摘要
目的降低先天性心脏病(简称先心病)的发病及减少病死率,探索在基层医院的管理模式。方法2002至2005年对北京市郊区两所妇幼保健院(大兴、门头沟)出生的足月活产儿5640例,在生后7 d内查体筛查先心病,可疑者用彩色多普勒超声心动图进行诊断,出院后定期随访。结果足月活产儿中共检出先心病65例,检出率11.52‰。65例先心病中非青紫型占76.9%,以室间隔缺损(简称室缺)为主(60.1%),青紫型23.1%,以肺动脉狭窄(9.1%)及法洛四联症(6.2%)为主。随访12例重症先心病,10例家长放弃治疗(其中6例已死亡),仅2例手术治愈。先心病占同期婴儿死因的首位35.3%(6/17)。室缺37例随访中缺损自行闭合(自闭)、扩大及无明显变化者约各占1/3。缺损直径<5 mm者23例,12例(52%)自闭,缺损≥5 mm者14例中,自闭1例(7%),8例(57%)缺损继续扩大(2χ=9.4,P<0.01),其中2例死亡,3例已手术矫治。结论防治先心病应自宫内筛查作起,对重症难治的先心病建议及早终止妊娠,经定期随访不能自闭的病例,选择最佳时期手术矫治,降低病死率。
Objective To decrease the mortality and morbidity of congenital heart diaease （CHD）, and to investigate the model of management of CHD in local hospitals. Methods Screening for CHD within 7 days after birth was performed on 5640 livebirth newborns in two Maternity and Infant Hospitals from 2002 to 2005. The suspected cases were finally diagnosed by Color Doppler Echocardiography and were followed-up regularly after discharge. Results Among 5640 newborns, 65 was found with CHD （11.52‰）, 76.9% of which was acyanotic heart disease and ventricular septal defect （VSD） was the most common form （60%）. 23.1% of the CHD newborns were cyanotic heart disease most of which were pulmonary stenosis （9.1%） and tetralogy of Fallot （6.2%）. Only 2 of the 12 severe forms of CHD underwent operation and recovered, the other 10 cases did not received any management （6 died）. The first cause of infant death was CHD in the study period 35.3% （6/17）. Thirty-seven cases of VSD were followed up and spontaneous closure, enlarged or unchanged defect each attributed to one third of them. Among 23 cases with VSD〈5 mm, 12 cases （52%） spontaneously closed, while only one among the 14 cases with VSD≥5 mm. Eight cases （57%） were found the defect enlarged in size when follow-up （P〈0.01） among which 2 died and 3 underwent surgery. Conclusions Prenatal screening is important in prevention and management of CHD. Those with severe CHD should be provided with early interventions and surgery at proper time in order to reduce the mortality.
出处
《中华围产医学杂志》
CAS
2006年第4期258-261,共4页
Chinese Journal of Perinatal Medicine
基金
北京市卫生局妇幼处科研基金(2003)
