新生儿先天性心脏病385例彩色多普勒超声诊断及其临床意义

Diagnosis of 385 Cases of Neonatal Congenital Heart Disease by Color Doppler Echocardiography and It's Clinical Significance

目的 研究新生儿先天性心脏病 (简称先心病 )的类型并判断其预后 ,以提出减少发病及死亡的对策。 方法 分析 1991～ 1999年新生儿先心病 385例的彩色多普勒超声特点 ,并对 87例非青紫先心病进行随访 2个月～ 7年 ,观察其预后。 结果 本组病例常见类型的顺位是 :左向右分流畸形 (6 9.4% ) ,大动脉转位 (10 .4% ) ,肺动脉出口梗阻 (6 .2 % ) ,左室出口梗阻 (4 .4% ) ,肺静脉连接异常(3.6 % )。新生儿期住院的 335例中 ,16 0例 (4 7.8% )是在生后 1周内入院 ,335例中重症先心病 5 0例(14.9% )。本组病例死亡及抢救无望家长放弃者共 79例 (2 1% ) ,其中 47%出生日龄在 1周内 ,重症先心病中大动脉转位、左心发育不良、肺动脉狭窄或闭锁发病及死亡均早 ,死亡及放弃中以大动脉转位占首位 (33% )。室间隔缺损≤ 3m m者 ,经随访 6 5 %自然关闭 ;而≥ 6 m m者中 ,仍未闭或经手术矫治共占 92 % ,此组病例 5 1%合并肺动脉高压。房间隔缺损 5～ 6 mm者 ,经随访 6 0 %自然关闭 ;7～ 10 mm者 ,6 7%未闭 ,33%手术。动脉导管未闭 >5 mm者 10 0 %手术。 结论 为减少先心病的发病和减少死亡 ,应重视胎儿心脏超声检查 ,早期发现重症先心病及时终止妊娠 ;生后对先心病也应早做超声诊断 ,发现重症及早外科治疗 ,轻者定?

Objective To study the classification of neonatal congenital heart disease(NCHD)and the evaluation of the prognosis, to decrease the incidence and motality of NCHD. Methods 385 cases of NCHD diagnosed by color doppler echocardiography from 1991 through 1999 were studied for classification, and 87 cases followed up for 2 months to 7 years to evaluate the prognosis. Results The most common NCHD were left to right shunts (69.4%), transposition of great arteries(TGA,10.4%), pulmonary obstruction(PO,6.2%), left ventricular outflow obstruction (4.4%), and total anomalous pulmonary venous connection(TAPVC,3.6%). 47 8% cases were admitted within 7 days of life(160/335 cases of neonatal inpatients). 23.6%(79/385 cases) of them died,47% occurred within 7 days of life, TGA was the most common disease,(33%). The most critically ill NCHD were TGA, left heart hypoplasia and PO, the onset and death of them were all in the early days of life. The prognosis were better for CHDs with left to right shunts. Ventricular septal defect ≤3 mm in diameter were closed spontaneously in 65%, while that of ≥6 mm were unclosed or had surgery done in 92%, and 51% complicated with pulmonary hypertension. Atrial septal defect(secundum) of 5~6 mm were closed spontaneously in 60%, that of 7~10 mm were unclosed in 67%, and had surgery done in 33%. Patent ductus arteriosus of >5 mm had surgery in 100%. Conclusion Most severe CHD could be detected prenatally by fetal echocardiography, and the pregnancy should be terminated. The critical NCHD should be diagnosed by echocardiography for corrective or palliative surgery as early as possible in the first days of life. In mild cases of left to right shunts may close spontaneously, they should be followed up regularly.