新生儿先天性心脏病145例分析

The Clinical Analysis of 145 Cases of Neonatal Congenital Heart Disease

目的 了解新生儿先天性心脏病（简称先心病）的临床特点和预后。 方法 对１９９１年～１９９７年新生儿病房所收治的１４５例先心病进行分析，并随访２４例非青紫型先心病患者３个月～７年。 结果 非青紫型先心病９３例（６４．１％ ），青紫型５２例（３５．９％ ），最常见者依次为室间隔缺损（４４．１）％ 、动脉导管未闭１３．８％ 、大动脉转位（９．７％ ）。１３．１％ 合并有心外畸形，以染色体畸形居首位３１．６％ 。比较青紫型与非青紫型的临床表现（青紫型％ 、非青紫型％ ）：生后２４小时内出现青紫（４２．０％ 、０％ ）、气促（７０．０％ 、５９．０％ ）、心率快（４０．０％ 、２３．０％ ）、心力衰竭（４８．０％ 、１４．０％ ）、心脏杂音（７６．０％ 、８９．０％ ）、低氧血症（８２．６％ 、９．８％ ）、代酸（２１．７％ 、８．５％ ）、住院时的病死率（３６．５％ 、０％ ）、２例青紫型先心病在新生儿期作了手术，放弃治疗（５１．９％ 、１１．８％ ）。随访非青紫型者２４例，２例死亡、５例手术、１２例自愈、５例未愈无合并症。 结论 先心病是婴幼儿死亡的主要原因。现国外已用胎儿超声心动图作产前诊断并对重症终止妊娠。

Objective To review the clinical features and the outcome of 145 cases of neonatal congenital heart disease (NCHD). Methods 145 cases of NCHD in the ward for sick newborn infants from 1991 through 1997 were analyzed. 24 cases of non cyanotic NCHD were followed up for 3 months to 7 years. Results Non cyanotic NCHD were found in 93 cases (64.1%), cyanotic NCHD in 52 cases (35.9%). The most common defects were ventricular septal defect (44.1%), patent ductus arteriosus (13.8%), transposition of great arteries (9.7%) successively. 13.1% NCHD babies had extracardiac anomalies. Chromosomal abnormality was found much higher (31.6%) than others. Compared the percentage of clinical appearance between cyanotic and noncyanotic NCHD (cyanotic vs noncyanotic NCHD), cyanotic in first 24 hours (42% vs 0), tachypnea (70% vs 59%), tachycardia (40% vs 23%), heart failure (48% vs 14%), heart murmur (76% vs 89%), hypoxemia (82.6% vs 9.8%), metabolic acidosis (21.7% vs 8.5%), motality of inpatients (36.5% vs 0), the patients gave up treatment (51.9% vs 11.8%). 2 cases of cyanotic NCHD were operated in neonatal period. 24 cases of noncyanotic NCHD were followed up for 3 months to 7 years. 2 babies died, 5 cases had operation, 12 babies recovered naturally and 5 babies unrecovered but without any complication. Conclusion NCHD is an important cause of death in infancy and childhood. Up to date, most of severe cardiac anormaly has been detected prenatally by fetal echocardiography and resulted in a termination of the pregnancy. This screening program should be extended to all obstetric centers nationwide for the eugenic purpose.