Andrade Joana Verdelho, Magalhães Joana, Resende Catarina, Gomes Dora, Laranjo Gabriela, Campos Joana, Santos Elisabete, Faria Cristina
Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal.
Acta Med Port. 2018 Sep 28;31(9):489-495. doi: 10.20344/amp.9639.
Pulmonary thromboembolism and deep venous thrombosis occur in pediatric age, with unknown incidence, morbidity and mortality. Our aim is to review the epidemiology, clinical presentation, complementary diagnostic tests and prognosis of patients with pulmonary thromboembolism and deep venous thrombosis.
Retrospective, descriptive and analytical study of pediatric patients admitted to a Level II hospital for pulmonary thromboembolism and deep venous thrombosis, between 2000 and 2014. Demographic characteristics, clinical history, comorbidities and risk factors were studied.
Eleven patients (n = 7 pulmonary thromboembolism, n = 5 deep venous thrombosis, n = 1 both), 64% females and with 16 years old average, were admitted. All patients with pulmonary thromboembolism presented symptoms of chest pain and/or dyspnea, 25% syncope/palpitations and 25% fever. All patients with deep venous thrombosis reported localized pain at the site of obstruction, 83% edema/cyanosis of the affected limb and 17% fever. The study of positive thrombophilia was the most frequent risk factor in both entities. The mean value of D-dimers was 3252 ug/dL and 2660 ug/dL in pulmonary thromboembolism and deep venous thrombosis, respectively. All patients started anticoagulation, three required intensive care, two had sequelae and one died.
All patients had at least one risk factor, and hereditary hypercoagulability was most commonly established.
The increased incidence in the pediatric population described in some studies can be attributed to an increased awareness of this pathology, medical advances and increasing survival of chronic diseases. There is a lack of evidence-based recommendations identifying patients at risk of thrombosis so that decisions can be made carefully, balancing the risk and benefit in each case.
儿童期会发生肺血栓栓塞症和深静脉血栓形成，其发病率、发病率和死亡率尚不清楚。我们的目的是回顾肺血栓栓塞症和深静脉血栓形成患者的流行病学、临床表现、辅助诊断检查及预后。
对2000年至2014年间在一家二级医院因肺血栓栓塞症和深静脉血栓形成入院的儿科患者进行回顾性、描述性和分析性研究。研究了人口统计学特征、临床病史、合并症和危险因素。
共收治11例患者（7例肺血栓栓塞症，5例深静脉血栓形成，1例两者均有），女性占64%，平均年龄16岁。所有肺血栓栓塞症患者均出现胸痛和/或呼吸困难症状，25%出现晕厥/心悸，25%出现发热。所有深静脉血栓形成患者均报告梗阻部位局部疼痛，83%患肢出现水肿/发绀，17%出现发热。血栓形成倾向阳性的研究是这两种疾病最常见的危险因素。肺血栓栓塞症和深静脉血栓形成患者D-二聚体的平均值分别为3252μg/dL和2660μg/dL。所有患者均开始抗凝治疗，3例需要重症监护，2例有后遗症，1例死亡。
所有患者至少有一个危险因素，遗传性高凝状态最为常见。
一些研究中描述的儿科人群发病率增加可归因于对这种疾病的认识提高、医学进步和慢性病生存率的提高。缺乏基于证据的建议来识别有血栓形成风险的患者，因此在每种情况下都要谨慎决策，权衡风险和益处。
