经皮脉搏血氧饱和度和心脏杂音在新生儿先天性心脏病筛查中的应用分析

Application of percutaneous pulse oxygen saturation and cardiac murmur in screening for congenital heart disease in neonates

目的:探讨经皮脉搏血氧饱和度(SpO2)及心脏杂音应用于新生儿先天性心脏病(CHD)筛查中的价值,检验上述两项指标联合筛查CHD的实用性和有效性。方法:对2017年1月1日至2019年1月1日在广西壮族自治区妇幼保健院出生的17841例新生儿进行CHD筛查,每个新生儿在出生后均进行SpO2及心脏杂音筛查,把上述任何一项指标呈阳性的患儿再进行心脏超声心动图进一步筛查确诊,验证SpO2联合心脏杂音在CHD筛查中的特异度及灵敏度。结果:17841例新生儿中共筛查出CHD阳性161例,其中杂音组(单纯心脏杂音阳性)患儿128例,SpO2组(单纯SpO2阳性)患儿110例,SpO2+杂音组(SpO2及心脏杂音双阳性)患儿81例,SpO2或杂音组(SpO2或心脏杂音任一项阳性)患儿156例。CHD类型前7位依次为室间隔缺损(VSD)、动脉导管未闭(PDA)、VSD+PDA、房间隔缺损(ASD)、主动脉瓣狭窄(AS)、VSD+ASD+PDA和法洛四联症(TOF),该研究CHD发病率在0.902%。SpO2或杂音组的灵敏度明显高于其他3组(SpO2组、杂音+SpO2组、杂音组),特异度稍差于其他3组,但约登指数明显高于其他3组,且SpO2或杂音组与其他任何一组灵敏度或特异度比较,差异均有统计学意义(均P<0.05)。结论:SpO2联合心脏杂音能有效筛查CHD,操作简单宜行,可普遍用于CHD初步筛查的推广。

Objective:To explore the value of percutaneous pulse oxygen saturation(SpO2)and heart murmur in screening for neonatal congenital heart disease(CHD),and to test the practicability and effectiveness of combined screening of CHD with the above two indexes.Methods:A total of 17,841 neonates in ourhospital from Jan.1,2017 to Jan.1,2019 were screened for CHD.Each newborn was screened for SpO2 and heart murmur after birth.The positive children with any of the above indexes were further screened by echocardiography to verify the specificity and sensitivity of SpO2 combined with heart murmur in CHD screening.Results:Among 17,841 newborns,161positive cases of CHD were detected,including 128cases in murmur group(positive in heart murmur),110cases in SpO2 group(positive in SpO2),81cases in group SpO2+murmurgroup(positive in both SpO2 and heart murmur),156 cases in group SpO2 or murmur(positive in either SpO2 or cardiac murmur).The first seven types of CHD were ventricular septal defect(VSD),patent ductusarteriosus(PDA),VSD+PDA,atrial septal defect(ASD),aortic valve stenosis(AS),VSD+ASD+PDA,tetralogy of Fallot(TOF)and so on.The incidence of CHD in this study was 0.902%.The sensitivity of SpO2 or cardiac murmur group was significantly higher than that of the other three groups(SpO2 group,murmur+SPO2 group and murmur group),but the specificity was slightly lower than that of the other three groups,but the Youden index was significantly higher than that of the other three groups.The sensitivity or specificity of SpO2 or cardiac murmur group was significantly higher than that of any other group(all P<0.05).Conclusion:SpO2 combined with heart murmur can effectively screen CHD,which is simple and feasible,and can be widely used in the popularization of preliminary screening of CHD.