高原地区新生儿复杂性先天性心脏病筛查中检测血氧饱和度的临床价值分析
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摘要
目的分析高原地区新生儿复杂性先天性心脏病(CCHD)筛查中检测血氧饱和度(POX)的临床价值。方法选择2016年3月-2017年10月于甘孜州人民医院妇产科分娩并入住新生儿科的新生儿331例,新生儿出生后均行POX测定,并在住院期间同时行心脏CT或心脏彩超检查确诊是否患有先天性心脏病(CHD)及其类型,根据诊断结果分为正常新生儿组(132例)、单纯性CHD组(83例)和CCHD组(116例)。比较3组新生儿体格检查和POX检测结果。结果 3组新生儿的性别差异不具有统计学意义(P>0. 05)。单纯性CHD组新生儿的孕周、体质量均显著低于正常新生儿组(P<0. 05); CCHD组新生儿POX显著低于正常新生儿组(P<0. 05); CCHD组新生儿的孕周、体质量、POX与单纯性CHD组比较差异均有统计学意义(均P<0. 05)。POX筛查诊断CHD的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为73. 87%、42. 42%、67. 37%、72. 41%、59. 38%。POX筛查诊断CCHD的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为82. 76%、38. 55%、64. 32%、65. 31%、61. 54%。116例CCHD患儿中,96例(82. 76%)患儿POX≤95%,20例(17. 24%)患儿POX>95%; 48例(41. 38%)患儿经临床特征及查体诊断为阳性,68例(58. 62%)患儿经临床特征及查体诊断为阴性。结论高原地区绝大部分CCHD患儿POX≤95%,POX筛查简单、方便、无创,可作为筛查CCHD的辅助手段,临床广泛应用可能有助于减少CCHD的漏诊率。
Objective To analyze the clinical value of blood oxygen saturation( POX) detection in screening of neonatal complex congenital heart disease( CCHD) in plateau area. Methods A total of 331 neonates born in Department of Gynecology and Obstetrics in People's Hospital of Ganzi Tibetan Autonomous Prefecture from March 2016 to October 2017 were selected as study object from Department of Neonatology,POX detection was performed after birth,cardiac CT or cardiac color ultrasonography were performed during hospitalization to confirm complicating with congenital heart disease( CHD) or not and the types. The neonates were divided into normal neonate group( 132 neonates),simple CHD group( 83 neonates),and CCHD group( 116 neonates) according to the diagnostic results. The results of physical examination and POX detection in the three groups were compared. Results There was no statistically significant difference in gender of neonates among the three groups( P>0. 05). Gestational week and weight of neonates in simple CHD group were statistically significantly lower than those in normal neonate group( P<0. 05). POX of neonates in CCHD group was statistically significantly lower than that in normal neonate group( P<0. 05). There were statistically significant differences in gestational week,weight,POX of neonates between CCHD group and simple CHD group( P<0. 05). The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of POX screening in diagnosis of CHD were 73. 87%,42. 42%,67. 37%,72. 41%,and 59. 38%,respectively. The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of POX screening in diagnosis of CCHD were 82. 76%,38. 55%,64. 32%,65. 31%,and 61. 54%,respectively. Among 116 CCHD neonates,POX≤95% was observed in 96 neonates( 82. 76%),POX>95% was observed in 20 neonates( 17. 24%); 48 positive neonates( 41. 38%) were diagnosed by clinical features and physical examination,and 68 negative neonates( 58. 62%) were diagnosed by clinical features and physical examination. Conclusion POX≤95% was observed in most CCHD neonates,POX screening is simple,convenient,and noninvasive,it can be used as an auxiliary means of screening CCHD,wide clinical application of POX screening can reduce the rate of missed diagnosis of CCHD.
