急性淋巴细胞白血病患儿合并深静脉血栓栓塞临床分析

发布时间：2018-02-16 08:30

本文关键词： 急性淋巴细胞白血病深静脉血栓血栓栓塞儿童　出处：《中国实验血液学杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的:探讨急性淋巴细胞白血病(ALL)儿童发生深静脉血栓的临床特点及转归。方法:对2010.1.1-2016.5.31确诊的266例ALL患儿中发生血栓的12例(占4.5%)进行了回顾性分析。对2015.1.1前诊断的183例患儿采用SCMC-ALL-05-方案治疗,对2015.1.1后诊治的80例患儿采用CCCG方案治疗。考虑有血栓形成者行彩超、MRI检查明确诊断。结果:发生深静脉血栓(DVT)的12例患儿中10例为肢体深静脉血栓,2例为颅内静脉窦血栓。DVT多发生在诱导或再诱导期间,中危患儿多发,大部分有感染及凝血象异常。给患儿以低分子肝素(LWHP)治疗,其中拔管5例;6例1周左右彩超复查显示血栓消失;1例颅内静脉窦血栓患儿半年后复查头颅MRI显示改善不明显。发生过DVT患儿,应用培门冬酰胺酶时给予LWHP预防治疗,其结果未再有血栓发生。结论:深静脉置管和化疗药物是发生血栓的主要因素;凝血功能异常、感染、危险度分层是血栓形成的危险因素。发生过血栓的患儿再次应用培门冬酰胺酶时予LWHP预防在临床上是获益的。
[Abstract]:Objective: to investigate the clinical characteristics and prognosis of deep venous thrombosis in children with acute lymphoblastic leukemia (ALL). Methods: 12 cases (4.5%) of 266 children with ALL diagnosed from January 1 to May 31, 2010.were retrospectively analyzed. 183 children were treated with SCMC-ALL-05- regimen. CCCG regimen was used in 80 children treated after January 1, 2015.Results: 10 of 12 children with DVT were diagnosed by color Doppler ultrasonography. Results: 10 cases were deep venous thrombosis of extremity and 2 cases were intracranial statics. Venous sinus thrombosis. DVT occurred during induction or reinduction. Most of them had infection and abnormal coagulation. They were treated with low molecular weight heparin (LWHP). Among them, 5 cases with extubation and 6 cases with intracranial venous sinus thrombosis were examined by color Doppler examination for about 1 week. Six cases with intracranial venous sinus thrombosis showed no significant improvement after half a year. The children with DVT were given prophylaxis and treatment with LWHP when they were treated with asparaginase. Conclusion: deep vein catheterization and chemotherapeutic drugs are the main factors of thrombosis. Risk stratification is a risk factor for thrombogenesis. Prophylaxis of LWHP in children with thrombus may benefit from repeated use of asparaginase.
【作者单位】：安徽医科大学第二附属医院儿科;
【分类号】：R543.6;R733.71

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