基层医院筛查先天性心脏病模式的探讨

Study on the screening model of congenital heart disease in basic hospital

目的:探讨符合基层医院特点的先天性心脏病筛查体系。方法:选取2017年4月-2019年4月进行产检的20~24周孕妇,常规进行胎儿心脏彩超筛查;婴儿出生后,给予常规体格检查,结合脉搏血氧仪筛查先天性心脏病(CHD)阳性病例;所有新生儿常规行心脏彩超检查(金标准)。评估胎儿心脏彩超、出生后不同筛查手段的真实性及可靠性。结果:共完成新生儿筛查6497例,其中确诊并完成随访的先天性心脏病71例,其中胎儿心脏彩超敏感度为85.9%,特异度为99.8%,阳性预测值为85.9%,阴性预测值为99.8%;单纯脉搏血氧仪筛查敏感度为7.0%,特异度为99.9%,阳性预测值为71.4%,阴性预测值为98.9%;脉搏血氧仪结合心脏杂音敏感度为78.9%,特异度为99.8%,阳性预测值为78.8%,阴性预测值为99.8%。结论:产前胎儿心脏彩超、出生后脉搏血氧仪筛查先天性心脏病简单方便、准确性高。

Objective:To explore the screening system of congenital heart disease in accordance with the characteristics of basic hospitals.Methods:20~24 weeks pregnant women with prenatal examination were selected from April 2017 to April 2019,and fetal heart color Doppler ultrasound screening was performed routinely,after birth,routine physical examination and pulse oximetry were performed to screen the congenital heart disease(CHD)and positive cases.All newborns underwent routine echocardiography(gold standard).We evaluated the authenticity and reliability of fetal echocardiography and different screening methods after birth.Results:A total of 6,497 newborns were screened,including 71 cases of congenital heart disease diagnosed and followed up.The sensitivity of the fetal heart was 95.9%,the specificity was 99.8%,the positive predictive value was 85.9%,and the negative predictive value 99.8%.The pulse oximeter screening sensitivity was 7.0%,specificity was 99.9%,positive predictive value was 71.4%,negative predictive value was 98.9%.The sensitivity of pulse oximeter combined with cardiac murmur was 78.9%,specificity was 99.8%,positive predictive value was 78.8%,and negative predictive value was 99.8%.Conclusion:Prenatal fetal heart color ultrasound and postnatal pulse oximetry are simple,convenient and accurate in screening congenital heart disease.