發(fā)布時(shí)間：2018-05-25 13:54

  本文選題：先天性心臟病 + 經(jīng)皮血氧飽和度　； 參考：《寧波大學(xué)》2017年碩士論文

【摘要】：目的:探討寧波市新生兒先天性心臟病篩查最優(yōu)方案,了解寧波市新生兒先天性心臟病的流行病學(xué)分布情況。方法:1、將寧波市婦女兒童醫(yī)院2011年7月至2015年12月符合篩查條件的48007名活產(chǎn)新生兒納入篩查對(duì)象,先后利用經(jīng)皮血氧飽和度結(jié)合不同臨床評(píng)估指標(biāo)的三種篩查方法進(jìn)行篩查,逐步優(yōu)化篩查方法,得出最佳篩查方案;2、對(duì)納入篩查的新生兒進(jìn)行3~12個(gè)月的隨訪觀察,最終確定寧波市新生兒先天性心臟病流行病學(xué)分布情況。結(jié)果:1、2011年7月至2012年12月利用經(jīng)皮血氧飽和度結(jié)合六項(xiàng)臨床評(píng)估指標(biāo)(先心病家族史、心臟雜音、呼吸困難、青紫、特殊面容、其他系統(tǒng)先天性畸形)的“七項(xiàng)篩查法”篩查新生兒18352例,篩查結(jié)果陽性246例中確診先心病109例,陽性確診率44.31%,對(duì)所有先心病/危重先心病的靈敏度、特異度、假陽性率、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為63.74%/86.67%、99.25%/98.73%、0.75%/1.27%、44.31%/5.28%、99.66%/99.99%,篩選出三項(xiàng)最佳指標(biāo):經(jīng)皮血氧飽和度、特殊面容、心臟雜音;2、2013年1月至2014年6月利用“三項(xiàng)篩查法(經(jīng)皮血氧飽和度+特殊面容+心臟雜音)”篩查新生兒13041例,篩查結(jié)果陽性125例中確診先心病73例,陽性確診率58.40%,對(duì)于所有先心病/危重先心病的靈敏度、特異度、假陽性率、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為62.93%/90.91%、99.60%/99.12%、0.40%/0.88%、58.40%/8.00%、99.67%/99.99%;經(jīng)皮血氧飽和度結(jié)合心臟雜音兩項(xiàng)指標(biāo)在篩查先心病方面具備與三項(xiàng)指標(biāo)相同的靈敏度,且假陽性率更低;3、2014年7月至2015年12月利用“兩項(xiàng)篩查法(經(jīng)皮血氧飽和度+心臟雜音)”篩查新生兒16614例,篩查結(jié)果陽性131例中確診先心病97例,確診陽性率74.05%,對(duì)于所有先心病/危重先心病的靈敏度、特異度、假陽性率、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為62.58%/92.86%、99.79%/99.29%、0.21%/0.71%、74.05%/9.92%、99.65%/99.99%;4、2011年7月至2015年12月48007例新生兒中,共確診先天性心臟病患兒442例,總檢出率0.92%。其中,室間隔缺損患兒共192例(43.44%),動(dòng)脈導(dǎo)管未閉患兒共111例(25.11%),房間隔缺損患兒共95例(21.49%),以上三種先心病患兒占確診先心病總數(shù)的90.05%。在442例先心病中,一般先心病402例,占確診先心病的90.95%,總檢出率0.84%;危重先心病患兒共40例,占確診先心病的9.05%,總檢出率為0.08%。5、胎齡、出生體重、母親學(xué)歷、母親疾病史、家族疾病史及單胎/多胎不同的新生兒先心病發(fā)病率有統(tǒng)計(jì)學(xué)差異(P0.05),性別、城鎮(zhèn)/農(nóng)村不同的新生兒先心病發(fā)病率無統(tǒng)計(jì)學(xué)差異(P0.05)。6、3~12個(gè)月的隨訪結(jié)果顯示,室間隔缺損自愈率23.44%,房間隔缺損自愈率31.58%,動(dòng)脈導(dǎo)管未閉自愈率32.43%,先天性心臟病總自愈率25.11%�；純撼錾荒陜�(nèi)最先自愈的是動(dòng)脈導(dǎo)管未閉,其次是房間隔缺損、室間隔缺損。結(jié)論:1、本研究逐步由七項(xiàng)篩查指標(biāo)優(yōu)化至三項(xiàng)篩查指標(biāo),最終優(yōu)化至兩項(xiàng)篩查指標(biāo),通過大樣本實(shí)驗(yàn)驗(yàn)證,“兩項(xiàng)篩查法(經(jīng)皮血氧飽和度95%+心臟雜音)”對(duì)于早期發(fā)現(xiàn)新生兒先天性心臟病具有重要意義,可以替代“七項(xiàng)篩查法”及“三項(xiàng)篩查法”,不僅具有較高的靈敏度,且具有更高的特異度,更低的假陽性率,是有效的、值得寧波市推廣普及的最佳的先心病篩查方案。2、寧波地區(qū)新生兒先天性心臟病的發(fā)病率略高,為0.92%。3、寧波地區(qū)新生兒先心病主要類型中室間隔缺損檢出率最高,其次為動(dòng)脈導(dǎo)管未閉、房間隔缺損;危重先心病中檢出率最高的是大房缺合并大室缺和法洛四連癥。4、早產(chǎn)、低出生體重、母親高學(xué)歷、母親疾病史、家族疾病史及多胎均是先心病發(fā)病的危險(xiǎn)因素。5、先心病總自愈率25.11%,影響先心病自愈的因素很多,現(xiàn)有資料結(jié)果示寧波地區(qū)先心病患兒出生一年內(nèi)自愈率先后順序?yàn)?動(dòng)脈導(dǎo)管未閉、房間隔缺損、室間隔缺損。
[Abstract]:Objective: To explore the optimal scheme of neonatal congenital heart disease screening in Ningbo, and to understand the epidemiological distribution of congenital heart disease in Ningbo. Method: 1, 48007 live births in Ningbo women's and children's Hospital from July 2011 to December 2015 were included in the screening subjects, and the percutaneous oxygen saturation was used successively. Three screening methods combined with different clinical evaluation indexes were screened, the screening method was optimized gradually, and the best screening scheme was obtained. 2, the follow-up observation of the newborns included in the screening was carried out for 3~12 months, and the epidemiological distribution of neonatal congenital heart disease in Ningbo was determined. The results were: from July 12011 to December 2012, percutaneous blood was used. The oxygen saturation combined with six clinical evaluation indexes (family history of congenital heart disease, heart murmur, dyspnea, purple, special face, and other congenital malformations) in the screening of 18352 newborns with "seven screening methods", 109 cases of congenital heart disease in 246 cases, 44.31% of positive diagnosis, and sensitive to all congenital heart disease / critical congenital heart disease. The degree, specificity, false positive rate, positive predictive value, negative predictive value were 63.74%/86.67%, 99.25%/98.73%, 0.75%/1.27%, 44.31%/5.28%, 99.66%/99.99%, and three best indexes were selected: percutaneous oxygen saturation, special face, heart murmur; from January 22013 to June 2014, using "three screening methods (percutaneous oxygen saturation + special face volume +) +. 