發(fā)布時間：2018-06-06 14:28

  本文選題：川崎病 + 冠狀動脈瘤��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對川崎病合并巨大冠脈瘤華法林抗凝治療的臨床研究及冠脈瘤的遠(yuǎn)期轉(zhuǎn)歸的探討。方法:本文收集2014年1月-2016年12月,在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院通過超聲心動圖診斷KD合并冠脈瘤的兒童,進(jìn)行回顧性研究。最終符合納入49例。分為小型冠脈瘤組、中型冠脈瘤組及巨大冠脈瘤組3組。巨大冠脈瘤組患兒給予華法林+阿司匹林的治療,同時給予其他抗血小板藥物。華法林組隨訪并維持國際標(biāo)準(zhǔn)化比值(INR)1.5-2.5之間。3組患兒均于出院后2周、1月、3月、6月及1年隨訪心臟彩超、心電圖,觀察冠脈瘤、血栓轉(zhuǎn)歸及心血管事件發(fā)生情況。結(jié)果:1.49例冠脈瘤,冠脈瘤最常累及左側(cè)冠脈主干(LM)38支(77.6%)、右側(cè)冠脈(RCA)36支(73.5%)、左側(cè)冠脈前降支(LAD)32支(65.3%),其次LCX累及13支(26.5%)。2.小型冠脈瘤組冠脈瘤完全回縮(100%),中型冠脈瘤組冠脈瘤回縮率88.9%。巨大冠脈瘤組在給予華法林+阿司匹林抗凝治療,發(fā)生回縮占40%,4例巨大冠脈瘤無變化;2例出現(xiàn)冠脈瘤增大,而其中1例有冠脈狹窄。小中冠脈瘤較巨大冠脈瘤更易回縮。巨大冠脈瘤組未出現(xiàn)心血管事件。3.小型冠脈瘤血栓形成有3例(14.3%)。中型冠脈瘤組9例冠脈內(nèi)血栓形成(50%),而巨大冠脈瘤組10例(100%)患兒均有血栓形成,小型冠脈瘤、中型冠脈瘤與巨大冠脈瘤比較P0.05,在血栓形成方面差異有統(tǒng)計學(xué)意義,提示冠脈瘤內(nèi)徑越大更易形成血栓形成。血栓形成好發(fā)于左冠脈,更易出現(xiàn)在左前降支。3組總31支冠狀動脈形成血栓,在冠脈內(nèi)徑4mm和4≤r5時各有3例形成血栓,冠脈直徑≥5mm有25例形成血栓,提示冠脈瘤直徑≥5mm可能是血栓形成的危險因素。4.中小冠脈瘤組總計11例(100%)血栓均消失。巨大冠脈瘤組10例(100%)血栓形成,4例(40%)血栓減小,5例(50%)血栓消失,1例(10%)出現(xiàn)血栓增大。隨訪期間6例患兒出現(xiàn)新增血栓。從兩組血栓轉(zhuǎn)歸比較,同樣給予抗凝治療,巨大冠脈瘤血栓難消失。5.巨大冠脈瘤組中使用華法林抗凝期間有4例發(fā)生了少量鼻出血、磕碰后瘀斑,1例患兒外傷后嚴(yán)重出血。結(jié)論:1.巨大冠脈瘤預(yù)后差,可發(fā)生冠脈瘤進(jìn)一步擴(kuò)大、血栓形成、冠脈狹窄及心功能降低。2.冠狀動脈瘤內(nèi)徑越大出現(xiàn)血栓的風(fēng)險越高,冠脈瘤內(nèi)徑≥5mm可能是形成血栓的高危因素。3.對于巨大冠脈瘤應(yīng)用華法林抗凝,在預(yù)防心血管事件的預(yù)后尚未得出結(jié)論,但華法林增加出血風(fēng)險,需謹(jǐn)慎使用,應(yīng)長期隨訪華法林不良反應(yīng)及心臟彩超。
[Abstract]:Objective: to investigate the long-term outcome of warfarin anticoagulant therapy for Kawasaki disease complicated with giant coronary aneurysm. Methods: from January 2014 to December 2016, children with KD complicated with coronary artery aneurysm were diagnosed by echocardiography in affiliated Children's Hospital of Chongqing Medical University. Finally, 49 cases were included. The patients were divided into three groups: small coronary aneurysm group, medium coronary aneurysm group and giant coronary aneurysm group. Children with giant coronary aneurysms were treated with warfarin aspirin and other anti-platelet drugs. The patients in warfarin group were followed up and maintained the ratio of INRN 1.5-2.5. 3 children were followed up at 2 weeks, 1 month, 3 months, 6 months and 1 year after discharge to observe the coronary aneurysm, thrombus prognosis and cardiovascular events during the follow-up period of two weeks, one month, three months, six months and one year after discharge. Results in 1.49 cases of coronary aneurysms, 38 branches of left main coronary artery were involved most frequently, 36 branches of RCA of right coronary artery were involved and 73.5%, 32 branches of left anterior descending coronary artery were involved with 65.3 branches, and 13 branches of LCX were involved with 26. 5% of left coronary artery, 26. 5% of left anterior descending coronary artery, 26. 5% of left coronary artery and 26. 5% of left coronary artery. The total retraction of coronary aneurysm was 100% in small coronary aneurysm group, and 88. 9% in medium coronary aneurysm group. In the large coronary artery aneurysm group, 40% of the patients received warfarin aspirin anticoagulant therapy, 4 cases of giant aneurysm showed no change, 2 cases showed enlargement of coronary artery, and 1 case had coronary stenosis. Small, medium and small coronary aneurysms are more likely to shrink back than large ones. There was no cardiovascular event in giant coronary aneurysm group. Thrombosis of small coronary aneurysm occurred in 3 cases. 9 cases of moderate coronary artery aneurysm group and 10 cases of giant coronary artery aneurysm group had thrombus formation, small coronary aneurysm, medium coronary aneurysm and giant coronary artery aneurysm (P0.05), there was significant difference in thrombogenesis between 9 cases of moderate coronary aneurysm group and 10 cases of giant coronary artery aneurysm group (P 0.05). It is suggested that the larger the diameter of coronary artery aneurysm, the easier it is to form thrombosis. Thrombosis occurred in the left coronary artery, and was more likely to occur in the left anterior descending coronary artery group than in the left anterior descending coronary artery group. There were 3 cases of thrombosis at 4mm and 4 鈮，

本文編號：1986933