围生期先天性心脏病的发生趋势及产前诊断

Trends in epidemiology and prenatal diagnosis of perinatal congenital heart disease

目的为了解围生期先天性心脏病(简称先心病)的发生趋势及产前诊断情况,为制定预防干预措施提供依据。方法选择2家市级医院于2003年10月至2006年9月对医院出生的孕28w至产后7天的围生儿包括活产儿、死胎、死产和治疗性引产儿进行先心病及相关因素监测。结果2003年10月至2006年9月共监测围生儿29589例,发现先心病351例,平均发生率为11.86‰,围生期先心病的发生率呈逐年上升趋势(χ2=29.32,P<0.01),性别发生率无统计学意义。孕母年龄≥30岁组的围生期先心病发生率明显增加,尤其年龄≥35岁组(χ2=24.73,P<0.01)。351例先心病儿中产前诊断20例,占5.97%,主要类型为室间隔缺损伴心脏其它畸形、法洛四联症、完全性房室通道、大血管错位、永存动脉干与左心发育不良等,其中治疗性引产19例。结论开展围生期先心病监测及病因研究,减少先心病的发生,对提高出生人口素质和儿童生存质量有重要意义。重视母亲孕前与孕期干预工作,对有高危因素的孕妇尽早在孕28w前进行产前诊断,提高胎儿心脏超声诊断水平是目前提高先心病早期诊断的关键。

Objective ： To investigate trends in epidemiology and prenatal diagnosis of perinatal congenital heart disease （CHD） in Ningbo so as to provide scientific evidence for taking preventive measures. Methods ： Between October 2003 and September 2006, CHD and its related factors were monitored in all perinatals （from 28 weeks of gestation to a period of 7 days after birth）, who were born in two city level hospitals, including live - births, fetal deathes, still births, and remedial induced deliveries. Results ： A total of 351 cases of CHD were detected in 29559 perinatals from October 2003 to September 2006, the average prevalence was 11. 86 per 1000. Significant difference and increasing time trend were observed in annual prevalence rate during 2003 -2006 （χ^2 = 29. 32, P 〈 0. 001 ）. There was no striking difference of prevalence rates between different sex. Moreover, the prevalence rates of perinatal CHD for maternal age groups over 30 years old were remarkably higher than those under 30 years old, especially the prevalence rate over 35 year maternal age group were the highest of all groups （χ^2 = 24. 73, P 〈 0. 001 ）. Among 351 cases of CHD, 20 were detected by prenatal diagnosis, whose main types were ventricular septal defects association of extracardiac anomalies, tetralogy of Fallot, complete atrioventricular canal defect, malposition of the great arteries, persistent truncus arteriosus and hypoplastic left heart syndrome and 19 were performed remedial induced labor. Conclusion： This study indicated hat conducting CHD surveillance and its etiologic research will have great significance for diminishing the prevalence of CHD, enhancing quality of population, and improving the qualities of life of children. Now we should adopt measures as follows： paying attention to intervention before and during maternal pregnancy, performing prenatal diagnosis as early as possible for gravidas with high - risk factors before 28 weeks of gestation, and improving diagnostic level of fetal echocardiography examination, which are key to improve early diagnosis of CHD.