1.川崎病多系统损害临床分析 2.儿童室间隔缺损介入治疗封堵器的选择及疗效
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摘要
目的:总结分析川崎病( KD )多系统损害的发生情况及其与冠状动脉(冠脉)损害( CAL )之间的关系,以提高对KD的诊断水平。
方法:回顾性分析2006年1月至2007年12月我院收治的522例KD患儿的临床资料,结合临床表现、实验室及相关辅助检查确定受累系统及CAL。
结果:522例KD患儿中,男315例,女207例,男女之比为1.52 : 1;年龄2月~ 12岁,年龄中位数为2.6岁。< 5岁的KD患儿460例,占88.1 %;发病季节以4 ~ 8月份多发。KD各系统受累情况:心血管系统396例( 75.9 % )、血液系统323例( 61.9 % )、消化系统186例( 35.6 % )、泌尿系统132例( 25.3 % )、呼吸系统77例( 14.8 % )、中枢神经系统16例( 3.1 % )、四肢关节8例( 1.5 % )。心血管系统、中枢神经系统、泌尿系统、消化系统、呼吸系统、血液系统、四肢关节受损害时,伴发CAL的百分率分别为89.4 %、87.5 %、71.2 %、70.4 %、68.8 %、68.7 %、37.5 %;同时2个系统受累时伴发CAL为74.3 %,3个系统受累时伴发CAL为81.3 %,4个及以上系统受累时伴发CAL为83.1 %。
结论:KD可发生全身多系统损害;以发生心血管及中枢神经系统损害时,伴发CAL的发生率高;随着受累系统的增加,CAL的发生率亦增高。
目的:探讨儿童室间隔缺损( VSD )介入治疗不同类型封堵器的选择及疗效。
方法:介入治疗2004年5月~ 2007年7月150例VSD患儿,经胸超声心动图( TTE )确诊膜部VSD 143例,嵴内型VSD 4例,主动脉瓣下型VSD 3例;封堵后即刻TTE及左室造影观察封堵效果;术后24 h,1、3、6、12月复查TTE和心电图( ECG ),以后每年随访1次。
结果:126例VSD患儿封堵成功,技术成功率84 %;应用对称型膜部VSD封堵器114例,偏心型膜部VSD封堵器9例,小腰大边型膜部VSD封堵器3例。术后2例患儿存在少量残余分流,3个月后随访消失。随访期间,所有随访患儿的封堵器形态、位置正常,且无严重心律失常发生。
结论:根据VSD的类型及形态特征合理选择不同类型的封堵器,进行儿童VSD介入治疗,安全有效。原则上应选择尽量小、对称的封堵器来封堵VSD,其他类型封堵器(如偏心型膜部VSD封堵器,小腰大边型膜部VSD封堵器)在某些特殊情况下选择使用。
Objective: To investigate the multi-system lesions and the occurrence of coronary artery lesion ( CAL ) in children with Kawasaki disease ( KD ) and to elevate the diagnosis level of KD.
Methods: The 522 cases with KD admitted from Jan. of 2006 to Dec. of 2007 were analyzed retrospectively. These systems involved and CAL were determined by clinical manifestation and checking blood routine, urine routine, stool routine, chest X-ray, Electrocardiography ( ECG ), liver function, ultrasonic cardiography ( UCG ).
Results: There are 315 males and 207 feales. The ratio of male to female was 1.52 : 1. The ages ranged from 2 month to 12 years, median age is 2.6 years, and 88.1% of cases age less than 5 years. The peak of onset season was from April to August. The incidence of various systems involved in 522 patients with KD respectively were cardiovascular system 75.9%, hematological system 61.9%, digestive system 35.6%, urinary system 25.3%, respiratory system 14.8%, central nervous system 3.1%, four limbs and Articular system 1.5%. The incidence of CAL accompanied with cardiovascular system, central nervous system, urinary system, digestive system, respiratory apparatus, hematological system, four and more systems complications of KD respectively were 89.4%, 87.5%, 71.2%, 70.4%, 68.8%, 68.7% and 37.5%. In addition, the incidence of CAL with two systems involved simultaneously was 29.3 %, three systems 24.7 %, four and more systems 12.6 % in 522 KD patients.
