体格检查、脉搏血氧饱和度筛查和灌注指数在新生儿先天性心脏病筛查中的作用
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摘要
目的寻找可靠、简便、易推广的先天性心脏病(CHD)筛查方法。方法选择2017年1月-7月出生的新生儿7 105例,以彩色超声心动图为CHD诊断金标准,评估体格检查、脉搏血氧饱和度筛查(POS)及灌注指数(PI)在CHD筛查中的真实性、可靠性。结果将体格检查、POS、PI单独作为筛查指标时,其灵敏度13.11%~73.77%,特异度50.20%~99.34%,约登指数0.12~0.70,总符合率50.40%~98.86%,阳性预测值1.27%~40.70%,阴性预测值99.29%~99.70%;以体格检查、POS及PI三个筛查指标组成混合组(三项指标中两项阳性或三项同时阳性)进行筛查时,其灵敏度、约登指数分别为85.25%、0.82,均较其他三个指标单独筛查CHD时的灵敏度、约登指数高,说明混合组真实性最高;混合组总符合率为97.07%,虽然比POS组(98.86%)和PI筛查组(98.58%)低,但仍具有较好的可靠性。结论联合体格检查、POS和PI筛查在新生儿CHD筛查中具有一定的临床推广价值。
Objective To find a reliable, simple, and easily-operated method for the screening of neonatal congenital heart disease(CHD). Methods A total of 7 105 neonates born from January 2017 to July 2017 were selected. The validity and reliability of physical examination, pulse oximetry screening(POS), and perfusion index(PI) in the screening of neonatal CHD were evaluated according to the diagnosis made by color Doppler echocardiography. Results When physical examination, POS or PI was used separately in screening for CHD, the sensitivities were in the range of 13.11%~73.77%, specificities 50.20%~99.34%, Youden indexes 0.12~0.70, the total coincidence rates 50.40%~98.86%, positive predictive values 1.27%~40.70%, and negative predictive values 99.29%~99.70%. When physical examination, POS and PI were combined(two or three indexes were positive) for screening, the sensitivities and Youden indexes were 85. 25 % and 0. 82 respectively, which were higher than those of single indicators and suggested that the combination had higher authenticities. The total coincidence rate of the combination was 97. 07 %, and, although it was lower than POS group( 98. 86 %) and PI screening group( 98. 58 %), it still had a good reliability. Conclusions The combination of physical examination, POS and PI has a certain clinical value in neonatal CHD screening.
Objective To find a reliable, simple, and easily-operated method for the screening of neonatal congenital heart disease(CHD). Methods A total of 7 105 neonates born from January 2017 to July 2017 were selected. The validity and reliability of physical examination, pulse oximetry screening(POS), and perfusion index(PI) in the screening of neonatal CHD were evaluated according to the diagnosis made by color Doppler echocardiography. Results When physical examination, POS or PI was used separately in screening for CHD, the sensitivities were in the range of 13.11%~73.77%, specificities 50.20%~99.34%, Youden indexes 0.12~0.70, the total coincidence rates 50.40%~98.86%, positive predictive values 1.27%~40.70%, and negative predictive values 99.29%~99.70%. When physical examination, POS and PI were combined(two or three indexes were positive) for screening, the sensitivities and Youden indexes were 85. 25 % and 0. 82 respectively, which were higher than those of single indicators and suggested that the combination had higher authenticities. The total coincidence rate of the combination was 97. 07 %, and, although it was lower than POS group( 98. 86 %) and PI screening group( 98. 58 %), it still had a good reliability. Conclusions The combination of physical examination, POS and PI has a certain clinical value in neonatal CHD screening.
引文
[1]董琴,李惠芬.脉搏血氧饱和度监测在新生儿先天性心脏病筛选中的应用分析[J].中国当代医药,2013,20(6):186-187.
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[3]黄国英.先天性心脏病筛查指标及临床价值[J].中国实用儿科杂志,2013,28(7):503-504.
[4]Mahle WT,Mertin GR,Beekman RH 3rd,et al.Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease[J].Pediatrics,2012,129(1):190-192.
[5]Granelli AW,Ostman-Smith I.Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction[J].Acta Paediatr,2007,96(10):1455-1459.
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[7]Franklin RC,Jacobs JP,Krogmann ON,et al.Nomenclature for congenital and paediatric cardiac disease:Historical perspectives and The international pediatric and congenital cardiac code[J].Cardiol Young,2008,18(Suppl 2):70-80.
