首都医科大学学报 ›› 2010, Vol. 31 ›› Issue (2): 206-209.

• 儿科学专题 • 上一篇    下一篇

儿童血友病合并颅内出血21例临床分析

苏雁*, 吴润晖   

  1. 首都医科大学附属北京儿童医院血液病中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-04-21 发布日期:2010-04-21
  • 通讯作者: 苏雁

Clinical Analysis on 21 Cases of Intracranial Hemorrhage in Children with Hemophilia

SU Yan*, WU Run-hui   

  1. Hematology-Oncology Center, Beijing Children's Hospital, Capital Medical University
  • Received:1900-01-01 Revised:1900-01-01 Online:2010-04-21 Published:2010-04-21
  • Contact: SU Yan

摘要: 目的 了解我国儿童血友病人合并颅内出血(intracranial hemorrhage,ICH)的临床特点、治疗方案及预后,以便做到早诊断、早治疗以减少致死、致残发生。方法 对北京儿童医院血友病工作组2006年12月至2009年5月登记的21例血友病合并ICH的病例资料进行回顾性分析及随访。结果 ① 发生ICH的平均年龄是2岁10月,小于3岁病例占66%,中、重型血友病占90%,76%病人发生ICH前有明确头部外伤史。② 50%以上病例在发生ICH后诊断为血友病,年龄均<3岁,轻/中型病人占82%。③ 7例(33%)再发ICH全部为中、重型病人,血友病B占43%,57%病人预后不良。④ 死亡3例,后遗症5例。预后不良组替代治疗因子剂量、疗程低于预后良好组。结论 中、重型血友病、3岁以下儿童、头部外伤史是儿童血友病人发生ICH的危险因素;ICH可能是轻中型血友病婴幼儿的首发症状;中重型、血友病B应警惕再发ICH可能,再发ICH预后不良;替代治疗欠缺(不及时、剂量小、疗程短)可导致预后不良。

关键词: 儿童, 血友病, 颅内出血

Abstract: Objective Among all the bleeding episodes in hemophilic patients, intracranial hemorrhage(ICH) is associated with the highest mortality and the largest possibility of longterm serious sequelae. Knowing the clinical characteristic, treatment protocol and prognosis of ICH in children with hemophilia in China can help clinician to early diagnosis and treatment in order to reduce ICH sequelae and mortality. Methods 21 hemophilic children with ICH, which were registered in Hemophilia Treatment Center of Beijing Children’s Hospital between December 2006 and May 2009, were reviewed retrospectively. Data was analyzed by SPSS 11.5. Results ① The mean age of ICH was 2.8 years old. 66% of patients were less than 3 years old. 90% of patients were moderate or severe disease, and 76% had head trauma before ICH. ② Hemophilia were diagnosed after ICH in more than 50% of patients. All patients were less than 3 years old and 82% were moderate or severe hemophilia. ③ ICH in 7(33%) patients which were all moderate or severe recurred. 43% of patients were hemophilia B and 57% of patients with recurring ICH had poor prognosis. ④ 3 patients were dead and 5 had sequelae. The dosage of replacement therapy was lower and the period was shorter in team of poor prognosis than in team of good prognosis. Conclusion ① The risk factors of ICH in hemophilic children include moderate or severe disease, age with less than 3 years old and head trauma before ICH. ② ICH may be the first symptom of hemophilia in hemophilic infants, especially in mild and moderate patients. ③ The patients with hemophilia B, moderate or severe disease have more chances of recurring ICH. Recurring ICH has poor outcomes. ④ Delaying treatment, low dosage and insufficient replacement therapy should lead to poor prognosis.

Key words: children, hemophilia, intracranial hemorrhage

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