Li Shuangzi, Luo Yetao, Deng Jiaxin, Zeng Junqi, Fan Mingping, Wang Ting, Xia Qing
Neurological Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Department of Nosocomial Infection Control, Second Affiliated Hospital, Army Medical University, Chongqing, China.
Transl Pediatr. 2022 Nov;11(11):1840-1851. doi: 10.21037/tp-22-529.
This study aimed to explore the risk factors of catheter-related thrombosis (CRT) in children in Southwest China who underwent central venous catheter (CVC) insertion.
An observational cohort study was conducted at a single tertiary center in southwest China between November 2019 and February 2020. All patients who received a CVC were enrolled and Doppler-ultrasound examination was performed weekly until CVC removal. All patients in this study were hospitalized and were observed and followed up in this hospital. Patient demographics, medication, biochemical indexes, catheter maintenance practice, activities after CVC placement data were analyzed. The Kaplan-Meier method was used to calculate the incidence of CRT, and the Cox regression model was used to analyze the factors influencing CRT.
A total of 594 children were included in the study, and the median indwelling time was 10 days, with the shortest being 1 day and the longest 60 days. The overall incidence of CRT was 26.60% (158/594), the 15-day cumulative incidence rate was 30.81%, and the 45-day cumulative incidence rate was 46.27%. After 45 days, the incidence of CRT further increased. Age <12 months [hazard ratio (HR), 1.654; 95% confidence interval (CI): 1.171-2.338], use of 20% mannitol or glycerol fructose (HR, 1.593; 95% CI: 1.058-2.398), CVC placement by a pediatric intensive care unit (PICU) doctor (HR, 1.921; 95% CI: 1.347-2.740), placement length ≥9 cm (HR, 1.633; 95% CI: 1.142-2.336), and D-dimer >1.5 mg/L (HR, 1.451; 95% CI: 1.044-2.015) were risk factors for CRT. Limb exercises (HR, 0.660; 95% CI: 0.469-0.929) after placement was a protective factor for CRT.
The incidence of CRT was higher in children with CVCs, and the key duration of CRT monitoring should be within 15 and 45 days after placement. Patients with age <12 months, using 20% mannitol or glycerol fructose, insertion length ≥9 cm, D-dimer >1.5 mg/L before placement are more likely to happen CVC-CRT than other patient, and it is necessary to be highly vigilant and take preventive measures.
本研究旨在探讨中国西南地区接受中心静脉导管（CVC）置入术的儿童发生导管相关血栓形成（CRT）的危险因素。
2019年11月至2020年2月在中国西南部一家三级中心进行了一项观察性队列研究。纳入所有接受CVC的患者，每周进行多普勒超声检查，直至拔除CVC。本研究中的所有患者均住院，并在该医院进行观察和随访。分析患者的人口统计学、用药情况、生化指标、导管维护措施、CVC置入后的活动数据。采用Kaplan-Meier法计算CRT的发生率，采用Cox回归模型分析影响CRT的因素。
本研究共纳入594例儿童，中位留置时间为10天，最短1天，最长60天。CRT的总体发生率为26.60%（158/594），15天累积发生率为30.81%，45天累积发生率为46.27%。45天后，CRT的发生率进一步升高。年龄<12个月[风险比（HR），1.654；95%置信区间（CI）：1.171-2.338]、使用20%甘露醇或甘油果糖（HR，1.593；95%CI：1.058-2.398）、由儿科重症监护病房（PICU）医生进行CVC置入（HR，1.921；95%CI：1.347-2.740）、置入长度≥9 cm（HR，1.633；95%CI：1.142-2.336）以及D-二聚体>1.5 mg/L（HR，1.451；95%CI：1.044-2.015）是CRT的危险因素。置入后进行肢体锻炼（HR，0.660；95%CI：0.469-0.929）是CRT的保护因素。
CVC患儿CRT的发生率较高，CRT监测的关键时间段应为置入后15天和45天内。年龄<12个月、使用20%甘露醇或甘油果糖、置入长度≥9 cm、置入前D-二聚体>1.5 mg/L的患者比其他患者更易发生CVC-CRT，有必要高度警惕并采取预防措施。