Objective To analyze the clinical value of blood oxygen saturation( POX) detection in screening of neonatal complex congenital heart disease( CCHD) in plateau area. Methods A total of 331 neonates born in Department of Gynecology and Obstetrics in People's Hospital of Ganzi Tibetan Autonomous Prefecture from March 2016 to October 2017 were selected as study object from Department of Neonatology,POX detection was performed after birth,cardiac CT or cardiac color ultrasonography were performed during hospitalization to confirm complicating with congenital heart disease( CHD) or not and the types. The neonates were divided into normal neonate group( 132 neonates),simple CHD group( 83 neonates),and CCHD group( 116 neonates) according to the diagnostic results. The results of physical examination and POX detection in the three groups were compared. Results There was no statistically significant difference in gender of neonates among the three groups( P>0. 05). Gestational week and weight of neonates in simple CHD group were statistically significantly lower than those in normal neonate group( P<0. 05). POX of neonates in CCHD group was statistically significantly lower than that in normal neonate group( P<0. 05). There were statistically significant differences in gestational week,weight,POX of neonates between CCHD group and simple CHD group( P<0. 05). The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of POX screening in diagnosis of CHD were 73. 87%,42. 42%,67. 37%,72. 41%,and 59. 38%,respectively. The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of POX screening in diagnosis of CCHD were 82. 76%,38. 55%,64. 32%,65. 31%,and 61. 54%,respectively. Among 116 CCHD neonates,POX≤95% was observed in 96 neonates( 82. 76%),POX>95% was observed in 20 neonates( 17. 24%); 48 positive neonates( 41. 38%) were diagnosed by clinical features and physical examination,and 68 negative neonates( 58. 62%) were diagnosed by clinical features and physical examination. Conclusion POX≤95% was observed in most CCHD neonates,POX screening is simple,convenient,and noninvasive,it can be used as an auxiliary means of screening CCHD,wide clinical application of POX screening can reduce the rate of missed diagnosis of CCHD.
引文
[1]韩宗红.复杂性先天性心脏病患儿维生素D缺乏症患病率及危险因素研究[J].中国急救医学,2017,37(6):519-523.
[2] Chubb H,O'Neill M,Rosenthal E. Pacing and defibrillators in complex congenital heart disease[J]. Arrhythm Electrophysiol Rev,2016,5(1):57-64.
[3]赵趣鸣,刘芳,吴琳,等.危重先天性心脏病新生儿产科医院出院前漏诊情况分析[J].中华儿科杂志,2017,55(4):260-266.
[4]邬晓臣,岳琴,张近宝,等.高原地区先天性心脏病并发重度肺动脉高压的围术期管理[J].心脏杂志,2015,27(1):88-91.
[5] Van Naarden Braun K,Grazel R,Koppel R,et al. Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit[J]. J Perinatol,2017,37(10):1117-1123.
[6]吴开元,李斌,范太兵,等.先天性心脏病漏诊及误诊分析[J].中华实用诊断与治疗杂志,2016,30(2):207-208.
[7] Pinto NM,Weng C,Sheng X,et al. Modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease[J]. J Matern Fetal Neonatal Med,2016,29(20):3340-3346.
[8]吴淑燕,江燕萍,韩凤珍.胎儿复杂性先天性心脏病产前与出生后诊断处理的价值及预后比较[J].实用妇产科杂志,2016,32(1):45-48.
[9] Miller KK,Vig KS,Goetz EM,et al. Pulse oximetry screening for critical congenital heart disease in planned out of hospital births and the incidence of critical congenital heart disease in the Plain community[J]. J Perinatol,2016,36(12):1088-1091.
[10] Kumar P,Iyengar H,Kumar P. Public views on pulse oximetry screening for critical congenital heart disease[J]. World J Pediatr Congenit Heart Surg,2017,8(2):130-134.
[11] Oakley JL,Soni NB,Wilson D,et al. Effectiveness of pulse-oximetry in addition to routine neonatal examination in detection of congenital heart disease in asymptomatic newborns[J]. J Matern Fetal Neonatal Med,2015,28(14):1736-1739.
[12]莫兆冬,郭小玲,王维琼,等.脉搏血氧仪筛查先天性心脏病的有效性研究[J].中国新生儿科杂志,2015,30(5):343-346.
[13]包志丹,万俊.脉氧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].中国妇幼健康研究,2015,26(5):1048-1050.
[14] Narayen IC,Blom NA,Ewer AK,et al. Aspects of pulse oximetry screening for critical congenital heart defects:when,how and why?[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(2):F162-F167.
[15]贾安琪,吴军华,郭岸英,等.经皮血氧饱和度筛查新生儿先天性心脏病监测时间段分析[J].临床儿科杂志,2016,34(5):357-359.