Conclusions: There may be multi-system lesions in children with KD. Our study suggests that the incidence of CAL is obviously higher if KD patients have cardiovascular system and central nervous system complication others. The incidence of CAL increased accompanied with 2 or more systems involved simultaneously in KD patients.
Objective: To investigate the methods of selecting different shape occluders and to evaluate effect of transcatheter closures of congenital ventricular septal defect ( VSD ) in children.
Methods: Transcatheter closures were performed in 150 children with congenital VSD during May. 2004 to July. 2007 under guidance of transthoracic echocardiography ( TTE ). There were 143 patients with membranous VSD, 4 patients with intracristal VSD and 3 patients with below aortic valve VSD. Left ventriculography and TTE were performed repeatedly after the procedure to assess the effect of occlusion. TTE and Electrocardiography ( ECG ) were scheduled in 24 hours and 1, 3, 6, l2 month after closed, then once every year in follow-up.
Results: These occludings were deployed successfully in 126 patients. The successful rate of operation was 84%. And different shap of occluders were used, such as the equal side shape occluders were used in 114 patients, the eccentric shape occhders were used in 9 patients, the thin waist shape occluders were used in 3 patients. There were 2 patients with a sprinkle residual shunt after closed soon, and that disappeared in third month of follow-up. There were no cardiac arrhythmia after closure.
Condusions: It is very important in selecting suitable occluders according to anatomy and pathologic characteristics in transcatheter closure VSD in children. It is an effective and safety treatment in children with VSD. And it’s required that as small as possible and symmetrical side occluder can be used in closure VSD, other shape occluders can be considered only in special types of VSD.
方法:回顾性分析2006年1月至2007年12月我院收治的522例KD患儿的临床资料,结合临床表现、实验室及相关辅助检查确定受累系统及CAL。
结果:522例KD患儿中,男315例,女207例,男女之比为1.52 : 1;年龄2月~ 12岁,年龄中位数为2.6岁。< 5岁的KD患儿460例,占88.1 %;发病季节以4 ~ 8月份多发。KD各系统受累情况:心血管系统396例( 75.9 % )、血液系统323例( 61.9 % )、消化系统186例( 35.6 % )、泌尿系统132例( 25.3 % )、呼吸系统77例( 14.8 % )、中枢神经系统16例( 3.1 % )、四肢关节8例( 1.5 % )。心血管系统、中枢神经系统、泌尿系统、消化系统、呼吸系统、血液系统、四肢关节受损害时,伴发CAL的百分率分别为89.4 %、87.5 %、71.2 %、70.4 %、68.8 %、68.7 %、37.5 %;同时2个系统受累时伴发CAL为74.3 %,3个系统受累时伴发CAL为81.3 %,4个及以上系统受累时伴发CAL为83.1 %。
结论:KD可发生全身多系统损害;以发生心血管及中枢神经系统损害时,伴发CAL的发生率高;随着受累系统的增加,CAL的发生率亦增高。
目的:探讨儿童室间隔缺损( VSD )介入治疗不同类型封堵器的选择及疗效。
方法:介入治疗2004年5月~ 2007年7月150例VSD患儿,经胸超声心动图( TTE )确诊膜部VSD 143例,嵴内型VSD 4例,主动脉瓣下型VSD 3例;封堵后即刻TTE及左室造影观察封堵效果;术后24 h,1、3、6、12月复查TTE和心电图( ECG ),以后每年随访1次。
结果:126例VSD患儿封堵成功,技术成功率84 %;应用对称型膜部VSD封堵器114例,偏心型膜部VSD封堵器9例,小腰大边型膜部VSD封堵器3例。术后2例患儿存在少量残余分流,3个月后随访消失。随访期间,所有随访患儿的封堵器形态、位置正常,且无严重心律失常发生。
结论:根据VSD的类型及形态特征合理选择不同类型的封堵器,进行儿童VSD介入治疗,安全有效。原则上应选择尽量小、对称的封堵器来封堵VSD,其他类型封堵器(如偏心型膜部VSD封堵器,小腰大边型膜部VSD封堵器)在某些特殊情况下选择使用。
Objective: To investigate the multi-system lesions and the occurrence of coronary artery lesion ( CAL ) in children with Kawasaki disease ( KD ) and to elevate the diagnosis level of KD.
