经皮血氧饱和度检测结合临床评估筛查新生儿先天性心脏病的可行性研究

Feasibility study of screening for congenital heart disease in neonates by using pulse oximetry combined with clinical assessment

目的探讨应用经皮血氧饱和度检测(POX)结合临床评估(先心病家族史、特殊面容、心脏杂音、其他先天畸形)的方法筛查先天性心脏病(先心病)的可行性与可靠性。方法对2011年8月1日至2014年12月31日在昆山市所有产科医院出生的所有新生儿(出生后0~7d)进行先天性心脏病的初筛,筛查阳性(POX阳性或者临床评估阳性)的新生儿用彩色多普勒超声心动图进行确定诊断;假阴性结果通过临床随访和家长反馈获得。分别计算POX筛查结合其他临床评估方法筛查的灵敏度、特异度、阳性/阴性预测值、阳性/阴性似然比,并进行比较。结果本研究共筛查62 000名新生儿,检出先心患儿539例。POX结合临床评估筛查先心病的灵敏度为93%(95%CI:86.4%~95.4%),特异度为94.3%(95%CI:85.6%~96.0%),约登指数为0.87。结论 POX结合临床评估的方法筛查先天性心脏病灵敏度和特异度较高,可行性强。而临床评估以心脏杂音为主作为筛查手段,这种简便精确的方法适用于基层单位对新生儿先心病的筛查。

Objective To evaluate the feasibility and reliability of screening for congenital heart disease （CHD） in new- born by using percutaneous oxygen saturation detection （POX） combined with clinical assessment. Methods Screening for CHD within 7 days after birth was performed in 62 000 newborns from August,2011 to December,2014 in Kunshan cit- y. The suspected cases were finally diagnosed by Color Doppler echocardiography and were followed up regularly after dis- charge. Indexes including sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were calculated and compared. Results Among 62 000 newborns,539 cases were diagnosed with CHD. The sensitivity of pox screening combined with clinical assessment of congenital heart disease was 93 - （95 % CI：86.4 % - 95.4 % ）, the specificity was 94.3 - （95 - CI：85.6 % - 96.0 % ）, and the Youden index was 0.87. Conclusions POX combined with clinical evalua- tion for screening congenital heart disease is of high sensitivity and specificity. Cunent clinical assessment mainly use heart murmur as a screening tool,which is simple and accurate and is suitable for grassroots units to screen for newborns congeni- tal heart disease screening.