Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D, Bernstein M, Brisson L, Cairney B, DeSai D
Children's Hospital at Chedoke-McMaster, Hamilton, Ontario, Canada.
Blood. 1994 Mar 1;83(5):1251-7.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) occur in pediatric patients; however, the incidence, associated morbidity, and mortality are unknown. A Canadian registry of DVT and PE in children (ages 1 month to 18 years) was established July 1, 1990 in 15 tertiary-care pediatric centers. One-hundred thirty-seven patients were identified prospectively and are the subject of this report. The incidence of DVT/PE was 5.3/10,000 hospital admissions or 0.07/10,000 children in Canada. Infants under 1 year old and teenagers predominated with equal numbers of both sexes. DVT were located in the upper (n = 50) and lower (n = 79) venous system, or as PE alone (n = 8). Central venous lines (CVLs) were present in approximately 33% of children with DVT (n = 45). Associated conditions were present in 96% of children and 90% of children had two or more associated conditions for DVT. DVT was diagnosed by venography (n = 83), duplex ultrasound (n = 37), and other combinations (n = 17). Twenty-two of the 31 ventilation/perfusion scans performed were interpreted as high-probability scans for PE. Therapy consisted of heparin (n = 115), thrombolysis (n = 15), surgical removal of a CVL or thrombus (n = 22), and oral anticoagulant therapy (n = 103). Significant bleeding complications did not occur. However, three (2.2%) children died as a direct consequence of their thromboembolic disease; DVT reoccurred in 23 children and postphlebitic syndrome (PPS) occurred in 26. In conclusion, DVTs occur in a significant number of hospitalized children with a mortality of 2.2%. Complications are not hemorrhagic, but thrombotic, and characterized by PE, recurrent disease, and PPS. In contrast to adults, the upper venous system is frequently affected because of the use of CVLs. The frequency of DVT/PE justifies controlled trials of primary prophylaxis in high-risk groups, and therapeutic trials to determine optimal treatment.
小儿患者会发生深静脉血栓形成（DVT）和肺栓塞（PE）；然而，其发病率、相关发病率及死亡率尚不清楚。1990年7月1日在15家三级护理儿科中心建立了加拿大儿童DVT和PE登记处。前瞻性确定了137例患者，为本报告的研究对象。在加拿大，DVT/PE的发病率为每10000例住院患者中有5.3例，或每10000名儿童中有0.07例。1岁以下婴儿和青少年占主导，男女数量相等。DVT位于上（n = 50）、下（n = 79）静脉系统，或仅表现为PE（n = 8）。约33%患DVT的儿童（n = 45）有中心静脉置管（CVL）。96%的儿童存在相关疾病，90%患DVT的儿童有两种或更多相关疾病。DVT通过静脉造影（n = 83）、双功超声（n = 37）及其他组合方式（n = 17）诊断。31例通气/灌注扫描中有22例被解读为PE的高概率扫描。治疗包括肝素治疗（n = 115）、溶栓治疗（n = 15）、手术取出CVL或血栓（n = 22）及口服抗凝治疗（n = 103）。未发生严重出血并发症。然而，3例（2.2%）儿童因血栓栓塞性疾病直接死亡；23例儿童DVT复发，26例发生了血栓后综合征（PPS）。总之，大量住院儿童发生DVT，死亡率为2.2%。并发症不是出血性的，而是血栓性的，表现为PE、疾病复发和PPS。与成人不同，由于使用CVL，上静脉系统经常受到影响。DVT/PE的发生率证明有必要对高危人群进行一级预防的对照试验，以及确定最佳治疗方法的治疗试验。
