深圳市新生儿先心病出生监测和绿色通道的建立

Abstract

目的：了解深圳市先心病发病率，初步建立先心病救治绿色通道管理系统。方法：筛查2016年上半年在深圳市部分辖区内妇幼医院连续分娩的新生活产婴儿。如果临床表现和经皮血氧饱和度的测定结果提示有先心病可能者推荐为继续做超声心动图检查。对于重症先心病病例，通过绿色通道转诊至先心病诊疗终端医院进行相应的干预、治疗。结果：三家医院连续分娩14,221名活产新生儿，其中男孩53.2% (7566例)，女孩46.8% (6655例)；足月儿95.8%，早产儿(<孕37周) 4.2%。平均出生体重3310 ± 460 g，超声心动图检查的平均时间为生后47小时(2~97小时)。共诊断先心病患儿138名(男孩41.3%，女孩58.7%)，发病率9.7‰ (138/14221)，其中轻症先心病约占2/3 (92/138)。最常见的先心病为VSD (6.3‰)，其中肌部缺损占将近2/3，其次是ASD (2.3‰)、PDA (0.5‰)。在所有先心病患儿中，61例(44.2%)患儿通过心脏杂音检出，提示新生儿期间许多先心病没有杂音，故不能单独依靠心脏听诊来区分是否存在先心病。有2例重症先心病患儿于新生儿期进行手术矫治。4例于婴儿期行矫治术。结论：本研究初步明确深圳市先心病的发病率为9.7‰，对重症先心病开通了先心病诊疗的绿色通道系统。 Objective: To study the morbidity of congenital heart disease (CHD) in Shenzhen, establish a green channel system of CHD management. Methods: Live birth babies were monitored for CHD screening in 3 women and children hospitals in Shenzhen. Echocardiography was recommended if a baby had suspicious CHD clinical manifestation and/or low oxyhemoglobin saturation. Severe CHD cases were transferred through green channel system to terminal CHD diagnosis and treatment hospital for further management and intervention. Results: Continuous partal 14,221 live babies in the first half year of 2016 were monitored with 7566 male babies and 6655 female babies. CHD diagnoses were established in 138 cases (male 41.3%, female 58.7%). The morbidity of CHD was 9.7‰ (138/14221). Most CHD cases were mild (92/138). The most common CHD was ventricular septal defect (6.3‰), secondly atrial septal defect (2.3‰), the third patent ductus arteriosus (0.5‰). Heart murmurs were found only in 61 babies. That meant many CHD babies had no heart murmurs in the newborn period. So CHD diagnosis in this period didn’t rely on heart murmurs only. Surgical procedure was implemented among two severe babies in the newborn period, 4 cases in infant period. Conclusion: The study preliminarily reveals that the morbidity of CHD in Shenzhen is 9.7‰. The green channel system is helpful to CHD management.