期刊文献+

胎儿先天性心脏病分娩风险分级在产前产后一体化诊治策略中的作用 被引量:9

Effects of delivery classification scale for fetal cardiac disease on the prenatal and postnatal integrated treatment strategies
原文传递
导出
摘要 目的 回顾性分析胎儿先天性心脏病(先心病)分娩风险分级在先心病产前诊断、产后治疗一体化策略中的作用.方法 依据美国费城儿童医院胎儿先心病分娩风险分级:Ⅰ级,分娩后血流动力学稳定的胎儿先心病;Ⅱ级,分娩后依赖动脉导管的胎儿心脏畸形;Ⅲ级,分娩后具有血流动力学不稳定高风险的胎儿先心病;IMPACT(分娩时立即心脏干预)级,脱离胎盘循环后血流动力学不稳定的胎儿心脏畸形.2006年8月至2010年5月,46例产前诊断先心病胎儿,其中Ⅰ级33例,Ⅱ级9例,Ⅲ级4例,无IMPACT级胎儿.结果 分娩男婴39例,女婴7例,平均胎龄(38.0±1.4)孕周.出生后1周内,13例患儿接受心脏干预治疗,包括Ⅰ级2例、Ⅱ级7例、Ⅲ级4例,死亡1例.婴儿期心脏干预治疗7例,包括Ⅰ级5例,Ⅱ级2例,死亡1例.余26例Ⅰ级患儿随访到幼儿和学龄前期,外科手术7例,介入治疗17例,自愈2例,无死亡.结论 胎儿先心病分娩风险分级将有利于细化产前诊断先心病胎儿出生后的治疗策略,使产前、产后一体化诊治的衔接更为紧密.其中产前确定的Ⅰ级胎儿大部分不需要过早的心脏干预治疗,Ⅱ级和Ⅲ级胎儿需要在新生儿科的配合下开展早期心脏治疗. Objective To explore the effects of delivery classification scale for fetal cardiac disease on the prenatal and postnatal integrated treatment strategies.Methods Delivery classification scale for fetal cardiac disease included:grade Ⅰ,no hemodynamics instability; grade Ⅱ,ducted-dependent lesions,stable hemodynamics anticipated;grade Ⅲ,possibility or likelihood of hemodynamic instability; IMPACT(delivery immediately heart intervention) level,hemodynamic instability is anticipated at separation from placental circulation.During August 2006 to May 2010,a retrospective study of 46 cases of prenatal diagnosis of congenital heart disease and delivery in one cardiac center was taken,in which 33 in grade Ⅰ,9 in grade Ⅱ,4 in grade Ⅲ,and no IMPACT.Results Thirty-nine boys and 7 girls were born at (38.0 ± 1.4) weeks of gestation and had consistent fetal diagnoses of mainly cardiac abnormalities with postnatal screen.Thirteen neonates underwent cardiac intervention within one week after birth with one death,including 2 in grade Ⅰ,7 in grade Ⅱ,4 in grade Ⅲ,of them 1 death.Seven infants including 5 in grade Ⅰ and 2 in grade Ⅱ underwent cardiac intervention with one death.The remaining 26 children in grade Ⅰ had uneventfully outcomes,in which 7 cases of surgical operation,17 cases of interventional therapy,2 cases of spontaneous healing.Conclusion Delivery classification scale for fetal cardiac disease should have some guiding significance for early treatment strategies and could enhance closely integration of prenatal diagnosis and postnatal treatment.The most fetuses in grade Ⅰ need not undergo cardiac interventions in neonatal stage.However,early cardiac intervention for fetuses in grade Ⅱ and Ⅲ should be carried out postnatally with the help of neonatologists.
出处 《中华胸心血管外科杂志》 CSCD 2015年第3期145-147,共3页 Chinese Journal of Thoracic and Cardiovascular Surgery
基金 “十二五”国家科技支撑计划课题(2011BAI11B22)
关键词 胎儿 先天性心脏病 分娩风险 治疗策略 Fetus Congenital heart disease Delivery risk Treatment strategies
  • 相关文献

参考文献6

  • 1潘微,周成斌,张智伟,陈寄梅,李渝芬,何少茹,韩凤珍,庄建.胎儿先天性心脏病产前诊断与生后治疗一体化模式的探讨[J].中华小儿外科杂志,2012,33(8):561-564. 被引量:8
  • 2Rychik J. Prenatal practice care model and delivery of the fetus with cardiovascular disease. //Rychik J, Tian Z. Fetal cardiovascular im- aging: a disease-based approach [ M 1. Philadelphia : Elsevier Inc. , 2012.
  • 3Tulzer G, Arzt W. Fetal cardiac interventions: rationale, risk and benefit[J]. Semin Fetal Neonatal Med, 2013, 18 (5): 298-301. doi : 10. lO16/j, siny. 2013.04. 002.
  • 4周成斌,陈寄梅,庄建,张智伟,潘微,何少茹,韩凤珍.产前产后一体化诊治大动脉转位畸形5例[J].中华胸心血管外科杂志,2011,27(7):409-411. 被引量:7
  • 5Trento LU, Pruetz JD, Chang RK, et al. Prenatal diagnosis of congen- ital heart disease: impact of mode of delivery on neonatal outcome [ J ]. Prenat Diagn,2012, 32 ( 13 ) : 1250-1255. doi: 10. 1002/pd. 3991.
  • 6Trines J, Fruitman D,Zuo K J, et al. Effectiveness of prenatal screen- ing for congenital heart disease : assessment in a jurisdiction with uni- versal access to health care[J]. Can J Cardiol,2013, 29(7) : 879- 885. doi: 10. 1016/j. cjca. 2013.0g. 028.

二级参考文献9

共引文献13

同被引文献61

引证文献9

二级引证文献108

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部