儿科学-川崎病双语（七年制第三版）.ppt

Five main symptoms and above； Four main symptoms ＋ evidence of coronary artery lesions including coronary artery aneurysm or ectasia when other diseases are excluded Diagnostic Criteria for Kawasaki Disease 川崎病诊断标准 不完全川崎病 6个症状中只有3项，但心超或冠脉造影证实有冠状动脉瘤 6个症状中有4项，但心超可见冠状动脉壁辉度增强 Incomplete Kawasaki disease Three main symptoms ＋ evidence of coronary artery aneurysm proved by ECHO or coronary arteriongraphy Four main symptoms ＋ brightness enhancement of coronary artery wall proved by ECHO Diagnostic Criteria for Kawasaki Disease 鉴别诊断 Differential Diagnosis 1. 败血症：血培养阳性，抗生素治疗有效 2. 渗出性红斑：有疱疹、皮肤糜烂出血 3. 幼年型类风湿性关节炎全身型：无结膜充血、无皲裂，无手足硬肿脱皮、无冠脉损害 4. 猩红热：皮疹多于发热当日或次日出疹，粟粒样均匀丘疹，疹间皮肤潮红，无皲裂，无指趾肿胀，青霉素治疗有效 5. 结节性多动脉炎：好发于9-11岁，全身性坏死性中小动脉炎 治 疗 1.阿司匹林 抑制环氧化酶而抑制前列腺素合成，阻断血小板产生血栓素A 30~50mg/kg.d，至热退、症状消失 随后减至3~5mg/kg.d，一次顿服维持2~3月 血沉、血小板恢复正常可停药 冠状动脉病变用药至冠状动脉正常或终身服药 2.氟比洛芬（氟布洛芬）：对阿司匹林禁忌者 3~5mg/kg.d ，分三次 3. 大剂量丙种球蛋白 Intravenous immune globulin (IVIG) 作用：退热、预防或减轻冠状动脉病变 宜与阿司匹林合用 开始：发病10天内使用 剂量：2g/kg, iv drip in 10~12 hrs 内 对IVIG无反应者：可追加1次或加激素 4.其他治疗 （1）恢复期冠状动脉病变 阿司匹林 3~5mg/kg.d+ 双嘧达莫 3~5mg/kg.d 分2次 （2）巨大动脉瘤或多个动脉瘤无冠状动脉闭塞 长期： 阿司匹林 3~5mg/kg.d + 华法令 （3）对症、支持：补液、护肝、控制心衰 （4）心肌梗死：溶栓 （5）冠状动脉搭桥术 Prognosis Recover well Relapse 1%~2% Aneurism 20%~30% for not treatment Incidence of CA lesions obviously reduced by high dose IVIG treatment Follow-up CA normal: 1m, 3m, 6m and 1yr CA damage: 1m, 2m, 6m, once per 6-12 months after six months, lifetime follow-up Contents: PE, ECG, ECHO Conclusions Pathogenesis of KD Clinical manifestation of KD The diagnostic criteria of KD KD therapy Question 1. What’s the diagnostic criteria for the Kawasaki disease？ 2. What is the therapeutic measure of the Kawasaki disease? Reference 桂永浩，薛辛东.儿科学[M].第3版.人民卫生出版社，2015 Thanks for your attention 授课对象：本硕七年制 广西医科大学儿科学教研室 Kawasaki Disease Mucocutaneous lymph node syndrome (MCLS) Kawasaki disease (KD) First described in Japan in 1967 Definition: An acute febrile vasculitis ( the