新生儿先天性心脏病的诊治分析

Diagnosis and Treatment of Neonatal Congenital Heart Disease

目的探讨新生儿先天性心脏病尤其是青紫型先心病的临床症候、治疗和诊断方法。方法回顾分析本院新生儿科近7年收治的164例先天性心脏病患儿住院临床资料。结果①主要畸形类型非青紫型先心病前二位为室间隔缺损(VSD)、房间隔缺损(ASD),青紫型先心病前二位中以肺动脉瓣狭窄(PS)、法洛氏四联症(TOF)最多。②临床表现主要为青紫、呼吸急促、心脏杂音。辅助检查中心脏彩超、血气分析的诊断价值较高。③内科治疗包括强心、利尿、扩血管药物和前列腺素E1(PCE l)的运用。结论新生儿出生后即刻青紫和呼吸困难,经给氧治疗症状不消失,但对刺激反应仍较强,血气示严重低二氧化碳血症与严重低氧血症并存,高度提示紫绀型先心病的可能。尽早明确诊断并给予适当的内外科治疗有助于提高其生存率和改善预后。

Objective To investigate the clinical symptoms, diagnosis and treatment of neonatal congenital heart disease in particular the cyanotic congenital heart disease. Methods The clinical data of 164 neonates with congenital heart disease in neonatal department was analyzed retrospectively. Results ①The top two malformations types of non-cyanotic congenital heart disease were ventricular septal defect（VSD） and atrial septal defect（ ASD ）, and cyanotic congenital heart disease were pulmonary stenosis（PS） and tetralogy of Fallot（TOF）. ②The main clinical manifestations were cyanosis, shortness of breath, cardiac murmur. The color Doppler color ultrasound and blood gas analysis were valuable for the diagnosis in the auxiliary examinations. ③The cardiotonic,diuretic,vasodilator and prostaglandin E1 （PCE1） were administered in the medical treatment. Conclusions If the symptoms of cyanosis and dyspnea appeared soon after the birth don＇ t disappear by the oxygen treatment, but the body response were still strong to stimulus,and the blood gas analysis shows concurrent severe hypocapnia and hypoxemia, the cyanotic congenital heart disease should be supposed. The early diagnosis and appropriate medical treatment can increase the survival rate and improve the prognosis.