In treated children, prior history of thrombosis ( = .02), femoral vein catheter ( < .001), cancer ( = .02) and cranial trauma or craniectomy ( = .006), were more frequent in Iberian PICUs. Mechanical thromboprophylaxis was used in only 6.8% of candidates in Iberian PICUs, compared with 23.8% in the international PICUs ( < .001).
Despite the presence of risk factors for DVT in many patients, thromboprophylaxis is rarely prescribed, with low molecular weight heparin being the most used drug. Passive thromboprophylaxis use is anecdotal. There should be a consensus on guidelines of thromboprophylaxis in critically ill children.
尽管危重症儿童可能有发生深静脉血栓形成（DVT）的风险，但关于其发病率和血栓预防有效性的数据尚缺。
描述西班牙和葡萄牙危重症儿童血栓预防的使用情况，并将结果与国际数据进行比较。
对多国研究PROTRACT进行二次分析，该研究在7个发达国家的59个儿科重症监护病房（PICU）开展（4个来自葡萄牙，6个来自西班牙）。收集未接受治疗性血栓预防的18岁以下患者的数据。
将西班牙和葡萄牙（伊比利亚）PICU的308例患者与国际PICU收治的2176例患者进行比较。股静脉（P = 0.01）、颈静脉中心导管（P < 0.001）、癌症（P = 0.03）和脓毒症（P < 0.001）等危险因素在伊比利亚PICU中更为常见。两组接受药物性血栓预防的患者百分比相似（15.3%对12.0%）。伊比利亚患者更频繁使用低分子量肝素（P < 0.001）。在接受治疗的儿童中，既往血栓形成史（P = 0.02）、股静脉导管（P < 0.001）、癌症（P = 0.02）以及颅脑外伤或颅骨切除术（P = 0.006）在伊比利亚PICU中更为常见。伊比利亚PICU中仅6.8%的符合条件患者使用了机械性血栓预防，而国际PICU中这一比例为23.8%（P < 0.001）。
尽管许多患者存在DVT危险因素，但血栓预防很少被处方，低分子量肝素是最常用的药物。被动性血栓预防的使用情况少见。对于危重症儿童血栓预防指南应达成共识。
