新生儿先天性心脏病186例分析及部分随访

Clinical analysis and partial follow-up of 186 neonates with congenital heart disease

目的探讨新生儿先天性心脏病(先心病)的诊治经验,以便更好地与家长沟通配合治疗及随访。方法回顾性分析重医儿童医院新生儿病房1999年1月～12月收治的186例新生儿先天性心脏病的类型、临床特点及并发症,52例随访其转归。结果新生儿期严重的先天性心脏病及复合畸形多见,常表现为气急、青紫及心衰,常合并难治性肺炎,预后差,而单纯性房间隔缺损或室间隔缺损部分有望自愈。结论新生儿先心病杂音常有不典型,不稳定的特点,严重复合畸形及心衰的患儿可以听不到杂音,不能因听不到杂音而排除先心病的存在。新生儿先心病合并心衰时以洋地黄类药物为首选,一般有流出道梗阻的先心病禁用洋地黄,严重复合畸形宜早期采用介入治疗、早期手术。

Objective:To discuss the clinical experience of treating neonates' congenital heart disease,in order to encourage the neonates' parents' cooperation with doctors and following up in time.Methods:One hundred and eighty-six neonates with congenital heart disease in our ward from Jannuary to December 1999,were retrospectively analyzed,such as their clinical characteristics and complications,fifty-two cases of which were followed up.Results:In neonatal phase,severe congenital heart disease and combined anomalies often occur,and the patients usually appear tachypnea,cyanosis,heart failure,and often complicate refractory pneumonia with poor prognosis.Some of simple ASD (atrial septum defect)or VSD (vetride septum defect) may recover without treating.Conclusion:Heart murmur of neonatal congenital heart disease is usually atypical and unstable.However,severe combined anomalies and heart failure may not show murmur which couldn't exclude congenital heart diseases,A kind of digitalis is the fist line drug for neonatal congenital heart disease with heart failure,which should be prohibited when out-following tract obstruction.Severe combined anomalies should be given intervention therapy or early operation.