摘要
目的 探讨儿科中心静脉导管相关血栓（CRT）形成后不同干预措施对血栓转归的影响.方法 回顾性地分析2015年1月1日至12月31日在浙江大学医学院附属儿童医院各病房发生并上报护理管理系统的中心静脉CRT病例资料.结果 符合研究的病例资料108例.男女比例2：1.患儿年龄从出生1个月至14岁,年龄中位数24.5个月.神经系统内外科疾病占42.59%（46/108）.55.56%（60/108）CRT发生在中心静脉导管放置后1周内.发生血栓后临床上有4类干预方案,方案1：尿激酶溶栓同时联合那曲肝素钙抗凝治疗;方案2：仅抗凝治疗;方案3：仅溶栓治疗;方案4：无药物治疗.4类干预方案的结果差异有统计学意义（χ2=13.380,P=0.004）.患儿的CRT溶解效果与临床各相关要素先进行了单因素回归分析,最后进入多因素回归分析的要素：性别（OR=10.400,95%CI 1.879~57.563,P=0.007）;间隔时间（OR=1.107,95%CI 1.035~1.184,P=0.003）;血栓长度（OR=1.562,95%CI 1.033~2.362,P=0.035）;干预方案2（OR=11.757,95%CI 2.254~61.327,P=0.003）;干预方案4（OR=35.397,95%CI 3.493~358.760,P=0.003）.结论 早期血栓和小血栓更易溶解,溶栓治疗或联合抗凝治疗对血栓溶解有利,一旦CRT形成如无禁忌证应早期、足量、规范进行溶栓和抗凝治疗.
Objective To explore how the different intervention measures affect the outcome of central venous catheter-related thrombosis （CRT） in children. Methods A retrospective analysis was carried out to collect the clinical data of patients with CRT from the nursing management system of the Children′s Hospital Affiliated to Zhejiang University School of Medicine which reported by each nursing unit from January 1,2015 to December 31,2015. Results Totally 108 cases were included （72 boys and 36 girls）, median age of 24.5 months （ranged from 1 month to 14 years old）. Nearly 42.59% （46/108） patients suffered from neurological diseases. Nearly 55.56%（60/108） CRT was detected in the first week after catheterization. Once CRT conformed, there were four kinds clinical intervention options applied. Intervention 1： thrombolytic therapy with urokinase combined anticoagulation with nadroparin calcium. Intervention 2： anticoagulant therapy only. Intervention 3： thrombolytic therapy alone. Intervention 4： no medications. The differences of effective between the four kinds of intervention were statistically significant （χ2=13.380, P=0.004）. The single-factor regression analysis was done to each relevant factor. Finally the multivariate regression analysis showed four factors had impacts upon the results. The factors were as follows：gender （OR=10.400, 95%CI 1.879-57.563, P=0.007）;interval （OR=1.107, 95%CI 1.035-1.184, P = 0.003）, size of thrombus（OR = 1.562,95%CI 1.033-2.362,P=0.035; Intervention 2 （OR =11.757, 95% CI 2.254- 61.327, P = 0.003）, intervention 4 （OR = 35.397, 95% CI 3.493-358.760, P =0.003）. Conclusions The earlier and small size thrombus is more soluble. Thrombolytic therapy or combined anticoagulation is more effective. It is recommended that if no contraindications presents, thrombolytic combined with anticoagulant therapy should start early standardized treatment.
出处
《中国实用护理杂志》
2017年第6期418-423,共6页
Chinese Journal of Practical Nursing
基金
浙江省教育厅课题资助项目（Y201329986）
关键词
医院
儿科
导管插入术
中心静脉
静脉血栓形成
干预
Hospitals, pediatric
Catheterization, central venous
Venous thrombosis
Intervention
