Perkins J L, Johnson V A, Osip J M, Christie B A, Nelson S C, Moertel C L, Heisel M A
University of Minnesota Medical School, Minneapolis, USA.
J Pediatr Hematol Oncol. 1997 Jul-Aug;19(4):339-44. doi: 10.1097/00043426-199707000-00013.
Implantable venous access devices (IVADs), either centrally or peripherally implanted, have become increasingly popular in children with hemophilia to assist in the early treatment of bleeding episodes and in the prevention of arthropathy. Their use has been associated with complications including thrombosis, thrombophlebitis, and infection. We attempted to better define whether the benefits associated with IVADs in this population outweight the associated risks.
We studied the medical records of 35 children from the University of Minnesota's Comprehensive Hemophilia Center who received IVADs between 1992 and 1996.
There was no bleeding or thrombophlebitis associated with IVADs in our population. One patient required removal of a central IVAD due to thrombosis. The central IVADs were associated with local infection and bacteremia rates of 3% and 33%, respectively. The rates of local infection and bacteremia associated with peripheral IVADs were both 25%. The majority of infections were cleared with antibiotics, and ports remained intact. Both types of IVADs were associated with a high patient/parent satisfaction.
Despite being associated with a significant incidence of infection, we believe the benefits of IVADs for children with hemophilia and their families outweigh the risks. Possible explanations for the observed infection rates are discussed.
可植入静脉通路装置（IVADs），无论是中心静脉植入还是外周静脉植入，在血友病患儿中越来越普遍，有助于早期治疗出血发作和预防关节病。其使用与包括血栓形成、血栓性静脉炎和感染在内的并发症有关。我们试图更好地确定在这一人群中，IVADs的益处是否超过相关风险。
我们研究了明尼苏达大学综合血友病中心35名在1992年至1996年间接受IVADs的儿童的病历。
在我们的研究人群中，IVADs未引发出血或血栓性静脉炎。一名患者因血栓形成需要取出中心静脉IVAD。中心静脉IVADs的局部感染率和菌血症率分别为3%和33%。外周静脉IVADs的局部感染率和菌血症率均为25%。大多数感染通过抗生素清除，端口保持完好。两种类型的IVADs都有较高的患者/家长满意度。
尽管与显著的感染发生率相关，但我们认为IVADs对血友病患儿及其家庭的益处大于风险。文中讨论了观察到的感染率的可能原因。
