目的：观察川崎病(KD)冠状动脉瘤并发血栓药物治疗的效果。方法回顾性分析8例KD冠状动脉瘤合并血栓患儿的临床资料。结果8例KD患儿年龄0.2~5.2岁；男6例，女2例。冠状动脉瘤瘤体内径8.3~13.8 mm，血栓发生时间在冠状动脉瘤形成后19 d至5月余。初发症状为突发胸痛1例，有心肌梗死伴心力衰竭症状；休克样症状1例；无症状6例。心脏超声检查发现瘤内血栓最大径2.8 mm×15.4 mm，呈长段条索状。冠状动脉血栓右侧4例，左侧2例，双侧2例。使用肝素、尿激酶溶栓，华法林、阿司匹林及潘生丁抗凝，抗血小板治疗。7例消溶成功，完全消溶所需要时间7d至4月余。1例4个月后血栓复发；1例发病12 h死亡。结论 KD冠状动脉瘤合并血栓好发于KD发病半年内，药物溶栓治疗需要时间较长，血栓脱落不多见。%Objective To observe the efficacy of drug treatment of coronary aneurysm complicated with embolism in Kawasaki disease (KD). Methods The clinical data of eight KD children with coronary aneurysm and embolism were retrospectively analyzed. Results Eight KD children (six males and two females) at age of 0.25-5.2 years (mean=2.89) ,were diagnosed with gigantic coronary artery aneurysms. The diameter of aneurysm was around 8.3-13.8mm. Thrombosis appeared from 19 days to five months after coronary aneurysms formation. The onset manifestations included sudden chest pain and myocardial infarction with symptoms of heart failure in one case, shock in one case and no symptom in six cases. The maximum diameter of the thrombus was 2.8 mm×15.4 mm in the shape of funicular. Four cases had thrombus in the right coronary artery, two cases in the left coronary artery, and two cases in both sides. The patients underwent anticoagulant therapy taking heparin, urokinase, warfarin, aspirin and dipyridamole. Anticoagulant therapy was successful in 7 cases and the thrombus was completely dissolved in 7 days to more than 4 months. One case had recurrent coronary thrombosis after 4 months. One case died in 12 hours after thrombolysis. Conclusions Coronary thrombosis usually appears in the half year after the onset of KD coronary aneurysm. Thrombolysis therapy takes long time in Kawasaki patients. Breaking off of thrombus are rarely seen.
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