小儿心内血栓的诊断及治疗(附4例报告)

Diagnosis and treatment of children with intracardiac mural thrombus(report of 4 cases)

目的总结4例小儿心内血栓的临床特点,探讨低分子肝素在治疗心内附壁血栓的疗效及其安全性。方法4例心腔内附壁血栓患儿给予低分子肝素5～7d,治疗前、中、后分别行心脏彩色超声检查,对附壁血栓大小进行测定。结果4例患儿中,左室内附壁血栓3例,右房内附壁血栓1例。原发病分别为扩张型心肌病、心肌心包炎、心肌炎、结缔组织疾病。肝素治疗后其中3例血栓消失,1例大小无变化,但结构略松散,追加尿激酶2万U溶栓后,血栓消失。结论低分子肝素治疗小儿心腔内附壁血栓效果满意,应用较安全。

Objective To investigate the safety and efficacy of treatment for intracardiac thrombus in children. Methods Four cases of patients with intracardiac mural thrombus were enrolled and observed. All of the patients were treated with low molecular weight heparin therapy. Ecbecardiography examination was performed before and after treatment to measure the size of the internal mural thrombus. Results Mural thrombosis was detected in the four subjects （two males and two females）. Three eases were found in the left ventricle and one was in the right atrium. The primary diagnoses were dilated cardiomyopathy, myopericarditis, myocarditis and connective tissue diseases respectively. After heparin therapy, the thrombus was completely eliminated in three subjects. For the other case, no change was found with the size of the thrombus but it became slightly loose, and thrombolysis was achieved by a boost of urokinase （20 thousand units）. Conclusions Low molecular weight heparin therapy is effective in 75.0% patients. It is safe and effective in treating intracardiac mural thrombus in children.