Methods: The 522 cases with KD admitted from Jan. of 2006 to Dec. of 2007 were analyzed retrospectively. These systems involved and CAL were determined by clinical manifestation and checking blood routine, urine routine, stool routine, chest X-ray, Electrocardiography ( ECG ), liver function, ultrasonic cardiography ( UCG ).
Results: There are 315 males and 207 feales. The ratio of male to female was 1.52 : 1. The ages ranged from 2 month to 12 years, median age is 2.6 years, and 88.1% of cases age less than 5 years. The peak of onset season was from April to August. The incidence of various systems involved in 522 patients with KD respectively were cardiovascular system 75.9%, hematological system 61.9%, digestive system 35.6%, urinary system 25.3%, respiratory system 14.8%, central nervous system 3.1%, four limbs and Articular system 1.5%. The incidence of CAL accompanied with cardiovascular system, central nervous system, urinary system, digestive system, respiratory apparatus, hematological system, four and more systems complications of KD respectively were 89.4%, 87.5%, 71.2%, 70.4%, 68.8%, 68.7% and 37.5%. In addition, the incidence of CAL with two systems involved simultaneously was 29.3 %, three systems 24.7 %, four and more systems 12.6 % in 522 KD patients.
Conclusions: There may be multi-system lesions in children with KD. Our study suggests that the incidence of CAL is obviously higher if KD patients have cardiovascular system and central nervous system complication others. The incidence of CAL increased accompanied with 2 or more systems involved simultaneously in KD patients.
Objective: To investigate the methods of selecting different shape occluders and to evaluate effect of transcatheter closures of congenital ventricular septal defect ( VSD ) in children.
Methods: Transcatheter closures were performed in 150 children with congenital VSD during May. 2004 to July. 2007 under guidance of transthoracic echocardiography ( TTE ). There were 143 patients with membranous VSD, 4 patients with intracristal VSD and 3 patients with below aortic valve VSD. Left ventriculography and TTE were performed repeatedly after the procedure to assess the effect of occlusion. TTE and Electrocardiography ( ECG ) were scheduled in 24 hours and 1, 3, 6, l2 month after closed, then once every year in follow-up.
Results: These occludings were deployed successfully in 126 patients. The successful rate of operation was 84%. And different shap of occluders were used, such as the equal side shape occluders were used in 114 patients, the eccentric shape occhders were used in 9 patients, the thin waist shape occluders were used in 3 patients. There were 2 patients with a sprinkle residual shunt after closed soon, and that disappeared in third month of follow-up. There were no cardiac arrhythmia after closure.
Condusions: It is very important in selecting suitable occluders according to anatomy and pathologic characteristics in transcatheter closure VSD in children. It is an effective and safety treatment in children with VSD. And it’s required that as small as possible and symmetrical side occluder can be used in closure VSD, other shape occluders can be considered only in special types of VSD.
引文
[1]马翔,马依彤.室间隔缺损介入治疗的研究现状与发展[J].心血管病学进展, 2007,28(2):299-302.
[2]刘延玲,熊鉴然.临床超声心动图[M].北京:科学出版社,2001.238-253.
[3]中华儿科杂志编辑委员会,中华医学杂志英文版编辑委员会.先天性心脏病经导管介入治疗指南[J].中华儿科杂志,2004,42(3):234-239.
[4] Hijazi ZM, Hakim F, Haweleh AA, et a1. Catheter closur of perimembranous ventricular septal defects using the new amplatzer membranous VSD occluder: Initial clinical experience [J]. Catheter Cardiovasc interv, 2002,56(4):508-515.
[5]周达新,葛均波,陈灏珠.宦间隔缺损封堵治疗的疗效和安性[J].中华心血管病杂志,2003,31:330-333.
[6] Fabrega SJ, Rodes J, Piechaud J, et al. Percutaneous closure of amid muscular residul ventrlcular septal defect using the AmplalTer (TM) device [J], An Esp Pediatr, 2002,57 (1) : 66-69.
[7]张玉顺,李寰,代政学,等.膜周部室间隔缺损介入治疗的临床评价[J].中国循环杂志,2005,20(1):14-16.
[8]王玉林.先天性心脏病的介入治疗进展[J].实用儿科临床杂志,2005,20(7):612 -614.
[9]王震,解启莲,张密林,等.经导管治疗假性室间隔膜部瘤226例临床分[J].临床心血管病杂志,2006,22(2):88-90.
