What to do if Kawasaki disease recurs for the second time

Kawasaki disease is a common symptom among children. The course of this disease is generally divided into two types. That is, the acute attack period and the recovery period. During the acute attack period, Kawasaki disease can be treated with certain drugs. Immunoglobulin, aspirin, and corticosteroids all have certain therapeutic effects on Kawasaki disease. During the recovery period, anticoagulant therapy, thrombolytic therapy, coronary angioplasty, surgical treatment and other methods can be adopted.

1. Acute phase treatment: Take medication within 10 days after onset of the disease.

Early oral aspirin can control the acute inflammatory process, and intravenous immunoglobulin plus oral aspirin treatment can reduce the incidence of coronary artery aneurysms in Kawasaki disease.

1. Immunoglobulin

Administer 400 mg/kg of immunoglobulin intravenously every day, over 2 to 4 hours, for 4 consecutive days; at the same time, take 50 to 100 mg/kg of aspirin orally per day, divided into 3 to 4 times, for 4 consecutive days, and then reduce it to 5 mg/kg per day, taken all at once.

2. Aspirin

The dosage is 30-100 mg/kg per day, divided into 3-4 times. After taking it for 14 days, reduce the dosage to 3-5 mg/kg per day, taken once, to achieve the anti-platelet aggregation effect.

3. Corticosteroids

Prednisone and aspirin can be used in combination for treatment. Corticosteroids alone are generally not used to control the early inflammatory response of Kawasaki disease. Prednisone, oral, adults start with 15mg ~ 40mg / day, if needed, can be increased to 60mg / day, taken in divided doses, and gradually reduced after the condition stabilizes. The maintenance dose is 5mg~10mg/day.

2. Treatment during the recovery period

1. Anticoagulant therapy

Take aspirin 3-5 mg/kg once a day until the erythrocyte sedimentation rate and platelet count return to normal. If there is no coronary artery abnormality, generally stop the drug 6-8 weeks after onset. Patients with residual chronic coronary artery disease need to take anticoagulants for a long time and be closely followed up. Patients with small single coronary artery aneurysms should take aspirin 3 to 5 mg/kg/d for a long time until the aneurysm disappears. For those who are intolerant to aspirin, 3 to 6 mg/kg of diphenylmethane can be taken daily, divided into 2 to 3 doses. Patients with giant tumors are prone to thrombosis, coronary artery stenosis or occlusion, and can use oral warfarin anticoagulants.

2. Thrombolytic therapy

For patients with myocardial infarction and thrombosis, intravenous or percutaneous intracoronary puncture is used to administer the drug to promote coronary artery reopening and myocardial reperfusion. Intravenous thrombolysis: infuse urokinase 20000u/kg within 1 hour, followed by 3000-4000u/kg per hour. Infuse urokinase 1000u/kg within 1 hour of coronary artery administration. Streptokinase can also be used. 10,000 u/kg of streptokinase should be injected intravenously within 1 hour for thrombolysis, and it can be used again after half an hour. The above drugs can dissolve fibrin quickly, have good effects and no adverse reactions.

3. Coronary angioplasty

In recent years, the use of balloon catheters to dilate coronary artery stenosis has been successful.

4. Surgical treatment

Indications for coronary artery bypass grafting are:

① The left main trunk is highly occluded;

②Multiple branches are highly occluded;

③The left anterior descending branch is almost highly occluded. For cases of severe mitral regurgitation that are ineffective with medical treatment, valvuloplasty or valve replacement may be performed.