[8]潘素娇,林爱琳,陈美云.彩色多普勒超声检测正常小儿心脏瓣膜反流情况[J].实用儿科临床杂志,1999,14(2):101-102.
[9]乔飞,刘迎龙.先天性心脏病相关肺动脉高压诊断与治疗的研究进展[J].中国医药,2017,12(6):938-941.
[10]万俊,包志丹,凌厉,等.脉氧监护仪在先天性心脏病筛查中的应用[J].上海医药,2014,(19):41-42.
[11]Ewer AK.Pulse oximetry screening for critical congenital heart defects In newborn infants:should it be routine[J].Arch Dis Child Fetal Neonatal Ed,2014,99(1):93-95.
[12]de-Wahl Granelli A,Wennergren M,Sandberg K,et al.Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease:a Swedish prospective screening study in 39821 newborns[J].BMJ,2009,338:a3037.
[13]Zhao QM,Ma XJ,Ge XL,et al.Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in china:a prospective study[J].Lancet,2014,384(9945):747-754.
[14]刘大鹏,李朝辉,李蕊,等.脉搏血氧饱和度检测联合体格检查在新生儿先天性心脏病诊断中的价值[J].国际医药卫生导报,2016,22(11):1559-1561.
[15]Glazener CM,Ramsay CR,Campbell MK,et al.Neonatal examination and screening trial(NEST):a randomised,controlled,switchback trial of alternative policies for low risk infants[J].BMJ,1999,318(7184):627-631.
[16]Thangaratinam S,Brown K,Zamora J,et al.Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies:a systematic review and meta analysis[J].Lancet,2012,379(9835):2459-2464.
[2]Schena F,Picciolli I,Agosti M,et al.Perfusion index and pulse oximetry screening for congenital heart defects[J].J Pediatr,2017,183:74-79.
[3]黄国英.先天性心脏病筛查指标及临床价值[J].中国实用儿科杂志,2013,28(7):503-504.
[4]Mahle WT,Mertin GR,Beekman RH 3rd,et al.Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease[J].Pediatrics,2012,129(1):190-192.
[5]Granelli AW,Ostman-Smith I.Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction[J].Acta Paediatr,2007,96(10):1455-1459.
[6]Khositseth A,Muangyod N,Nuntnarumit P.Perfusion index as a diagnostic tool for patent ductusarteriosus in preterm infants[J].Neonatology,2013,104(4):250-254.
[7]Franklin RC,Jacobs JP,Krogmann ON,et al.Nomenclature for congenital and paediatric cardiac disease:Historical perspectives and The international pediatric and congenital cardiac code[J].Cardiol Young,2008,18(Suppl 2):70-80.
[8]潘素娇,林爱琳,陈美云.彩色多普勒超声检测正常小儿心脏瓣膜反流情况[J].实用儿科临床杂志,1999,14(2):101-102.
[9]乔飞,刘迎龙.先天性心脏病相关肺动脉高压诊断与治疗的研究进展[J].中国医药,2017,12(6):938-941.
[10]万俊,包志丹,凌厉,等.脉氧监护仪在先天性心脏病筛查中的应用[J].上海医药,2014,(19):41-42.
[11]Ewer AK.Pulse oximetry screening for critical congenital heart defects In newborn infants:should it be routine[J].Arch Dis Child Fetal Neonatal Ed,2014,99(1):93-95.
[12]de-Wahl Granelli A,Wennergren M,Sandberg K,et al.Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease:a Swedish prospective screening study in 39821 newborns[J].BMJ,2009,338:a3037.
[13]Zhao QM,Ma XJ,Ge XL,et al.Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in china:a prospective study[J].Lancet,2014,384(9945):747-754.
[14]刘大鹏,李朝辉,李蕊,等.脉搏血氧饱和度检测联合体格检查在新生儿先天性心脏病诊断中的价值[J].国际医药卫生导报,2016,22(11):1559-1561.
[15]Glazener CM,Ramsay CR,Campbell MK,et al.Neonatal examination and screening trial(NEST):a randomised,controlled,switchback trial of alternative policies for low risk infants[J].BMJ,1999,318(7184):627-631.
[16]Thangaratinam S,Brown K,Zamora J,et al.Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies:a systematic review and meta analysis[J].Lancet,2012,379(9835):2459-2464.