Nozawa Hisataka, Fujimura Tomomi, Yamagata Tomosato, Kunikata Ayumi, Uchida Kaname, Ota Hidehito, Ebishima Hironori, Hayashi Kenichiro, Matsui Hikoro
Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
Ann Thorac Surg Short Rep. 2024 Feb 16;2(3):380-384. doi: 10.1016/j.atssr.2024.01.013. eCollection 2024 Sep.
Understanding the development of central venous catheter-related thrombus (CVCRT) is vital for the prevention of adverse events caused by thrombi after cardiac surgery in children. However, the risks associated with CVCRT remain controversial. This study analyzed the risk factors of CVCRT based on a detailed evaluation of its morphometric features and severity.
Patients aged <15 years who underwent catheter insertion into the internal jugular vein for cardiac surgery were included, and those receiving extracorporeal membrane oxygenation were excluded. The clinical data of the eligible patients, including the ultrasound CVCRT images and the ratio of the catheter occupying the internal jugular vein area (C/V ratio) by reassuming the images, were consistently collected. Logistic regression analysis using clinical factors was performed for the 2 groups divided according to morphologic severity.
Forty-seven patients were included in the study. CVCRT developed in 38 patients. Five graded types, ranging from wall-localized small thrombi to complete occlusion of the vein, were detected, and those who developed sheath-like thrombus were classified in to the severe group. Patients in the severe group were significantly younger and had higher C/V ratios. There were no significant differences in the surgical procedure, its difficulty, or postoperative severity score. Logistic regression analysis revealed the C/V ratio as the sole significant risk factor (odds ratio, 1.120; 95% CI, 1.01-1.24; = .036).
Our findings show the clinical implications of thrombus evaluation and morphologic classification to properly assess the risk factors of CVCRT in children with heart disease.
了解中心静脉导管相关血栓（CVCRT）的形成对于预防儿童心脏手术后血栓引起的不良事件至关重要。然而，与CVCRT相关的风险仍存在争议。本研究基于对其形态特征和严重程度的详细评估，分析了CVCRT的危险因素。
纳入年龄<15岁、因心脏手术行颈内静脉置管的患者，排除接受体外膜肺氧合的患者。持续收集符合条件患者的临床资料，包括超声CVCRT图像以及通过重新构建图像得到的导管占据颈内静脉面积的比例（C/V比）。对根据形态学严重程度划分的两组患者进行使用临床因素的逻辑回归分析。
47例患者纳入研究。38例患者发生CVCRT。检测到五种分级类型，从壁局部小血栓到静脉完全闭塞，形成鞘样血栓的患者被归类为严重组。严重组患者年龄显著更小，C/V比更高。手术操作、难度或术后严重程度评分无显著差异。逻辑回归分析显示C/V比是唯一显著的危险因素（比值比，1.120；95%置信区间，1.01 - 1.24；P = .036）。
我们的研究结果显示了血栓评估和形态学分类对正确评估心脏病患儿CVCRT危险因素的临床意义。
