经皮脉搏血氧饱和度测定联合病史收集体格检查筛查新生儿主要先天性心脏病

Percutaneous Pulse Oximetry Combined with Medical History to Collect Physical Examination Screening Newborn Neonatal Congenital Heart Disease

目的探讨经皮脉搏血氧饱和度测定联合病史收集、体格检查在筛查新生儿先天性心脏病的临床应用价值。方法选取该院2015年7月-2017年7月产科分娩且住院满3 d,由专科医师询问病史完善体检、完成3 d血氧饱和度检测、完善心超检查的共2044例新生儿纳入该研究,以心超检查为诊断新生儿先天性心脏病的金标准。分析病史体检、脉搏血氧饱和度测定和联合评估时的灵敏度、特异度、假阴性率、假阳性率、似然比、预测值和约登指数。结果联合筛查的灵敏度为94.4%,特异度为99.7%,假阳性率为0.4%,假阴性率为5.6%,阳性似然比为314.7,阴性似然比为0.1,阳性预测值为68.0%,阴性预测值为99.9%,约登指数为94.1。联合筛查的灵敏度、特异度、阳性似然比、阳性预测值、阴性预测值和约登指数均高于病史体检筛查与POS筛查,假阳性率、假阴性率、阴性似然比明显低于病史体格检查筛查和POS筛查。结论经皮脉搏血氧饱和度测定联合病史收集、体格检查是新生儿CHD可行、可靠、有效的筛查方法,同时操作简单,具有较好的经济效益,值得在县级及以下基层医院广泛推广。

Objective To investigate the clinical application value of percutaneous pulse oximetry combined with medical history collection and physical examination in screening neonatal congenital heart disease.Methods A total of 2044 newborns were enrolled in the hospital from July 2015 to July 2017 and were hospitalized for three days,medical history examination,3-day blood oxygen saturation test and echocardiography examination were completed by specialists.Echocardiography was taken as the gold standard for the diagnosis of neonatal congenital heart disease.Analyze the sensitivity,specificity,false-negative rate,false-positive rate,likelihood ratio,predictive value and yoden index during the history of physical examination,pulse oximetry and joint assessment.Results The sensitivity of joint screening was94.4%,the specificity was 99.7%,the false positive rate was 0.4%,the false negative rate was 5.6%,the positive likelihood ratio was 314.7,the negative likelihood ratio was 0.1,and the positive predictive value was 68.0%,the negative predictive value is 99.9%,and the Yoden index is 94.1.The sensitivity,specificity,positive likelihood ratio,positive predictive value,negative predictive value and Yueden’s index of joint screening were higher than the medical history screening and POS screening,and the false positive rate,false negative rate and negative likelihood ratio were significantly lower than that of physical examination screening and POS screening.Conclusion Percutaneous pulse oximetry combined with medical history collection and physical examination is a feasible,reliable and effective screening method for neonatal CHD.Simultaneous operation is simple and has good economic benefits.It is worthy of extensive use in county-level and below primary hospitals.