宁波市新生儿先天性心脏病筛查方案优化的研究及应用

发布时间：2018-05-25 13:54

本文选题：先天性心脏病 + 经皮血氧饱和度　；参考：《宁波大学》2017年硕士论文

【摘要】：目的:探讨宁波市新生儿先天性心脏病筛查最优方案,了解宁波市新生儿先天性心脏病的流行病学分布情况。方法:1、将宁波市妇女儿童医院2011年7月至2015年12月符合筛查条件的48007名活产新生儿纳入筛查对象,先后利用经皮血氧饱和度结合不同临床评估指标的三种筛查方法进行筛查,逐步优化筛查方法,得出最佳筛查方案;2、对纳入筛查的新生儿进行3~12个月的随访观察,最终确定宁波市新生儿先天性心脏病流行病学分布情况。结果:1、2011年7月至2012年12月利用经皮血氧饱和度结合六项临床评估指标(先心病家族史、心脏杂音、呼吸困难、青紫、特殊面容、其他系统先天性畸形)的“七项筛查法”筛查新生儿18352例,筛查结果阳性246例中确诊先心病109例,阳性确诊率44.31%,对所有先心病/危重先心病的灵敏度、特异度、假阳性率、阳性预测值、阴性预测值分别为63.74%/86.67%、99.25%/98.73%、0.75%/1.27%、44.31%/5.28%、99.66%/99.99%,筛选出三项最佳指标:经皮血氧饱和度、特殊面容、心脏杂音;2、2013年1月至2014年6月利用“三项筛查法(经皮血氧饱和度+特殊面容+心脏杂音)”筛查新生儿13041例,筛查结果阳性125例中确诊先心病73例,阳性确诊率58.40%,对于所有先心病/危重先心病的灵敏度、特异度、假阳性率、阳性预测值、阴性预测值分别为62.93%/90.91%、99.60%/99.12%、0.40%/0.88%、58.40%/8.00%、99.67%/99.99%;经皮血氧饱和度结合心脏杂音两项指标在筛查先心病方面具备与三项指标相同的灵敏度,且假阳性率更低;3、2014年7月至2015年12月利用“两项筛查法(经皮血氧饱和度+心脏杂音)”筛查新生儿16614例,筛查结果阳性131例中确诊先心病97例,确诊阳性率74.05%,对于所有先心病/危重先心病的灵敏度、特异度、假阳性率、阳性预测值、阴性预测值分别为62.58%/92.86%、99.79%/99.29%、0.21%/0.71%、74.05%/9.92%、99.65%/99.99%;4、2011年7月至2015年12月48007例新生儿中,共确诊先天性心脏病患儿442例,总检出率0.92%。其中,室间隔缺损患儿共192例(43.44%),动脉导管未闭患儿共111例(25.11%),房间隔缺损患儿共95例(21.49%),以上三种先心病患儿占确诊先心病总数的90.05%。在442例先心病中,一般先心病402例,占确诊先心病的90.95%,总检出率0.84%;危重先心病患儿共40例,占确诊先心病的9.05%,总检出率为0.08%。5、胎龄、出生体重、母亲学历、母亲疾病史、家族疾病史及单胎/多胎不同的新生儿先心病发病率有统计学差异(P0.05),性别、城镇/农村不同的新生儿先心病发病率无统计学差异(P0.05)。6、3~12个月的随访结果显示,室间隔缺损自愈率23.44%,房间隔缺损自愈率31.58%,动脉导管未闭自愈率32.43%,先天性心脏病总自愈率25.11%。患儿出生一年内最先自愈的是动脉导管未闭,其次是房间隔缺损、室间隔缺损。结论:1、本研究逐步由七项筛查指标优化至三项筛查指标,最终优化至两项筛查指标,通过大样本实验验证,“两项筛查法(经皮血氧饱和度95%+心脏杂音)”对于早期发现新生儿先天性心脏病具有重要意义,可以替代“七项筛查法”及“三项筛查法”,不仅具有较高的灵敏度,且具有更高的特异度,更低的假阳性率,是有效的、值得宁波市推广普及的最佳的先心病筛查方案。2、宁波地区新生儿先天性心脏病的发病率略高,为0.92%。3、宁波地区新生儿先心病主要类型中室间隔缺损检出率最高,其次为动脉导管未闭、房间隔缺损;危重先心病中检出率最高的是大房缺合并大室缺和法洛四连症。4、早产、低出生体重、母亲高学历、母亲疾病史、家族疾病史及多胎均是先心病发病的危险因素。5、先心病总自愈率25.11%,影响先心病自愈的因素很多,现有资料结果示宁波地区先心病患儿出生一年内自愈率先后顺序为:动脉导管未闭、房间隔缺损、室间隔缺损。
[Abstract]:Objective: To explore the optimal scheme of neonatal congenital heart disease screening in Ningbo, and to understand the epidemiological distribution of congenital heart disease in Ningbo. Method: 1, 48007 live births in Ningbo women's and children's Hospital from July 2011 to December 2015 were included in the screening subjects, and the percutaneous oxygen saturation was used successively. Three screening methods combined with different clinical evaluation indexes were screened, the screening method was optimized gradually, and the best screening scheme was obtained. 2, the follow-up observation of the newborns included in the screening was carried out for 3~12 months, and the epidemiological distribution of neonatal congenital heart disease in Ningbo was determined. The results were: from July 12011 to December 2012, percutaneous blood was used. The oxygen saturation combined with six clinical evaluation indexes (family history of congenital heart disease, heart murmur, dyspnea, purple, special face, and other congenital malformations) in the screening of 18352 newborns with "seven screening methods", 109 cases of congenital heart disease in 246 cases, 44.31% of positive diagnosis, and sensitive to all congenital heart disease / critical congenital heart disease. The degree, specificity, false positive rate, positive predictive value, negative predictive value were 63.74%/86.67%, 99.25%/98.73%, 0.75%/1.27%, 44.31%/5.28%, 99.66%/99.99%, and three best indexes were selected: percutaneous oxygen saturation, special face, heart murmur; from January 22013 to June 2014, using "three screening methods (percutaneous oxygen saturation + special face volume +) +. 