[10] ARORA R, TREHAN V, KUMAR A, et a1. Transcatheter closure of congenital ventricular septal defects:experience with various device [J]. J interv Cardiol, 2003, 16:83-91.
[11]孙万峰,张国培,崔婷,等.国产偏心室间隔缺损封堵器在嵴内型室间隔缺损封堵中的临床应用[J].中华心血管病杂志,2005,33(3):232-233.
[12]高磊,张密林,崔史杰,等.室间隔缺损介入治疗中封堵器的选择[J].实用儿科临床杂志,2007,22(1):67-69.
[1]胡静,王大为,秦玉明.川崎病病因的研究进展[J].国际儿科学杂志,2007,34 (3): 193-195.
[2] Newburger J W, Takahashi M, Gerber M A, et a1. Diagnosis, treatment, and long- term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever,Endocarditis and Kawasaki Disease, Council on Cardiovas cular Disease in the Young, American Heart Association [J]. Circulation, 2004,110(17):2747-2771.
[3]中华医学会儿科学分会免疫学组.川崎病专题讨论会纪要[J].中华儿科杂志, 2007,45(11):826-830.
[4]张乾忠.不典型川崎病的临床表现和诊断[J].中国实用儿科杂志,2006,21 (10): 728-730.
[5] Ayusawa M, Sonobe T, Uemura S, et al. Revision of diagnostic guidelines for Kawasaki disesse (the 5th revised edition). Pediatr int, 2005,47:232-234.
[6]廖静,田杰,白永虹,等.不完全川崎病136例[J].实用儿科临床杂志,2006,21 (11):692-693.
[7]张伟,李秋,赵晓东,等.942例川崎病的临床分析[J].中华儿科杂志,2006, 4(5): 324-328.
[8]胡秀芬,程佩萱.超抗原与川崎病[J].实用儿科临床杂志,2001,16(5):335-337.
[9]王宏伟.川崎病的病因及发病机制的研究进展[J].中华儿科杂志,2002,40(2): 120-121.
[10]孙景辉,翟淑波.川崎病发病机制研究进展[J].实用儿科临床杂志,2007,22 (13): 1037-1040.
[11]魏洪平,吴敏,朱红枫.川崎病易感基因研究进展[J].实用儿科临床杂志.2008, 23(9):705-707.
[12]李晓惠,杜军保.川崎病的病因与发病机制[J].中国全科医学,2007,10(5): 388-390.
[13]黄敏,杨晓东.不完全川崎病的诊断与治疗[J].实用儿科临床杂志,2008,23(1): 76-78.
[14]王云峰,周忠蜀.以颈淋巴结大为首要表现的不典型川崎病1例[J].实用儿科临床杂志,2007,22(21):1680.
[15]闵丽君,徐和祥,王铁民,等.伴有肌肉肿痛的川崎病1例[J].中国实用儿科杂志,2006,21(10):750.
[16]吴爱勤.川崎病肝脏损害12例临床分析[J].中华现代儿科学杂志,2006,3(2): 132-133.
[17]李兰,李运壁.特殊症状的川崎病3例报告[J].中国当代儿科杂志,2004,6(4): 346-347.
[18]陈新民.川崎病的诊断治疗现状[J].实用儿科临床杂志,2008,23(9): 719-720.
[19] Kobayashi T,Inoue Y,Takeuchi K,et a1. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease [J].Circulation,2006,113: 2606-2612.
[20]张清友,杜军保.不完全川崎病的诊治现状[J].中华儿科杂志,2006,44(5): 339-341.
[21] Durongpisitkul K,Soongswang J,lmohaprasitiporn D,el al. Immunoglobulin failure mad retreatment in Kawasaki disease[J]. Pediatr Cardiol, 2003,24(2): l45-148.
[22]杜忠东,张永兰,赵地,等.静脉丙种球蛋白的无反应性川崎病的治疗及危险因素分析[J].中国实用儿科杂志,2006, 21: 738-741.
[23] Fukunishi M, Kikkawa M, Hamana K, et a1.Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset. J Pediatr, 2000,137 :172-176.
[24] Sundel RP, Baker AL, Fulton DR, el a1. Corticosteroids in the initial treatment of Kawasaki disease: Report of a randomized trial[J], J Pediatr,2003,142(6): 611-616.
