2020 年第 2 期 第 15 卷

低分子肝素联合阿司匹林在儿童心导管术后股动脉血栓治疗中的效果

Effect of low molecular weight heparin combined with aspirin on femoral artery thrombosis after cardiac catheterization in children

作者：戴辰程何楠肖燕燕王霄芳郭保静焦萌梁永梅李刚金梅

英文作者：

单位：首都医科大学附属北京安贞医院小儿心脏中心100029 

英文单位：

关键词：心导管术；股动脉血栓；低分子肝素；阿司匹林

英文关键词：

• 摘要：

• 【摘要】目的    评价低分子肝素联合阿司匹林在儿童心导管术后股动脉血栓形成治疗中的效果。方法    回顾性分析2015年9月至2019年3月于首都医科大学附属北京安贞医院小儿心脏中心行心导管术后24 h仍存在股动脉血栓的10例住院患儿的临床资料、治疗经过及转归。所有患儿均给予皮下注射低分子肝素联合口服阿司匹林治疗股动脉血栓。结果    10例患儿中男2例、女8例；月龄9～80个月，平均（32±24）个月；体质量5.8～17.5 kg，平均（12±4）kg。10例患儿中7例为动脉导管未闭，1例为法洛四联症，1例为房间隔缺损，1例为阵发性室上性心动过速，股动脉血栓发生率为0.84%（10/1 189）。7例为股总动脉闭塞，1例为股浅动脉闭塞，1例为股总动脉合并股浅动脉血栓闭塞，1例为股总动脉中度狭窄，血栓长度0.7～2.7 cm。7例患儿于股动脉血栓形成第2天应用皮下注射低分子肝素联合口服阿司匹林治疗，1例于第3天应用，2例于第5天才应用。皮下注射低分子肝素疗程3～28 d，平均（10±8）d。口服阿司匹林最终治疗剂量2.0～4.6 mg/kg，平均（3.2±0.8）mg/kg。所有患儿经治疗后股动脉血流均恢复正常，足背动脉搏动恢复，皮肤温度恢复正常。随访1～33个月，所有患儿超声多普勒提示股动脉血流通畅，血栓均未复发。治疗期间无出血、过敏、皮疹、消化道症状、血小板减少及肝肾功能损伤等并发症发生。结论    皮下注射低分子肝素联合口服阿司匹林治疗儿童心导管术后股动脉血栓安全有效。

• 【Abstract】Objective    To observe the efficacy of low molecular weight heparin combined with aspirin in treatment of femoral artery thrombosis after cardiac catheterization in children. Methods    Ten children who had femoral artery thrombosis 24 h after cardiac catheterization in Beijing Anzhen Hospital, Capital Medical University from September 2015 to March 2019 were retrospectively analyzed. All children were treated with subcutaneous injection of low molecular weight heparin combined with oral aspirin. Clinical data, treatments and outcomes were analyzed. Results    There were 2 boys and 8 girls, aged 9-80 months, with an average of （32±24）months; body mass was 5.8-17.5 kg, with an average of （12±4）kg. There were 7 cases of patent ductus arteriosus, 1 case of tetralogy of Fallot, 1 case of atrial septal defect and 1 case of paroxysmal supraventricular tachycardia. The incidence of femoral artery thrombosis was 0.84%(10/1 189), including 7 cases of common femoral artery occlusion, 1 case of superficial femoral artery occlusion, 1 case of common femoral artery with superficial femoral artery thrombosis occlusion, 1 case of moderate stenosis of common femoral artery; the length of thrombus was 0.7-2.7 cm. Seven children were treated with subcutaneous injection of low molecular weight heparin combined with oral aspirin on the second day of thrombosis; 1 child started treatment on the third day and 2 children started on the fifth day. The course of low molecular weight heparin injection was 3-28 days, with an average of (10±8)d. The final dose of aspirin was 2.0-4.6 mg/kg, with an average of (3.2±0.8)mg/kg. After treatment, blood flow of femoral artery, pulsation of dorsal pedal artery and skin temperature returned to normal in all children. No thrombosis reoccurred during 1-33 months follow-up. No complications such as bleeding, allergy, rash, digestive symptoms, thrombocytopenia, liver and kidney injury were observed during treatment. Conclusion    Subcutaneous injection of low molecular weight heparin combined with oral aspirin is safe and effective in treating femoral artery thrombosis after cardiac catheterization in children.