13041 newborns were screened by heart murmur, and 73 cases of congenital heart disease were confirmed in 125 cases with positive screening results. The positive rate of diagnosis was 58.40%. The sensitivity, specificity, false positive rate, positive predictive value and negative predictive value for all congenital heart disease / critical congenital heart disease were 62.93%/90.91%, 99.60%/99.12%, 0.40%/0.88%, 58.40%/8.00%, 99.67%/99.99%, and percutaneous blood. The two indexes of oxygen saturation combined with heart murmur have the same sensitivity as three indexes in screening the congenital heart disease, and the false positive rate is lower. From July 32014 to December 2015, 16614 cases of newborn were screened by "two screening methods (percutaneous oxygen saturation + heart murmur)", and 97 cases of congenital heart disease diagnosed in 131 cases were confirmed. The positive rate was 74.05%. The sensitivity, specificity, false positive rate, positive predictive value, negative predictive value and negative predictive value were 62.58%/92.86%, 99.79%/99.29%, 0.21%/0.71%, 74.05%/9.92%, 99.65%/99.99% for all congenital heart disease / critical heart disease, and 442 cases of congenital heart disease were diagnosed in 48007 cases from July 42011 to December 2015, the total detection rate was 0.. In 92%., there were 192 cases (43.44%) with ventricular septal defect, 111 cases (25.11%) in children with patent ductus arteriosus, 95 cases of atrial septal defect (21.49%), and three kinds of congenital heart disease in 442 cases with congenital heart disease in 442 cases of congenital heart disease, including 402 cases of congenital heart disease, 90.95% of diagnosed congenital heart disease, the total detection rate 0.84%, critical congenital heart disease. A total of 40 children, accounting for 9.05% of the diagnosis of congenital heart disease, the total detection rate was 0.08%.5, gestational age, birth weight, mother's education, mother's disease history, family history of disease and single fetal / multi fetal congenital heart disease incidence rate was statistically different (P0.05), sex, urban / rural different neonatal congenital heart disease incidence was not statistically different (P0.05).6,3~12 months The follow-up results showed that the self healing rate of ventricular septal defect was 23.44%, the self healing rate of atrial septal defect was 31.58%, the self healing rate of patent ductus arteriosus was 32.43%. The first self healing rate of 25.11%. in children with congenital heart disease was patent ductus arteriosus, atrial septal defect and ventricular septal defect. Conclusion: 1, this study was gradually made up of seven screening indicators. It is optimized to three screening indicators and finally optimized to two screening indicators. Through large sample experiments, the "two screening methods (95%+ heart murmurs)" is of great significance for early detection of neonatal congenital heart disease, which can be replaced by "seven screening methods" and "three screening methods", not only with high sensitivity. Degree, with higher specificity and lower false positive rate, is effective. It is worth the best screening program for congenital heart disease (.2) to popularize and popularize in Ningbo. The incidence of neonatal congenital heart disease in Ningbo is slightly higher, which is 0.92%.3. The detection rate of ventricular septal defect in the main types of congenital heart disease in Ningbo is the highest, followed by the patent ductus arteriosus The highest detection rate in critical congenital heart disease was large atrial deficiency combined with large ventricular deficiency and tetralogy of Fallot,.4, preterm birth, low birth weight, mother's high education, mother's disease history, family history and multiple births were risk factors of congenital heart disease.5, the total self healing rate of congenital heart disease was 25.11%, and there were many factors affecting the self healing of congenital heart disease. The results showed that the self-healing rate of children with congenital heart disease in Ningbo within one year was: patent ductus arteriosus, atrial septal defect and ventricular septal defect.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.1

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