摘要
目的:报告5例川崎病并发心肌梗死患儿资料,以提高对该病的认识和临床诊治水平。方法:分析该院5例川崎病并发心肌梗死患儿的临床表现、辅助检查(心肌酶谱、心电图、UCG)、治疗及预后。结果:4例患儿发生心肌梗死时表现为烦躁不安,面色苍白等,1例患儿无任何临床表现。5例均有CK-MB升高、CTnI阳性,心电图出现病理性Q波,ST-T段改变。UCG可见节段性室壁运动异常,其中2例合并冠状动脉瘤形成,2例冠状动脉扩张,另1例未发现冠状动脉病变。其中3例给予尿激酶溶栓治疗,5例均同时予抗血小板、抗凝治疗后抢救成功。对5例患儿均长期、规范随诊,至撰稿日未再出现心肌梗死,预后良好。结论:心肌梗死是川崎病主要死亡原因之一,发病时隐匿但凶险,可根据典型心电图、心肌酶谱及UCG明确诊断,治疗需给予及时溶栓,后期规范随诊,以防心肌梗死再发。
Objectives： To describe the clinical features of 5 children diagnosed as Kawasaki disease （KD） complicated with myocardial infarction. Methods： Five children suffered from KD complicated with myocardial in- farction were included. Clinical features, laboratory data [ serum myocardial enzymes, electrocardiogram （ECG） and echocardiography ], treatment and prognosis were retrospectively studied and related literatures were reviewed. Results： Four cases presented as irritable and pale, one as asymptomatic. All cases had elevated levels of CK- MB, positive CTnI, abnormal deep Q waves, change of ST segment and T waves. Abnormalities of the left ventric- ular regional wall motion were detected by echocardiography. Two cases had coronary aneurysms, two with dilated coronary, one with normal coronary artery. Three children received thrombolytic therapy with urokinase. All cases were treated with anti-platelet and anticoagulation. Myocardial infarction does not recur in the long-term follow-up, with very good outcome. Conclusion： The clinical manifestations are not representative in KD with myocardial in- farction. Prompt diagnosis could be attained according to the change of serum myocardial enzymes, ECG and echo- cardiography. Thrombolytic therapy should provide immediately. And long-term follow up is required for preventing myocardial infarction recurrence.
出处
《新医学》
2013年第4期243-246,共4页
Journal of New Medicine
关键词
川崎病
心肌梗死
冠状动脉病变
Kawasaki disease
Myocardial infarction
Coronary artery lesions
