385例胎儿先天性心脏病围生结局及预后分析

Perinatal outcomes and prognosis analysis of 385 fetuses with congenital heart disease

目的探讨各种胎儿先天性心脏病的围生儿结局和预后,为妇幼信息上报、产前咨询、产后处理提供依据。方法回顾分析2013年度在深圳市龙岗区产前和(或)产后经多普勒彩色超声心动图检查诊断为胎儿先天性心脏病,并通过妇幼信息系统上报的385例的病历资料,并对出生1年后的情况进行随访。结果深圳市龙岗区的胎儿先天性心脏病的发病率为0.89%,其中简单型先天性心脏病占73.77%,复杂性先天性心脏病占26.23%。83.90%病例确诊时间为产后;复杂型先心病的孕期发现率要高于简单型先心病,差异有统计学意义(x^2=119.86,P<0.01)。385例先心病结局为:引产60例,死产1例,7天内死亡3例,活产321例(其中含3例7天后死亡),存活率为83.38%;简单型先心病存活率显著高于复杂性先心病的存活率,差异有统计学意义(x^2=119.46,P<0.01)。追踪随访活产儿282例,随访率87.85%,其中51例预后较差,占随访病例的18.09%。结论深圳市龙岗区胎儿先天性心脏病以简单型为主,确诊时间主要为产后,产前诊断率较低,不利于进行早期干预,因此提高产前诊断技术,在妊娠期尽早发现和确诊胎儿先天性心脏病,尤其是复杂性先心病,能获得更好的预后。

Objective To explore the perinatal outcomes and prognosis of various congenital heart diseases （CHD） and to provide evidence for MCH information report, prenatal counseling and postpartum treatment of CHD. Methods A retrospective analysis was conducted on clinical data of 385 fetuses diagnosed with CHD by prenatal and （or） postpartum color eehoeardiography and reported through maternal and child information system in Longgang District in 2013, and the cases were followed up for one year after birth. Results The incidence rate of CHD in Longgang District was 0.89% , including 73.77% of simple type of CHD and 26.23% of complex CHD. Of the eases 83.90% were finally diagnosed after birth. The detection rate of complex CHD was higher than simple CHD with statistical signifieanee （X2 = 119.86 ,P 〈 0.01 ）. There were 60 cases of abortion, 1 case of stillbirth, 3 dead eases within 7 days, and 321 eases of live birth （ of which 3 cases died after 7 days ） , and the survival rate was 83.38%. The survival rate of simple CHD was significantly higher than that of complex CHD, and the difference was significant （X2 = 119.46, P 〈 0.01 ）. Totally 282 eases were followed up and the follow-up rate was 87.85% , and the results showed there were 51 cases with poor prognosis, which accounted for 18.09% of all follow-up cases. Conclusion Simple CHD is the main reported CHD, and most of cases are diagnosed after birth. Prenatal diagnostie rate is low, whieh is not beneficial for early intervention. Therefore, improving prenatal diagnostic technique and detecting and diagnosing CHD at pregnancy, especially complex CHD can obtain better prognosis.