中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
12期
925-929
,共5页
周书来%罗建平%齐延琦%梁宇光%汪伟%龚方戚
週書來%囉建平%齊延琦%樑宇光%汪偉%龔方慼
주서래%라건평%제연기%량우광%왕위%공방척
黏膜皮肤淋巴结综合征%血栓形成%猝死
黏膜皮膚淋巴結綜閤徵%血栓形成%猝死
점막피부림파결종합정%혈전형성%졸사
Mucocutaneous lymph node syndrome%Thrombosis%Death,sudden
目的 提高对川崎病急性冠状动脉血栓形成患儿临床特征的认识.方法 收集2004年1月至2013年1月浙江大学医学院附属儿童医院收治的川崎病急性冠状动脉血栓形成病例,分析患儿的一般情况与临床表现、实验室检查,超声心动图、心电图检查以及治疗与转归情况等.结果 本组6例,男5例,女1例,平均月龄(17.2±1 1.3)个月.超声心动图检查显示5例左冠状动脉血栓形成,其中4例在左冠状动脉前降支瘤样扩张处形成,1例左、右冠状动脉血栓形成,死亡1例,最大血栓约1.60 cm×0.80 cm,位于左冠状动脉前降支.6例中2例左冠状动脉瘤形成,4例左、右冠状动脉瘤形成,左冠状动脉内径(0.44±0.07) cm,右冠状动脉内径(0.45±0.07) cm.心电图V5导联ST段压低1例(例3),心肌梗死表现1例(例6).急性期治疗中,3例行静脉注射丙种球蛋白(IVIG)治疗,3例未行IVIG治疗,5例口服阿司匹林.亚急性期及恢复期治疗中,6例口服小剂量阿司匹林抗凝治疗,5例口服华法林抗凝治疗,5例口服双嘧达莫抗血小板治疗.超声心动图检查发现血栓形成后,6例行尿激酶溶栓治疗,4例加用肝素钠抗凝治疗.治疗后,超声心动图检查发现4例血栓缩小,1例血栓未见明显改变.1例死于心肌梗死.结论 川崎病急性冠状动脉血栓多在左冠状动脉(左冠状动脉前降支瘤样扩张处)形成.这些患儿有猝死的风险,需警惕血栓形成引起心肌梗死导致患儿猝死事件的发生.
目的 提高對川崎病急性冠狀動脈血栓形成患兒臨床特徵的認識.方法 收集2004年1月至2013年1月浙江大學醫學院附屬兒童醫院收治的川崎病急性冠狀動脈血栓形成病例,分析患兒的一般情況與臨床錶現、實驗室檢查,超聲心動圖、心電圖檢查以及治療與轉歸情況等.結果 本組6例,男5例,女1例,平均月齡(17.2±1 1.3)箇月.超聲心動圖檢查顯示5例左冠狀動脈血栓形成,其中4例在左冠狀動脈前降支瘤樣擴張處形成,1例左、右冠狀動脈血栓形成,死亡1例,最大血栓約1.60 cm×0.80 cm,位于左冠狀動脈前降支.6例中2例左冠狀動脈瘤形成,4例左、右冠狀動脈瘤形成,左冠狀動脈內徑(0.44±0.07) cm,右冠狀動脈內徑(0.45±0.07) cm.心電圖V5導聯ST段壓低1例(例3),心肌梗死錶現1例(例6).急性期治療中,3例行靜脈註射丙種毬蛋白(IVIG)治療,3例未行IVIG治療,5例口服阿司匹林.亞急性期及恢複期治療中,6例口服小劑量阿司匹林抗凝治療,5例口服華法林抗凝治療,5例口服雙嘧達莫抗血小闆治療.超聲心動圖檢查髮現血栓形成後,6例行尿激酶溶栓治療,4例加用肝素鈉抗凝治療.治療後,超聲心動圖檢查髮現4例血栓縮小,1例血栓未見明顯改變.1例死于心肌梗死.結論 川崎病急性冠狀動脈血栓多在左冠狀動脈(左冠狀動脈前降支瘤樣擴張處)形成.這些患兒有猝死的風險,需警惕血栓形成引起心肌梗死導緻患兒猝死事件的髮生.
목적 제고대천기병급성관상동맥혈전형성환인림상특정적인식.방법 수집2004년1월지2013년1월절강대학의학원부속인동의원수치적천기병급성관상동맥혈전형성병례,분석환인적일반정황여림상표현、실험실검사,초성심동도、심전도검사이급치료여전귀정황등.결과 본조6례,남5례,녀1례,평균월령(17.2±1 1.3)개월.초성심동도검사현시5례좌관상동맥혈전형성,기중4례재좌관상동맥전강지류양확장처형성,1례좌、우관상동맥혈전형성,사망1례,최대혈전약1.60 cm×0.80 cm,위우좌관상동맥전강지.6례중2례좌관상동맥류형성,4례좌、우관상동맥류형성,좌관상동맥내경(0.44±0.07) cm,우관상동맥내경(0.45±0.07) cm.심전도V5도련ST단압저1례(례3),심기경사표현1례(례6).급성기치료중,3례행정맥주사병충구단백(IVIG)치료,3례미행IVIG치료,5례구복아사필림.아급성기급회복기치료중,6례구복소제량아사필림항응치료,5례구복화법림항응치료,5례구복쌍밀체막항혈소판치료.초성심동도검사발현혈전형성후,6례행뇨격매용전치료,4례가용간소납항응치료.치료후,초성심동도검사발현4례혈전축소,1례혈전미견명현개변.1례사우심기경사.결론 천기병급성관상동맥혈전다재좌관상동맥(좌관상동맥전강지류양확장처)형성.저사환인유졸사적풍험,수경척혈전형성인기심기경사도치환인졸사사건적발생.
Objective To improve the awareness of acute coronary artery thrombosis in Kawasaki disease (KD).Method Six KD patients with acute coronary artery thrombosis (Jan.2004 to Jan.2013)were studied retrospectively.The basic information,clinical manifestations,laboratory data,echocardiography and electrocardiography (ECG),method and consequence of thrombolytic therapy were analyzed.Result The mean age of patients with coronary artery thrombosis (5 males and 1 female) was (17.2 ± 11.3) months.Five cases had thrombosis in left coronary artery (LCA),and four cases had thrombosis in aneurysm of left anterior descending artery (LAD).One case had thrombosis in both left and right coronary artery (RCA).One case died.Maximum thrombus was about 1.60 cm × 0.80 cm,locating in LAD.The diameter of LCA and RCA was (0.44 ± 0.07) cm and (0.45 ± 0.07) cm.Two patients showed abnormal ECG.Case 3 showed ST segment depression in lead VS.Case 6 showed myocardial infarction.In acute phase of KD,three patients received treatment with intravenous immunoglobin (IVIG),five patients were treated with aspirin.In sub-acute and convalescent phase of KD,all patients were treated with low-dose aspirin.Warfarin and dipyridamole were applied in 5 patients.All cases were treated with thrombolytic therapy using urokinase and/or heparin.After thrombolytic therapy,echocardiography showed thrombolysis in four cases and no change in one.One patient died of myocardial infarction.Conclusion Most of acute coronary thrombosis in KD occurred in LAD.KD patients with coronary artery thrombosis are at risk of sudden death due to myocardial infarction.