[16]李毅,谢新权.西地那非治疗高海拔地区儿童先天性心脏病并发重度肺动脉高压的临床研究[J].现代药物与临床,2015,30(7):837-840.
[17]刘世明,杜悦新,王晶,等.高原先天性心脏病与gdf1基因突变的分子流行病学研究[J].中国计划生育学杂志,2015,23(8):530-533.
[18]罗江秀,钱稚萍,谭裕尧.四川甘孜州高原地区世居藏族青少年先天性心脏病发病率调查[J].医学信息,2015,15(40):349.
[19] Hasan A. Relationship of high altitude and congenital heart disease[J]. Indian Heart J,2016,68(1):9-12.
[20] Ghimire LV. Congenital heart disease and high altitude:is chronic hypoxia a common factor in intellectual impairment?[J]. High Alt Med Biol,2017,18(3):299-300.
[2] Chubb H,O'Neill M,Rosenthal E. Pacing and defibrillators in complex congenital heart disease[J]. Arrhythm Electrophysiol Rev,2016,5(1):57-64.
[3]赵趣鸣,刘芳,吴琳,等.危重先天性心脏病新生儿产科医院出院前漏诊情况分析[J].中华儿科杂志,2017,55(4):260-266.
[4]邬晓臣,岳琴,张近宝,等.高原地区先天性心脏病并发重度肺动脉高压的围术期管理[J].心脏杂志,2015,27(1):88-91.
[5] Van Naarden Braun K,Grazel R,Koppel R,et al. Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit[J]. J Perinatol,2017,37(10):1117-1123.
[6]吴开元,李斌,范太兵,等.先天性心脏病漏诊及误诊分析[J].中华实用诊断与治疗杂志,2016,30(2):207-208.
[7] Pinto NM,Weng C,Sheng X,et al. Modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease[J]. J Matern Fetal Neonatal Med,2016,29(20):3340-3346.
[8]吴淑燕,江燕萍,韩凤珍.胎儿复杂性先天性心脏病产前与出生后诊断处理的价值及预后比较[J].实用妇产科杂志,2016,32(1):45-48.
[9] Miller KK,Vig KS,Goetz EM,et al. Pulse oximetry screening for critical congenital heart disease in planned out of hospital births and the incidence of critical congenital heart disease in the Plain community[J]. J Perinatol,2016,36(12):1088-1091.
[10] Kumar P,Iyengar H,Kumar P. Public views on pulse oximetry screening for critical congenital heart disease[J]. World J Pediatr Congenit Heart Surg,2017,8(2):130-134.
[11] Oakley JL,Soni NB,Wilson D,et al. Effectiveness of pulse-oximetry in addition to routine neonatal examination in detection of congenital heart disease in asymptomatic newborns[J]. J Matern Fetal Neonatal Med,2015,28(14):1736-1739.
[12]莫兆冬,郭小玲,王维琼,等.脉搏血氧仪筛查先天性心脏病的有效性研究[J].中国新生儿科杂志,2015,30(5):343-346.
[13]包志丹,万俊.脉氧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].中国妇幼健康研究,2015,26(5):1048-1050.
[14] Narayen IC,Blom NA,Ewer AK,et al. Aspects of pulse oximetry screening for critical congenital heart defects:when,how and why?[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(2):F162-F167.
[15]贾安琪,吴军华,郭岸英,等.经皮血氧饱和度筛查新生儿先天性心脏病监测时间段分析[J].临床儿科杂志,2016,34(5):357-359.
[16]李毅,谢新权.西地那非治疗高海拔地区儿童先天性心脏病并发重度肺动脉高压的临床研究[J].现代药物与临床,2015,30(7):837-840.
[17]刘世明,杜悦新,王晶,等.高原先天性心脏病与gdf1基因突变的分子流行病学研究[J].中国计划生育学杂志,2015,23(8):530-533.
[18]罗江秀,钱稚萍,谭裕尧.四川甘孜州高原地区世居藏族青少年先天性心脏病发病率调查[J].医学信息,2015,15(40):349.
[19] Hasan A. Relationship of high altitude and congenital heart disease[J]. Indian Heart J,2016,68(1):9-12.
[20] Ghimire LV. Congenital heart disease and high altitude:is chronic hypoxia a common factor in intellectual impairment?[J]. High Alt Med Biol,2017,18(3):299-300.
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