摘要
目的探讨急诊床旁超声心动图在新生儿重症监护病房的应用价值。方法2007年1月至2011年7月，应用急诊床旁超声心动图（索诺声公司Micromaxl型便携式超声诊断仪或飞利浦iE33型彩色多普勒超声诊断仪）对668例有心脏病理性杂音、皮肤紫绀、气促等临床表现的患儿进行探查，以手术结果为金标准，评价急诊床旁超声心动图的诊断准确性及其在新生儿重症监护病房中的应用价值。结果668例患儿中男347例，女321例；足月儿309例，平均胎龄（39．1±0．6）周（37．0～42．1周）；早产儿359例，平均胎龄（33．7±0．91）周（28．9～36．9周）。患儿平均日龄为（7．2±1．3）d。共检出心血管异常507例，其中动脉导管未闭268例（早产儿232例，足月儿36例），先天性心脏病115例，持续胎儿循环99例，心律不齐25例。共54例行外科手术治疗，1例行介入手术治疗；手术成功51例，4例死亡。这55例手术患儿术前未进一步行CT、磁共振或创伤性心导管造影检查，直接行手术治疗。其余452例患儿经药物及时治疗后好转出院392例，无明显好转26例，死亡14例，放弃治疗20例。以手术结果为金标准，便携式超声诊断仪诊断先天性心脏病的准确率为94．5％（52／55），iE33型彩色多普勒超声诊断仪诊断准确率为96．4％（53／55）。结论急诊床旁超声心动图能迅速评价危重患儿心脏结构功能及肺动脉压力，具有较高的临床价值。
Objective To evaluate the clinical value of emergency bedside echocardiography in neonatal intensive care unit. Methods Six hundred and sixty-eight infants with cardiac pathological murmurs, cyanosis and shortness of breath were detected by emergency bedside echocardiography （Sonosite Micromax 1 portable ultrasound or Philips iE33 ultrasonic systems） during January 2007 to July 2011. The accuracy of emergency bedside echocardiography in the diagnosis of neonatal heart diseases was evaluated according to the results of surgical exploration. Results Among 668 enrolled neonates with the mean age of （7.2± 1.3） d, there were 347 males and 321 females, and 309 term infants [mean gestational age （39. 1± 0.6） weeks （37.0±42.1 weeks）] and 359 premature infants [mean gestational age （33.7±0.91） weeks （28.9±36.9 weeks）]. Totally, 507 cases were found cardiac abnormality by emergency bedside echocardiography, including 268 cases of patent ductus arteriosus （232 premature and 36 term infants）, 115 congenital heart disease, 99 persistent fetal circulation and 25 arrythmia. Surgeries were performed on 54 infants and invasive therapy was performed on one infant, and none of them received CT, magnetic resonance imaging or invasive examinations before operation; among which, 51 surgeries suecessed and 4 infants died. Other 452 infants were treated with medications, 392 infants recovered and discharged, 26 infants did not recover, 14 cases died and 20 cases left the hospital before recovery. The accuracy rate of Micromax 1 portable ultrasound in diagnosing congenital heart diseases was 94.5 % （52/55）, while 96.4%（53/55） for philips iE33 ultrasonic systems. Conclusions Emergency bedside-echocardiography could provide instant and valuable information of cardiovascular system, which would be helpful in making quick clinical decisions.
出处
《中华围产医学杂志》
CAS
北大核心
2012年第12期727-731,共5页
Chinese Journal of Perinatal Medicine
