肝素联合华法林抗凝治疗儿童血栓形成的疗效观察

doi:10.3969/j.issn.1000-3606.2020.10.004

临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (10): 736-.doi: 10.3969/j.issn.1000-3606.2020.10.004

肝素联合华法林抗凝治疗儿童血栓形成的疗效观察

杜庆霞, 李磊, 别文辉, 李新香, 于培儒, 周欣, 张新

山东大学齐鲁儿童医院济南市儿童医院心血管内科（山东济南 250022）

出版日期:2020-10-15 发布日期:2020-10-10
通讯作者: 李磊电子信箱：talilei1981@163.com

Effect of heparin combined with warfarin in the treatment of thrombogenesis in children

DU Qingxia, LI Lei, BIE Wenhui, LI Xinxiang, YU Peiru, ZHOU Xin, ZHANG Xin

Cardiovascular Medicine Department, Qilu Pediatric Hospital of Shandong University, Jinan 250022, Shandong, China

Online:2020-10-15 Published:2020-10-10

摘要/Abstract

摘要： 目的了解儿童血栓形成的常见病因，观察肝素联合华法林抗凝治疗效果。方法回顾分析2017年3月至 2019年3月诊断为血栓形成并接受肝素联合华法林抗凝治疗患儿的临床资料。根据治疗过程中国际标准化比值的（INR）目标值将患儿分为INR?1.0~1.5组、INR?1.5~2.0组及INR>2.0组，比较分析三组患儿抗凝治疗时间及疗效。结果纳入64 例患儿，男40例、女24例， <2岁29例（45.3%）。原发病以血液肿瘤疾病（36例，56.2%）、心血管疾病（20例，31.2%）为主。血栓形成原因为中心静脉置管38例（59.38%）、外周动静脉穿刺12例（18.75%）、重症感染4例（6.25%）、肿瘤4例（6.25%）、股静脉置管2例（3.12%）、心律失常2例（3.12%）、川崎病冠状动脉病变2例（3.12%）。INR?1.0~1.5组20例（男11例、女9例）， INR?1.5~2.0组28例（男18例、女10例），INR>2.0组13例（男9例、女4例），三组间抗凝治疗中位时间差异有统计学意义（P<0.05）。两两比较，INR?1.5~2.0组较INR?1.0~1.5组抗凝所用时间明显缩短，差异有统计学意义（P=0.014）。结论抗凝是治疗儿童血栓形成的主要方法且效果良好，低剂量华法林抗凝即可抑制血栓形成，无需将INR调整到>2.0。

关键词: 血栓形成；抗凝治疗；肝素；华法林；儿童

Abstract: Objective? To?explore?the?common?causes?of?thrombogenesis?in?children?and?observe?the?anticoagulant? effect?of?heparin?combined?with?warfarin.?Methods? The?clinical?data?of?children?diagnosed?with?thrombosis?and?receiving? anticoagulant?treatment?of?heparin?combined?with?warfarin?from?March?2017?to?March?2019?were?analyzed?retrospectively.? According?to?the?target?value?of?international?standardized?ratio?(INR)?during?treatment,?the?children?were?divided?into?INR? 1.0~1.5?group,?INR?1.5~2.0?group?and?INR>2.0?group,?and?the?duration?and?efficacy?of?anticoagulation?therapy?among?the?three? groups?were?compared?and?analyzed.?Results? Sixty-four?children?were?included?(40?males?and?24?females),?and?29?patients? (45.3%)?were?younger?than?2?years?old.?The?primary?diseases?were?mainly?hematological?tumor?diseases?(36?cases,?56.2%)?and? cardiovascular?diseases?(20?cases,?31.2%).?Thrombogenesis?was?caused?by?central?venous?catheterization?in?38?cases?(59.38%),? peripheral?arteriovenous?puncture?in?12?cases?(18.75%),?severe?infection?in?4?cases?(6.25%),?tumor?in?4?cases?(6.25%),?femoral? venous?catheterization?in?2?cases?(3.12%),?arrhythmia?in?2?cases?(3.12%),?and?coronary?artery?disease?of?Kawasaki?disease?in?2? cases?(3.12%).?There?were?20?cases?in?the?INR?1.0~1.5?group?(11?males?and?9?females),?28?cases?in?the?INR?1.5~2.0?group?(18? males?and?10?females),?and?13?cases?in?the?INR>2.0?group?(9?males?and?4?females).?There?was?a?statistically?significant?difference? in?the?median?time?of?anticoagulation?treatment?among?the?three?groups?(P<0.05).?In?pairwise?comparison,?the?anticoagulation? treatment?time?in?the?INR?1.5~2.0?group?was?significantly?shorter?than?that?in?the?INR?1.0~1.5?group,?and?the?difference?was? statistically?significant?(P=0.014).?Conclusion? Anticoagulation?is?the?main?method?for?the?treatment?of?thrombogenesis?in? children?and?its?efficacy?is?good.?Low-dose?warfarin?anticoagulation?can?inhibit?thrombogenesis?and?there?is?no?need?to?adjust? INR?to?>2.0.

Key words: thrombogenesis;? anticoagulant?therapy;? heparin;? warfarin;? child

杜庆霞，李磊，别文辉，等. 肝素联合华法林抗凝治疗儿童血栓形成的疗效观察[J]. 临床儿科杂志, 2020, 38(10): 736-.

DU Qingxia, LI Lei, BIE Wenhui, et al. Effect of heparin combined with warfarin in the treatment of thrombogenesis in children[J]. Journal of Clinical Pediatrics, 2020, 38(10): 736-.

肝素联合华法林抗凝治疗儿童血栓形成的疗效观察

Effect of heparin combined with warfarin in the treatment of thrombogenesis in children

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