基于心音采集系统的新生儿先天性心脏病筛查

Screening of neonatal congenital heart diseases based on heart sound acquisition system

【目的】探讨心音采集远程会诊在基层医院新生儿先天性心脏病(congenital heart disease,CHD)筛查及转诊中的价值。【方法】选取2019年11月5日—2021年3月31日期间,在上海市浦东新区妇幼保健院出生的4 030例活产非危重新生儿,出生后给予常规心脏听诊的同时进行心音采集远程会诊,联合经皮氧饱和度测定开展CHD筛查。针对任一指标筛查呈阳性者,均建议其前往上海儿童医学中心完善心脏超声检查明确诊断。比较不同筛查方法的诊断价值。【结果】常规筛查共检出阳性110例,失访16例,经心脏超声检查确诊CHD 46例,阳性确诊率为48.94%(46/94);常规筛查+心音采集远程会诊共检出阳性51例,经心脏超声检查确诊CHD 42例,阳性确诊率为82.35%(42/51),两者差异有统计学意义(P<0.001)。【结论】在常规新生儿CHD筛查的基础上,联合心音采集远程会诊,可以有效提高筛查的阳性确诊率,减少不必要的转诊。该方法操作简便易行,在缺少CHD诊治专业技术人员的基层医院有一定的实用价值。

[Objective]To investigate the value of remote consultation of heart sound acquisition in screening and referral of neonates with congenital heart diseases(CHD)in primary hospitals.[Methods]A total of 4 030 neonates with non-critical diseases were selected. They were born in Shanghai Pudong New Area Maternal and Child Health Hospital from November 5,2019 to March 31,2021. After birth,routine cardiac auscultation was performed and remote consultation of heart sound collection were performed at the same time in combination with percutaneous oxygen saturation measurement to screen CHD. The children with any positive screening index were advised to verify the diagnosis by cardiac ultrasound examination in Shanghai Children’s Medical Center. The diagnostic value of different screening methods was compared.[Results]A total of 110 cases were detected positive by routine screening. Among them,16 cases were lost to follow-up,and 46 cases were confirmed by cardiac ultrasound examination,with a positive diagnosis rate of 48.94%(46/94). A total of 51 cases were detected positive by routine screening and remote consultation of heart sound collection simultaneously. Among them,42 cases were confirmed by cardiac ultrasound examination,with a positive diagnosis rate of 82.35%(42/51). The difference between the two positive diagnosis rates was statistically significant(P<0.001).[Conclusion]Remote consultation of heart sound acquisition on the basis of routine neonatal CHD screening can effectively improve the positive diagnosis rate of CHD screening in primary hospitals,and reduce unnecessary referrals. This method is simple and feasible. It has practical value in primary hospitals that lack professional technicians for the diagnosis and treatment of CHD.