先天性心脏病"双期三步法"筛查诊断流程推广应用初探

The Preliminary Exploration for Application of Screening and Diagnosis Process of Congenital Heart Disease with Two-stage Three-step Method

目的:分析"双期三步法"筛查诊断流程在西安咸阳地区新生儿先天性心脏病筛查中的推广与应用价值。方法:选取2021年1月1日-2021年12月31日在医院产检的胎儿和出生的新生儿作为研究对象,收集胎儿期、新生儿期和婴儿期的先心筛查数据,将新生儿分为杂音组、经皮氧饱和度阳性组、双阳性组,评价"双期三步法"筛查方法的使用价值。结果:共对12318例新生儿进行了筛查,筛查阳性497例。确诊126例,实际发病率为10.23‰。在确诊的例先心病患儿中,位于前3位的疾病类型分别为房间隔缺损66例(52.38%),室间隔缺损41例(32.54%),动脉导管未闭11例(8.73%)。杂音组184例,单纯心脏杂音筛查检出率1.49%,灵敏度为82.5%,特异度为99.3%。经皮氧饱和度阳性组147例,单纯经皮氧饱和度阳性筛查检出率1.19%,灵敏度为58.7%,特异度为99.4%。双阳性组166例,两项指标联合筛查检出率1.35%,灵敏度为94.4%,特异度为99.6%。结论:"双期三步法"筛查诊断流程特别是心脏听诊和经皮氧饱和度联合筛查有利于早期发现新生儿CHD,值得推广应用。

Objective:Analyze the promotion and application value of"two-stage three-step method"screening and diagnosis process in screening newborn congenital heart disease in Xi'an and Xianyang area.Methods:Fetuses and newborns born in the hospital from January 1,2021 to December 31,2021 were selected as the study subjects,and the data of precordial screening in fetal period,neonatal period and infancy were collected,and the newborns were divided into murmur group,positive transcutaneous oxygen saturation group and double-positive group to evaluate the"two-phase,three-step method We evaluated the value of the"two-stage,three-step"screening method.Results:A total of 12318 neonates were screened and 497 were positive.126 cases were confirmed and the actual incidence was 10.23‰.Among the confirmed cases of children with CHD,the top 3 disease types were atrial septal defect in 66 cases(52.38%),ventricular septal defect in 41 cases(32.54%)and patent ductus arteriosus in 11 cases(8.73%).The detection rate of single heart murmur was 1.49%,the sensitivity was 82.5%,and the specificity was 99.3%.In the positive percutaneous oxygen saturation group of 147 cases,the detection rate,sensitivity and specificity of pure percutaneous oxygen saturation were 1.19%,58.7%and 99.4%.In the double-positive group of 166 cases,the detection rate,sensitivity and specificity were 1.35%,94.4%and 99.6%,respectively.Conclusion:The"two-stage three-step"screening and diagnostic procedure,especially the combined screening of cardiac auscultation and percutaneous oxygen saturation,is beneficial to the early detection of neonatal CHD,and is worthy of popularization and application.