17例儿童川崎病休克综合征的临床分析

Clinical Analysis of Kawasaki Disease Shock Syndrome in 17 Children

目的:探讨川崎病休克综合征(KDSS)患儿的临床表现、早期识别、治疗方案以及预后。方法:回顾性收集17例KDSS患儿的住院临床资料,同时为每例KDSS患儿选取同期住院的非休克川崎病患儿4例作为对照组,比较其临床特征及实验室特点。结果:KDSS组患儿心脏损害更加严重,KDSS组左室射血分数较对照组下降,氨基末端脑钠肽较对照组显著升高,并能作为有效的早期识别KDSS发生的指标;KDSS组冠脉损害发生率高于对照组;KDSS组患儿血小板计数降低;KDSS组患儿中性粒细胞数、C反应蛋白较对照组患者升高。结论:KDSS是川崎病一种严重的表现形式,其全身炎症及心脏损伤较非休克川崎病患儿更为剧烈。丙种球蛋白和血管活性药物的治疗安全且有效,大多数患儿预后良好。

Objective:To explore the clinical manifestations,early diagnosis,treatment options and prognosis of patients with Kawasaki disease shock syndrome(KDSS).Methods:The clinical data of 17 patients with KDSS were retrospectively collected.Four patients hospitalized at the same time were selected as the control group for each KDSS patient.The clinical characteristics and laboratory characteristics were compared.Results:Heart damage in the KDSS group was more severe.Compared with the control group,the left ventricular ejection fraction in the KDSS group decreased,and the amino terminal brain natriuretic peptide increased,which could be used as an effective indicator for early identification of KDSS.The incidence of coronary artery damage in the KDSS group was significantly higher than that in the control group.The platelet count in the KDSS group decreased;the number of neutrophils and C-reactive protein in the KDSS group were significantly higher than those in the control group.Conclusion:KDSS is a kind of severe form of Kawasaki disease,and its systemic inflammation and cardiac injury are more severe than those of non shock Kawasaki disease.The treatment of gamma globulin and vasoactive drugs is safe and effective,and the follow-up of most patients shows good prognosis.