Saxena A, Gupta R, Kumar R K, Kothari S S, Wasir H S
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Cathet Cardiovasc Diagn. 1997 Aug;41(4):400-3. doi: 10.1002/(sici)1097-0304(199708)41:4<400::aid-ccd11>3.0.co;2-p.
Arterial thrombosis is the most frequent major complication of percutaneous arterial catheterization in children. We prospectively studied the effect of randomized dosage of heparin, 50 IU/kg-group I and 100 IU/kg-group II, on the incidence of arterial thrombosis in 366 children and analysed the various factors which may influence the occurrence of this complication. The age of patients ranged from 17 d to 11 yr (mean age 39.5 +/- 40.9 mo) and mean weight was 11.2 +/- 7.8 kg (range 3 to 39 kg). The incidence of arterial thrombosis was 9.8% in group I and 9.3% in group II (P = NS). There was no statistical difference in precatheterization and procedure variables in the two groups and also in the group with absent pulse (n = 35) to the group with pulse present post cath (n = 331). There were 24.9% infants in our study and 14.3% of these had arterial thrombosis. The loss of pulse was more often seen with more number of attempts at arterial puncture (P < 0.001), absence of back bleed at the end of the procedure (P < 0.001), and increased duration of catheterization (P < 0.01). Use of larger sheath size in a given weight and body surface area of children increased incidence of arterial thrombosis. The administration of heparin 50 IU/kg was equally efficacious to heparin 100 IU/kg. Of the patients with arterial thrombosis, 23 responded with intravenous heparin and 12 needed streptokinase. There was no bleeding or haematoma. Thus our study shows that less attempt for arterial puncture, use of smaller sheath size, maintaining shortest procedure time and ensuring back bleed minimises incidence of arterial thrombosis post catheterization.
动脉血栓形成是儿童经皮动脉导管插入术最常见的主要并发症。我们前瞻性地研究了随机剂量肝素（I组50 IU/kg，II组100 IU/kg）对366例儿童动脉血栓形成发生率的影响，并分析了可能影响该并发症发生的各种因素。患者年龄为17天至11岁（平均年龄39.5±40.9个月），平均体重为11.2±7.8 kg（范围3至39 kg）。I组动脉血栓形成发生率为9.8%，II组为9.3%（P=无显著性差异）。两组在导管插入术前和操作变量方面无统计学差异，在导管插入术后无脉搏组（n=35）和有脉搏组（n=331）之间也无统计学差异。我们的研究中有24.9%为婴儿，其中14.3%发生了动脉血栓形成。动脉穿刺尝试次数越多（P<0.001）、操作结束时无回血（P<0.001）以及导管插入时间延长（P<0.01），越常出现脉搏消失。在给定体重和体表面积的儿童中使用较大尺寸的鞘管会增加动脉血栓形成的发生率。给予50 IU/kg肝素与100 IU/kg肝素同样有效。在发生动脉血栓形成的患者中，23例对静脉注射肝素有效，12例需要链激酶治疗。未出现出血或血肿。因此，我们的研究表明，减少动脉穿刺尝试次数、使用较小尺寸的鞘管、保持最短操作时间并确保回血可将导管插入术后动脉血栓形成的发生率降至最低。
