中国西部8省≤18岁儿童先天性心脏病不同延迟诊断时长与术后康复结果对比分析

Impact of delayed diagnosis time on post-surgery recovery in 0-18 years old congenital heart disease patients in 8 western provinces of China:a comparative analysis

目的探讨儿童先天性心脏病(CHD)不同延迟诊断时长与患者术后康复结果的关系,为针对性的先心病早期筛查和治疗提供依据。方法于2017年1月—2020年12月,选取在云南省阜外心血管病医院接受治疗的来自8个省2879例≤18岁先心病患者为研究对象,采用横断面调查结合回顾性调查方法,收集患者电子病历并随访术后“身体-心理-社会适应”等信息,分析不同延迟诊断时长与术后康复结果的关系。结果2879例研究对象中,先心病延迟诊断1908例(66.3%),延迟诊断0.03~3年、3.01~7.5年、>7.5年分别有663例(23.0%)、615例(21.4%)、630例(21.9%)。延迟诊断0.03~3年患儿生长发育较慢(19.7%),且较难融入集体生活(28.0%);延迟诊断时长>7.5年组患儿出现消极情绪的比例最高(17.4%)。多因素非条件logistic回归分析结果显示,在调整了患儿性别、年龄、民族、CHD病种、家庭结构等相关因素后,与CHD延迟诊断时长>7.5年相比,延迟诊断0.03~3年(OR=0.685,95%CI=0.499~0.940)和3.01~7.5年(OR=0.630,95%CI=0.450~0.882)均使患儿术后产生悲伤难过等消极情绪的风险降低。与延迟诊断0.03~3年相比,延迟诊断0年(OR=0.717,95%CI=0.563~0.914)和>7.5年(OR=0.685,95%CI=0.528~0.888)均使患儿术后难以融入集体生活的风险降低。结论儿童先天性心脏病不同延迟诊断时长会对术后康复结果产生影响,CHD延迟诊断时长>7.5年与患儿术后产生消极情绪有关,延迟诊断0.03~3年与术后难以融入集体生活有关。

Objective To explore the association of delayed diagnosis time with post-surgery recovery in children with congenital heart disease(CHD)for providing evidences to effective early screening and treatment of CHD.Methods From January 2017 to December 2020,a CHD screening program was conducted among 3015470 students from 7783 schools in8 provincial-level regions in western China and totally 3805 diagnosed CHD patients were surgically treated at Fuwai Yunnan Cardiovascular Hospital and followed up for post-treatment management.Medical records and information on physical-psychological-social adaptation of the CHD patients aged 0-18 years were collected and analyzed to assess the correlation between delayed diagnosis time and post-surgery recovery in the child patients.Results Of the 2879 child patients included in the analysis,66.3%(1908)had delayed diagnosis of CHD and 23.0%(663),21.4%(615),and 21.9%(630)had delayed diagnosis time of 0.03-3 years,3.01-7.5 years,and longer than 7.5 years,respectively.Among the child patients with delayed diagnosis time of 0.03-3 years,19.7% had developmental retardation and 28.0% had difficulty in group living;of the child patients with the delayed diagnosed time longer than 7.5 years,17.4% were assessed being prone to have negative emotion.After adjusting for gender,age,ethnics,type of CHD,and family structure,the results of multivariate logistic regression analysis demonstrated that compared to those with the delayed diagnosis time of longer than 7.5 years,the child patients with shorter delayed diagnosis time were at a decreased the risk of post-surgery negative emotion with the odds ratio(OR)of 0.685(95% confidence interval[95%CI]:0.499-0.940)for those with the time of 0.03-3 years and the OR of 0.630(95%CI:0.450-0.882)for those with the time of 3.01-7.5 years;while,compared to those with the delayed diagnosis time of 0.03-3 years,the child patients being timely diagnosed and the patients with the delayed diagnosis time longer than 7.5 years were at a decreased risk of having difficulty in group living,with the OR of 0.717(95%CI:0.563-0.914)and OR of 0.685(95%CI:0.528-0.888),respectively.Conclusion Among child patients having surgery treatment,the delayed time of CHD diagnosis can influence post-surgery recovery;the delayed diagnosis time of 7.5 years is associated with the incidence of post-surgery negative emotion and that of 0.03-3 years is related to having difficulty in group living after surgery treatment.