小儿左心导管术后股动脉血栓形成的溶栓治疗

摘要

目的 探讨对左心导管术后并发股动脉血栓形成的患儿进行溶栓治疗的方法和疗效.方法 1999年1月至2009年4月,对左心导管术后并发股动脉血栓形成的16例患儿(男5例,女11例)进行溶栓治疗.首先经外周静脉途径溶栓,无效后再采用经对侧股动脉插管途径进行溶栓治疗.给予肝素100 U/kg,随后予尿激酶30 000～180 000 U冲击剂量后,以10 000～50 000 U/h静脉泵入维持至足背动脉恢复搏动.结果 16例患儿的年龄为(2.6±1.9)岁,身高(85.3±13.1)cm,体重(11.2 ±3.8)kg.同侧足背动脉搏动消失15例,明显减弱1例.紫绀属先天性心脏病患儿2例,非紫绀属先天性心脏病患儿14例,其中12例接受介入治疗.所有患儿经抗凝溶栓治疗后下肢缺血症状均恢复,其中3例患儿经对侧股动脉插管溶栓后成功,11例经外周静脉溶栓成功,另2例患儿给予肝素及解痉药物后恢复.术中所用肝素(950 ±682)U,尿激酶(295 357±198 770)U.溶栓起效时间(7.25 ±5.31)h.2例患儿溶栓后髂外动脉存在轻度残余狭窄,余患儿应用股动脉血管超声随访2周均提示管腔通畅.结论 采用尿激酶对左心导管术后股动脉血栓形成患儿进行溶栓治疗安全有效,当经外周静脉途径溶栓无效时,应尽早采用经对侧股动脉插管途径进行溶栓.%Objective The study was conducted to investigate the feasibility and effectiveness of fibrinolytic therapy for femoral artery thrombosis after left cardiac catheterization in children. Methods Thrombolytic therapy with urokinase was applied in 16 children (5 males) with femoral artery thrombosis after left cardiac catheterization. Patients were given a bolus injection of heparin, 100 U/kg. 30 000-100 000 U boluses of urokinase were injected intravenously, and then a continuous infusion of 10 000-50 000 U/h was started. Transcatheter thrombolysis was performed once previous procedures failed. Results All 16 patients presented lower limbs ischemia after left cardiac catheterizations. The age was (2. 6 ± 1.9) years,the height was (85.3 ± 13. 1) cm, the weight was (11.2 ±3.8) kg. Patients with cynosic and acynusic congenital heart disease were 2 and 14, respectively. Interventional therapy was performed in 12 patients. Absent arterial pulsations were found in 15 patients and reduced arterial pulsation in 1 patient. Femoral arterial perfusion became normal in all patients (3 after transcatheter thrombolysis, 11 post intravenous thrombolysis and 2 post intravenous heparin). The average doses of heparin and urokinase were (950 ±682)U and (295 357 ± 198 770)U. The average duration of therapy was (7.25 ±5.31 )h. Mild residual stenosis were found in 2 patients post various treatments. Conclusion Fibrinolytic therapy with urokinase is a safe and useful medality for children with femoral artery thrombosis after left cardiac catheterization.