川崎病的诊治进展及其心血管并发症杜忠东_培训课件.ppt

* * * Despite of the case of warfarin, some patients develop coronary artery obstruction. This patient developed right coronary obstruction at 1 year of illness without any ischemic symptoms. Fortunately, the obstructed site was recanalized spontaneously. * Comparing between PTCA and PTCRA, incidence of restenosis and incidence of neoaneurysm were not different between 2 groups, however, the incidence of reintervention of PTCRA was significantly higher than that of PTCA. The use of smaller burr size was mostly caused of such reintervention. Although the incidence of reintervention in PTCRA was significantly higher than that in PTCA, necessity of bypass surgery in PTCRA was significantly lower than that in PTCA. In PTCRA, no patients required bypass surgery after the intervention. The cause of this findings was once restenosis developed after the PTCA, most of those progress to complete occlusion of coronary artery. Thus, such patients could not be indicated of reintervention, subsequently transferred coronary bypass surgery. Importantly, complication including neoaneurysm formation, and dissection of coronary arterial wall was still found 10 to 15% of procedure. Echocardiogram of coronary RCA: 右冠状动脉 LCA: 左冠状动脉 Ao: 主动脉 冠状动脉并发症发生率 未用IVIG治疗: 20% 男 24%，女15%（P0.001) IVIG治疗后: 5~6% 未用IVIG治疗冠状动脉瘤: 4% IVIG治疗后: 1% 日本川崎病冠状动脉并发症发生率改变 Males Females 川崎病合并体循环瘤 时间：2003年12月1日~2004年11月31日 收住北京儿童医院心内科病房的全部川崎病患儿 川崎病按照2002年日本小儿川崎病诊断标准第五次修订版作为诊断标准 患儿入选前争得家长同意并签署知情同意书 82例患儿血管多普勒超声检查，1例发现双侧腋动脉瘤，发生率1.2%。 杜忠东，贾立群，张永兰等。中华儿科杂志, 2007;45(5):395-396. 体循环瘤 18 x 9 x 11 mm 川崎病体循环瘤 Axillary A. rt. 18 lt. 17 Co. iliac A. rt. 16 lt. 15 Int. iliac A. rt. 12 lt. 11 Renal A. 6 Mesent. A. 2 ITA rt. 2 lt. 2 Aorta 1 Digital gangrene 0 提要 定义和历史 流行病学特点 病因及发病机制 临床表现及诊断标准 治疗 心血管并发症诊断及治疗 川崎病治疗 急性期治疗(Primary therapy)： IVIG Asp 激素？ 慢性期治疗 溶栓 介入性治疗 搭桥手术 提要 定义和历史 流行病学特点 病因及发病机制 临床表现及诊断标准 治疗 心血管并发症诊断及治疗 川崎病心血管并发症 冠状动脉病变 　　短期冠状动脉扩张 279/1409 （19.8%） 冠状动脉瘤 313/2