13041 newborns were screened by heart murmur, and 73 cases of congenital heart disease were confirmed in 125 cases with positive screening results. The positive rate of diagnosis was 58.40%. The sensitivity, specificity, false positive rate, positive predictive value and negative predictive value for all congenital heart disease / critical congenital heart disease were 62.93%/90.91%, 99.60%/99.12%, 0.40%/0.88%, 58.40%/8.00%, 99.67%/99.99%, and percutaneous blood. The two indexes of oxygen saturation combined with heart murmur have the same sensitivity as three indexes in screening the congenital heart disease, and the false positive rate is lower. From July 32014 to December 2015, 16614 cases of newborn were screened by "two screening methods (percutaneous oxygen saturation + heart murmur)", and 97 cases of congenital heart disease diagnosed in 131 cases were confirmed. The positive rate was 74.05%. The sensitivity, specificity, false positive rate, positive predictive value, negative predictive value and negative predictive value were 62.58%/92.86%, 99.79%/99.29%, 0.21%/0.71%, 74.05%/9.92%, 99.65%/99.99% for all congenital heart disease / critical heart disease, and 442 cases of congenital heart disease were diagnosed in 48007 cases from July 42011 to December 2015, the total detection rate was 0.. In 92%., there were 192 cases (43.44%) with ventricular septal defect, 111 cases (25.11%) in children with patent ductus arteriosus, 95 cases of atrial septal defect (21.49%), and three kinds of congenital heart disease in 442 cases with congenital heart disease in 442 cases of congenital heart disease, including 402 cases of congenital heart disease, 90.95% of diagnosed congenital heart disease, the total detection rate 0.84%, critical congenital heart disease. A total of 40 children, accounting for 9.05% of the diagnosis of congenital heart disease, the total detection rate was 0.08%.5, gestational age, birth weight, mother's education, mother's disease history, family history of disease and single fetal / multi fetal congenital heart disease incidence rate was statistically different (P0.05), sex, urban / rural different neonatal congenital heart disease incidence was not statistically different (P0.05).6,3~12 months The follow-up results showed that the self healing rate of ventricular septal defect was 23.44%, the self healing rate of atrial septal defect was 31.58%, the self healing rate of patent ductus arteriosus was 32.43%. The first self healing rate of 25.11%. in children with congenital heart disease was patent ductus arteriosus, atrial septal defect and ventricular septal defect. Conclusion: 1, this study was gradually made up of seven screening indicators. It is optimized to three screening indicators and finally optimized to two screening indicators. Through large sample experiments, the "two screening methods (95%+ heart murmurs)" is of great significance for early detection of neonatal congenital heart disease, which can be replaced by "seven screening methods" and "three screening methods", not only with high sensitivity. Degree, with higher specificity and lower false positive rate, is effective. It is worth the best screening program for congenital heart disease (.2) to popularize and popularize in Ningbo. The incidence of neonatal congenital heart disease in Ningbo is slightly higher, which is 0.92%.3. The detection rate of ventricular septal defect in the main types of congenital heart disease in Ningbo is the highest, followed by the patent ductus arteriosus The highest detection rate in critical congenital heart disease was large atrial deficiency combined with large ventricular deficiency and tetralogy of Fallot,.4, preterm birth, low birth weight, mother's high education, mother's disease history, family history and multiple births were risk factors of congenital heart disease.5, the total self healing rate of congenital heart disease was 25.11%, and there were many factors affecting the self healing of congenital heart disease. The results showed that the self-healing rate of children with congenital heart disease in Ningbo within one year was: patent ductus arteriosus, atrial septal defect and ventricular septal defect.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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