Pulmonary artery thromboembolism in children

Development of thromboembolism of the pulmonary artery is facilitated by such factors as bed rest, heart disease, postoperative pathology, fractures, varicose veins, obesity.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Symptoms of thromboembolism of the pulmonary artery in children

Symptoms of thromboembolism of the pulmonary artery depends on the degree of vascular lesions of the pulmonary artery system. Patients complain of shortness of breath, chest pain, coughing, hemoptysis. Objectively identify tachypnea, cyanosis, tachycardia, swelling of the veins of the upper body, enlargement of the liver. Ascultative changes resemble the picture of pneumonia, the pleural friction noise is revealed in a later period. In severe cases, sudden loss of consciousness, seizures, signs of acute vascular or cardiovascular failure (cardiogenic shock) occur. The clinical picture can be erased, which often leads to untimely diagnosis or non-recognition of the disease. In the electrocardiogram, infarct-like changes may occur with signs of congestion of the right heart (P-pulmonale, an increase in the R wave in the leads II, III aVF, V ₁, V ₂, pronounced S in the leads V ₅ -V ₆, etc.), but without a pathological Q wave, and in the presence of a S wave . From the results of additional diagnostic methods, a decrease in pQ, and infiltrates on the roentgenogram of the chest, is of diagnostic importance.

Treatment of thromboembolism of the pulmonary artery in children

Emergency care for pulmonary embolism in children and adolescents depends on the severity of the disease. In a lightning-fast form, primary cardiopulmonary resuscitation is performed, intubation of the trachea is performed and ventilation is performed, oxygen therapy with oxygen 50%. For the purpose of anesthesia, narcotic analgesics are injected [1% morphine solution (0.1-0.15 mg / kg) or 1-2% solution of trimeridine (0.1 ml per year of life)]. To relieve psychomotor agitation intravenously, diazepam is administered at a dose of 0.3-0.5 mg / kg (10-20 mg). For the purpose of neuroleptanalgesia, 0.005% solution of fentanyl (1-2 ml), 1% morphine solution or 1-2% solution of trimepiperidine, if not previously administered, with 1-2 ml of 0.25% solution of droperidol can be used.

Thrombolytic therapy for the first 2 hours is carried out using streptokinase at a dose of 100,000-250,000 units intravenously drip for an hour. For the same purpose, heparin sodium can be used intravenously at a dose of 200-400 ED / kghsut) under the control of a coagulogram, dipyridamole (5-10 mg / kg).

Infusion therapy uses solutions of colloids and crystalloids (0.9% sodium chloride solution, 5-10% dextrose solution, Ringer's solution is administered at a rate of 10-20 ml / kg per hour). For inotropic support intravenously, dopamine 5-15 μg / kg kgmin (50 mg is diluted in 500 ml infusion saline solution) is drip slowly. In this case, systolic blood pressure in adolescents should be maintained at a level of at least 100 mm Hg.

With the development of ventricular arrhythmias due to the risk of ventricular fibrillation, a 1% solution of lidocaine (1-1.5 mg / kg) should be prescribed. Patients are hospitalized in the intensive care unit.