心脏杂音和POX在先心病筛查中的作用

The Role of Heart Murmur and Pulse Oximetry in the Screening of Congenital Heart Disease

目的:探讨心脏杂音听诊和经皮血氧饱和度测定(POX)在新生儿先天性心脏病(CHD)筛查中的作用。方法:选取2016年1月-2017年12月本院产科出生的活产新生儿5564例为临床研究对象进行CHD初筛,筛查阳性病例均给予超声心动图检查作为诊断金标准,评价心脏杂音听诊和POX对CHD诊断的灵敏度、特异度、正确指数、似然比、符合率和预测值。结果:1146例筛查阳性,心脏杂音灵敏度为95.00%,特异度为17.40%;POX异常灵敏度为13.33%,特异度为97.42%;心脏杂音+POX异常的特异度、阳性似然比、符合率及阳性预测值均高于心脏杂音、POX异常,而灵敏度低于心脏杂音、POX异常。结论:心脏杂音联合POX可以准确和快速地筛查新生儿CHD。对筛查可疑CHD病例行超声心动检查,可早期发现和诊断CHD,提供有效干预的时机,可以降低新生儿死亡率和提高新生儿生存质量。

Objective:To investigate the role of heart murmur and pulse oximetry(POX)in the screening of neonatal congenital heart disease(CHD).Method:A total of 5564 live birth neonatal in obstetrics from January 2016 to December 2017 were selected as clinical subjects for CHD preliminary screening,screening positive cases were all given echocardiography as the gold standard for diagnosis.The sensitivity,specificity,correct index,likelihood ratio,coincidence rate and predictive value of heart murmur auscultation and POX in diagnosis of CHD were evaluated.Result:1146 cases were screened positive.The sensitivity was 95.00%and the specificity was 17.40%of heart murmur.The sensitivity was 13.33%and the specificity was 97.42%of the abnormality of POX.The specificity,positive likelihood ratio,coincidence rate and positive predictive value of heart murmur+POX abnormalities were all higher than those of heart murmur and POX abnormalities,but the sensitivity were lower than those of heart murmur and POX abnormalities.Conclusion:Heart murmur combined with POX can accurately and rapidly screen neonatal CHD.The screening suspected CHD cases for echocardiography can early detection and diagnosis of CHD,provide an opportunity for effective intervention,which can reduce neonatal mortality and improve neonatal quality of life.