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[儿童急性淋巴细胞白血病诱导化疗期间导管相关血栓形成的发生率及危险因素]

[The incidence and risk factors of catheter-related-thrombosis during induction chemotherapy in acute lymphocytic leukemia children].

作者信息

Wei Y Y, Zhang Y Y, Zhen Y Z, Zhang L Q, Jia C G, Zhang R D, Zheng H Y, Wu X Y, Wu R H

机构信息

Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2017 Apr 14;38(4):313-317. doi: 10.3760/cma.j.issn.0253-2727.2017.04.010.

Abstract

To investigate the current status of catheter-related-thrombosis (CRT) and the risk factors of Chinese acute lymphocytic leukemia (ALL) children with peripherally inserted central catheter (PICC) . The clinical data of the 116 inpatients preliminarily diagnosed ALL in the Leukemia Ward of Beijing Children's Hospital with PICC from 1(st) March 2014 to 31(st) December 2014 were collected prospectively. ①Refer to the B-ultrasound on the 15(th) day after catheterization, the incidence of CRT was 28.4% (33/116 cases) , all cases were symptom-free. ②There were no statistical differences in terms of gender, age distribution, degree, immunotype between CRT and CRT-free groups. This study revealed no statistical differences of blood routine test items, coagulation function items, co-infection and catheterization vein between the two groups. While there was significant statistical difference of catheterization side, the frequency of right catheterization was higher in CRT group[75.8% (25/33) 55.4% (46/83) , =0.043]. ③On the 15(th) day after catheterization, significant statistical difference of D-Dimer between the two groups was revealed[0.18 (0.05-2.45) mg/L 0.11 (0.01-5.34) mg/L, =0.001], while no statistical differences of blood routine test items and other coagulation function items. Multivariate Logistic regression analysis verified catheterization on right was a risk factor of CRT. ④During the observation, there were 3 cases of catheter-related complications other than CRT, all of which were CRI, 2 of them had CRT meanwhile. ⑤The B-ultrasound on the 33(rd) day after catheterization showed that 73.1% of the cases had reduced thrombosis, 3.8% had growth thrombosis, 23.1% had no obvious change respectively. CRT was a common catheter related complication among ALL children during induction chemotherapy, and CRT cases with symptoms were rare. Catheterization on right was a risk factor for CRT, and regular test of D-Dimer and B ultrasound contributed to detect CRT. Most of the CRT cases had reduced thrombosis without specific management.

摘要

探讨中国急性淋巴细胞白血病(ALL)患儿经外周静脉穿刺中心静脉置管(PICC)后导管相关血栓形成(CRT)的现状及危险因素。前瞻性收集2014年3月1日至2014年12月31日在北京儿童医院白血病病房初次诊断为ALL并行PICC置管的116例住院患儿的临床资料。①参考置管后第15天的B超检查结果,CRT发生率为28.4%(33/116例),所有病例均无症状。②CRT组与非CRT组在性别、年龄分布、程度、免疫类型方面无统计学差异。本研究显示两组血常规检查项目、凝血功能项目、合并感染情况及置管静脉无统计学差异。而置管侧有显著统计学差异,CRT组右侧置管频率更高[75.8%(25/33)对55.4%(46/83),P = 0.043]。③置管后第15天,两组D - 二聚体有显著统计学差异[0.18(0.05 - 2.45)mg/L对0.11(0.01 - 5.34)mg/L,P = 0.001],而血常规检查项目及其他凝血功能项目无统计学差异。多因素Logistic回归分析证实右侧置管是CRT的危险因素。④观察期间,有3例非CRT的导管相关并发症,均为CRI,其中2例同时合并CRT。⑤置管后第33天的B超检查显示,73.1%的病例血栓缩小,3.8%的病例血栓增大,23.1%的病例无明显变化。CRT是ALL患儿诱导化疗期间常见的导管相关并发症,有症状的CRT病例少见。右侧置管是CRT的危险因素,定期检测D - 二聚体和B超有助于CRT的检出。大多数CRT病例血栓缩小,无需特殊处理。

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