高原地区新生儿复杂性先天性心脏病筛查中检测血氧饱和度的临床价值分析

Analysis on clinical value of blood oxygen saturation detection in screening of neonatal complex congenital heart disease in plateau area

目的分析高原地区新生儿复杂性先天性心脏病(CCHD)筛查中检测血氧饱和度(POX)的临床价值。方法选择2016年3月-2017年10月于甘孜州人民医院妇产科分娩并入住新生儿科的新生儿331例,新生儿出生后均行POX测定,并在住院期间同时行心脏CT或心脏彩超检查确诊是否患有先天性心脏病(CHD)及其类型,根据诊断结果分为正常新生儿组(132例)、单纯性CHD组(83例)和CCHD组(116例)。比较3组新生儿体格检查和POX检测结果。结果 3组新生儿的性别差异不具有统计学意义(P>0. 05)。单纯性CHD组新生儿的孕周、体质量均显著低于正常新生儿组(P<0. 05); CCHD组新生儿POX显著低于正常新生儿组(P<0. 05); CCHD组新生儿的孕周、体质量、POX与单纯性CHD组比较差异均有统计学意义(均P<0. 05)。POX筛查诊断CHD的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为73. 87%、42. 42%、67. 37%、72. 41%、59. 38%。POX筛查诊断CCHD的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为82. 76%、38. 55%、64. 32%、65. 31%、61. 54%。116例CCHD患儿中,96例(82. 76%)患儿POX≤95%,20例(17. 24%)患儿POX>95%; 48例(41. 38%)患儿经临床特征及查体诊断为阳性,68例(58. 62%)患儿经临床特征及查体诊断为阴性。结论高原地区绝大部分CCHD患儿POX≤95%,POX筛查简单、方便、无创,可作为筛查CCHD的辅助手段,临床广泛应用可能有助于减少CCHD的漏诊率。

Objective To analyze the clinical value of blood oxygen saturation( POX) detection in screening of neonatal complex congenital heart disease( CCHD) in plateau area. Methods A total of 331 neonates born in Department of Gynecology and Obstetrics in People’s Hospital of Ganzi Tibetan Autonomous Prefecture from March 2016 to October 2017 were selected as study object from Department of Neonatology,POX detection was performed after birth,cardiac CT or cardiac color ultrasonography were performed during hospitalization to confirm complicating with congenital heart disease( CHD) or not and the types. The neonates were divided into normal neonate group( 132 neonates),simple CHD group( 83 neonates),and CCHD group( 116 neonates) according to the diagnostic results. The results of physical examination and POX detection in the three groups were compared. Results There was no statistically significant difference in gender of neonates among the three groups( P>0. 05). Gestational week and weight of neonates in simple CHD group were statistically significantly lower than those in normal neonate group( P<0. 05). POX of neonates in CCHD group was statistically significantly lower than that in normal neonate group( P<0. 05). There were statistically significant differences in gestational week,weight,POX of neonates between CCHD group and simple CHD group( P<0. 05). The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of POX screening in diagnosis of CHD were 73. 87%,42. 42%,67. 37%,72. 41%,and 59. 38%,respectively. The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of POX screening in diagnosis of CCHD were 82. 76%,38. 55%,64. 32%,65. 31%,and 61. 54%,respectively. Among 116 CCHD neonates,POX≤95% was observed in 96 neonates( 82. 76%),POX>95% was observed in 20 neonates( 17. 24%);48 positive neonates( 41. 38%) were diagnosed by clinical features and physical examination,and 68 negative neonates( 58. 62%) were diagnosed by clinical features and physical examination. Conclusion POX≤95% was observed in most CCHD neonates,POX screening is simple,convenient,and noninvasive,it can be used as an auxiliary means of screening CCHD,wide clinical application of POX screening can reduce the rate of missed diagnosis of CCHD.