小儿心脏手术患者的临床因素与术后血栓形成之间的关系:单中心回顾性研究

Q4 Medicine
Critical care explorations Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI:10.1097/CCE.0000000000001170
Sven Chlench, Noa J Freudenthal
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引用次数: 0

摘要

重要性:术后血栓形成是小儿心脏手术患者的重要并发症,可导致发病率和死亡率。找出与血栓形成相关的临床因素,可以指导早期发现和干预,从而改善患者的预后:本研究旨在评估因先天性心脏病(CHD)而接受手术的 12 个月以下小儿患者术后血栓形成或血栓栓塞的相关因素。设计、地点和参与者:这项回顾性队列研究分析了2020年3月1日至2021年3月1日期间波恩德国儿科心脏中心儿科心血管重症监护室(PCICU)收治的儿科患者的电子病历。共有197名12个月以下接受心脏手术的儿童纳入分析:主要结果和测量方法:术后通过超声波、超声心动图和计算机断层扫描等成像方式诊断血栓形成。主要结果是血栓形成的发生率及其与年龄、中心静脉导管(CVC)持续时间、CRP水平和D-二聚体水平等临床因素的关系:在 197 名患者中,血栓形成的发生率为 8.63%,主要是静脉血栓(70.6%)。血栓形成与年龄较小、体重较轻、血细胞比容较高、发绀、中心静脉导管(CVC)使用时间较长、C反应蛋白(CRP)和二聚体水平升高之间存在初步关联。接收器操作特征分析表明,d-二聚体水平高于 5.47 mg/L 的患者风险更高。逐步多元回归分析发现,原位 CVC 持续时间较长 (β = 0.553; p < 0.001)、CRP 水平较高 (β = 0.217; p = 0.022) 和入院时年龄较小 (β = -0.254; p = 0.006) 是血栓形成的重要预测因素。决策树分析认为,CVC使用时间超过12.5天和CRP水平超过118.01 mg/L是最关键的风险因素:术后血栓形成是儿科心脏疾病患者,尤其是新生儿的一个显著风险。长期使用 CVC 和 CRP 水平升高是关键的风险因素。对 D-二聚体和 CRP 水平进行常规监测,并及时进行超声波筛查,有助于血栓的早期发现和干预。有必要开展进一步研究,以优化该人群的血栓预防策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Associations Between Clinical Factors and Postoperative Thrombosis in Pediatric Cardiac Surgery Patients: A Single-Center Retrospective Study.

Importance: Postoperative thrombosis is a significant complication in pediatric cardiac surgery patients, contributing to morbidity and mortality. Identifying clinical factors associated with thrombosis can improve patient outcomes by guiding early detection and intervention.

Objectives: This study aimed to assess factors associated with postoperative thrombosis or thromboembolism in pediatric patients under 12 months old who underwent surgery for congenital heart disease (CHD). Design, Setting, and Participants: This retrospective cohort study analyzed electronic medical records from pediatric patients admitted to the Pediatric Cardiovascular Intensive Care Unit (PCICU) at the German Paediatric Heart Center, Bonn, between March 1, 2020, and March 1, 2021. A total of 197 children under 12 months old who underwent cardiac surgery were included in the analysis.

Main outcomes and measures: Thrombosis was diagnosed postoperatively using imaging modalities such as ultrasound, echocardiography, and computed tomography. The primary outcome was the incidence of thrombosis and its association with clinical factors such as age, central venous catheter (CVC) duration, CRP levels, and D-dimer levels.

Results: Among 197 patients, the incidence of thrombosis was 8.63%, predominantly venous (70.6%). Initial associations were observed between thrombosis and younger age, lower body weight, higher hematocrit, cyanosis, longer central venous catheter (CVC) use, and elevated C-reactive protein (CRP) and d-dimer levels. Receiver operating characteristic analysis indicated a higher risk in patients with d-dimer levels above 5.47 mg/L. The stepwise multiregression analysis identified longer CVC duration in situ (β = 0.553; p < 0.001), higher CRP levels (β = 0.217; p = 0.022), and younger age at admission (β = -0.254; p = 0.006) as significant predictors of thrombosis. Decision tree analysis identified CVC use longer than 12.5 days and CRP levels above 118.01 mg/L as the most critical risk factors.

Conclusions and relevance: Postoperative thrombosis is a notable risk in pediatric CHD patients, particularly in neonates. Prolonged CVC use and elevated CRP levels are critical risk factors. Routine monitoring of D-dimer and CRP levels, along with timely sonographic screening, can aid early thrombosis detection and intervention. Further research is warranted to optimize thrombosis prevention strategies in this population.

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