彩色多普勒对川崎病冠状动脉病变诊断及治疗评价

目的：探讨彩色多普超声心动图诊断川崎病(Kawasaki disease，KD)冠状动脉病变及早期治疗和预后的评价。方法：彩色多普超声心动图检查73例川崎病患儿，测量冠状动脉直径，观察是否存在冠状动脉瘤、血栓和动脉狭窄，测量房室内径，计算心功能，观察是否有心包积液和瓣膜返流。结果：在受检的73例川崎病患儿中有冠状动脉损害的共27例，其中单纯左冠状动脉主干病变l5例，双支病变2例，5例发生冠状动脉瘤，l例动脉瘤回缩后主干轻度狭窄，2例冠状动脉于发病30天后发生改变，其中l例40天后发生左、右冠状动脉瘤和左冠状动脉主干血栓形成。27例冠状动脉受累者均合并轻度、中度二尖瓣及三尖瓣返流，l3例合并心包积液，2例有一过性的心功能降低。结论：使用高频探头能提高冠状动脉的显示率，特别是实时观察冠状动脉病理改变及动脉瘤形成和它的进展及转归，评价管壁的厚度和是否光滑、有无蛋白样物质沉积、钙化及血栓形成。早期联合使用阿斯匹林与大计量静滴丙种球蛋白，可减少冠状动脉瘤的发生及血栓形成。

Study on Diagnosis and Therapy of Kawasaki Disease with Coronary Arterial Lesions by Color Doppler Imaging

Objective:This study was to discuss the diagnosis of coronary arterial lesions in Kawasaki disease (KD) by Doppler echocardiography, earlier period treatment and the evaluation of prognosis.Methods:Seventy three cases with KD were examined by echocardiography.The coronary arterial diameter was measured and observed if there were coronary aneurysm, thrombus and stenosis present.The dimensions of the arteries and the ventricles were measured.the cardiac functions were calculated and pericardial effusion and valvular regurgitation were observed if present.Results:There were 27 patients with coronary arterial lesions in total 73 patients with KD.Fifteen patients had arterial lesions in single left main coronary artery and two patients had arterial lesions in two coronary arteries.Five patients had coronary aneurysms and one patient had slight stenosis in the left main coronary artery after coronary aneurysm drawn back.Two patients had coronary arterial lesions 30 days after KD and one patient had coronary aneurysms in left and right coronary arteries and thrombus in the left main coronary artery 40 days after the disease.Twenty seven patients with coronary arterial lesions had slight or moderate mitral and tricuspid regurgitation,13 patients had pericardial effusion and two patients had temporary cardiac dysfunction.Conclusions:High frequency ultrasound can raise the detection rate of the coronary artery and especially can be used to observe pathologic changings of the coronary artery,the aneurysm formation,progress and outcome.The thickness and smoothness of the vascular wall,protein like substance deposition,calcification and thrombosis can also be evaluated by ultrasound.Although the echocardiography cannot be used to detect the distal lesions,it is the most useful noninvasive technique to detect coronary arterial lesions.Coronary artery aneurysm and thrombosis may be reduced by using aspirin integrated with large dosage of inmmunoglobulin intravenously instillated during the early stage of KD.