[25]黄国英.川崎病的流行病学特征[J].中国全科医学,2007,10(5): 390-391.
[26]中华医学会上海儿科分会心血管学组.川崎病随访方案(试行)[J].临床儿科杂志,2006,24(5): 427-42.
[2]刘延玲,熊鉴然.临床超声心动图[M].北京:科学出版社,2001.238-253.
[3]中华儿科杂志编辑委员会,中华医学杂志英文版编辑委员会.先天性心脏病经导管介入治疗指南[J].中华儿科杂志,2004,42(3):234-239.
[4] Hijazi ZM, Hakim F, Haweleh AA, et a1. Catheter closur of perimembranous ventricular septal defects using the new amplatzer membranous VSD occluder: Initial clinical experience [J]. Catheter Cardiovasc interv, 2002,56(4):508-515.
[5]周达新,葛均波,陈灏珠.宦间隔缺损封堵治疗的疗效和安性[J].中华心血管病杂志,2003,31:330-333.
[6] Fabrega SJ, Rodes J, Piechaud J, et al. Percutaneous closure of amid muscular residul ventrlcular septal defect using the AmplalTer (TM) device [J], An Esp Pediatr, 2002,57 (1) : 66-69.
[7]张玉顺,李寰,代政学,等.膜周部室间隔缺损介入治疗的临床评价[J].中国循环杂志,2005,20(1):14-16.
[8]王玉林.先天性心脏病的介入治疗进展[J].实用儿科临床杂志,2005,20(7):612 -614.
[9]王震,解启莲,张密林,等.经导管治疗假性室间隔膜部瘤226例临床分[J].临床心血管病杂志,2006,22(2):88-90.
[10] ARORA R, TREHAN V, KUMAR A, et a1. Transcatheter closure of congenital ventricular septal defects:experience with various device [J]. J interv Cardiol, 2003, 16:83-91.
[11]孙万峰,张国培,崔婷,等.国产偏心室间隔缺损封堵器在嵴内型室间隔缺损封堵中的临床应用[J].中华心血管病杂志,2005,33(3):232-233.
[12]高磊,张密林,崔史杰,等.室间隔缺损介入治疗中封堵器的选择[J].实用儿科临床杂志,2007,22(1):67-69.
[1]胡静,王大为,秦玉明.川崎病病因的研究进展[J].国际儿科学杂志,2007,34 (3): 193-195.
[2] Newburger J W, Takahashi M, Gerber M A, et a1. Diagnosis, treatment, and long- term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever,Endocarditis and Kawasaki Disease, Council on Cardiovas cular Disease in the Young, American Heart Association [J]. Circulation, 2004,110(17):2747-2771.
[3]中华医学会儿科学分会免疫学组.川崎病专题讨论会纪要[J].中华儿科杂志, 2007,45(11):826-830.
[4]张乾忠.不典型川崎病的临床表现和诊断[J].中国实用儿科杂志,2006,21 (10): 728-730.
[5] Ayusawa M, Sonobe T, Uemura S, et al. Revision of diagnostic guidelines for Kawasaki disesse (the 5th revised edition). Pediatr int, 2005,47:232-234.
[6]廖静,田杰,白永虹,等.不完全川崎病136例[J].实用儿科临床杂志,2006,21 (11):692-693.
[7]张伟,李秋,赵晓东,等.942例川崎病的临床分析[J].中华儿科杂志,2006, 4(5): 324-328.
[8]胡秀芬,程佩萱.超抗原与川崎病[J].实用儿科临床杂志,2001,16(5):335-337.
[9]王宏伟.川崎病的病因及发病机制的研究进展[J].中华儿科杂志,2002,40(2): 120-121.
[10]孙景辉,翟淑波.川崎病发病机制研究进展[J].实用儿科临床杂志,2007,22 (13): 1037-1040.
[11]魏洪平,吴敏,朱红枫.川崎病易感基因研究进展[J].实用儿科临床杂志.2008, 23(9):705-707.
[12]李晓惠,杜军保.川崎病的病因与发病机制[J].中国全科医学,2007,10(5): 388-390.
[13]黄敏,杨晓东.不完全川崎病的诊断与治疗[J].实用儿科临床杂志,2008,23(1): 76-78.
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