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目的观察低分子肝素(LMWH)治疗川崎病(KD)急性期血液高凝状态的临床疗效。方法确诊为KD的46例住院患儿,对血小板(PLT)>600×109/L、纤维蛋白原(FIB)>4g/L及彩色多普勒显示有冠状动脉血栓形成的22例患儿。予LMWH注射液50~100IU/(kg·次),皮下注射,1次/d,连用7~10d。患儿按是否接受LMWH治疗分为应用LMWH组(H组)和未用LMWH组(NH组)。观察两组治疗前后血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原国际标准化比值(INR)、FIB水平、血浆黏度、血沉(ESR)、红细胞比容(HCT)等变化,并全程密切观察有无出血情况。结果1.治疗前H组PLT与FIB显著高于NH组(Pa<0.05);2.治疗后两组比较,H组ESR、血浆黏度、FIB均较NH组显著降低(Pa<0.05);3.两组治疗前后比较,H组治疗后PLT、ESR、血浆黏度及FIB均较治疗前显著降低(Pa<0.05);NH组治疗后ESR较治疗前明显降低(Pa<0.05),PLT、血浆黏度及FIB变化无统计学意义;4.两组治疗前后PT、APTT、INR变化均无统计学意义;5.H组皮下注射局部出现皮下瘀斑1例,经局部热敷4d后基本吸收消失,余无严重出血及过敏等不良反应。结论LMWH能有效控制亚急性期KD患儿血液高凝状态,并因其生物利用度高、依从性好、不良反应少,是一种安全、有效、使用方便的改善KD高凝状态、预防微血栓形成的药物。
Objective To observe the clinical effect of low molecular weight heparin (LMWH) on hypercoagulable state of Kawasaki disease (KD) in acute phase. Methods Forty-six inpatients were diagnosed as KD. Twenty-two children with coronary artery thrombosis were detected on platelet (PLT)> 600 × 109 / L, fibrinogen (FIB)> 4 g / L and color Doppler. To LMWH injection 50 ~ 100IU / (kg · times), subcutaneous injection, 1 / d, once every 7 ~ 10d. Children were divided into LMWH group (group H) and non-LMWH group (group NH) according to whether they received LMWH treatment. The plasma prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin international normalized ratio (INR), FIB level, plasma viscosity, erythrocyte sedimentation rate (ESR) and hematocrit ) And other changes, and close observation of the whole situation with or without bleeding. Results 1. The PLT and FIB in group H before treatment were significantly higher than those in group NH (P <0.05) .2. After treatment, the ESR, plasma viscosity and FIB in group H were significantly lower than those in group NH (P <0.05); 3 .The PLT, ESR, plasma viscosity and FIB of H group after treatment were significantly lower than those before treatment (P <0.05); ESR of NH group was significantly lower than that before treatment (P <0.05) Viscosity and FIB had no statistical significance.4.The changes of PT, APTT and INR in two groups had no statistical significance before and after treatment.5.The subcutaneous injection of subcutaneous ecchymosis in group H was found in 1 case.After 4 days, local absorption disappeared, I no serious bleeding and allergies and other adverse reactions. Conclusion LMWH can effectively control blood hypercoagulability in children with subacute KD, and is a safe, effective and easy-to-use method to improve hypercoagulability of KD and prevent microelement because of its high bioavailability, good compliance and few adverse reactions. Thrombosis drugs.