2013-2017年住院新生儿先天性心脏病诊疗现状调查分析
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摘要
目的探讨陕西省某综合三级医院新生儿科先天性心脏病的诊疗现状,了解该病的构成比,为先天性心脏病的防控以及围产期保健提供相关信息及依据。方法回顾性收集2013年1月至2017年12月陕西省人民医院住院新生儿临床和(或)影像学诊断为先天性心脏病患儿的病例资料。填写疾病调查表,对所有数据进行整理、汇总和统计分析。结果研究期间陕西省人民医院共收治新生患儿9617例,诊断先天性心脏病和(或)合并其他出生缺陷患儿共2576例,占住院患儿的构成比为26.78%(2013—2017年分别为19.43%,26.69%,30.09%,22.28%,21.84%)。其中单纯性先天性心脏病2299例,合并其他出生缺陷277例,占总的先天性心脏病的比例为12.05%;单纯性先天性心脏病患儿中男性1353例,占58.9%;平均胎龄(36.2±3.6)w;足月儿937例(40.8%),早产儿1362例,其中胎龄29-34w592例,胎龄≤28w20例;平均出生体重(2636±571)g;低出生体重儿1151例,极低出生体重儿143例。最常见单纯性先天性心脏病的类型为动脉导管未闭(86.9%),其次为房间隔缺损(37.8%)、室间隔缺损(4.3%)。常见先心合并出生缺陷的为:先天性髋关节发育异常35%(97/277)、尿道下裂19.1%(53/277)、隐睾10.8%(30/277)。男婴、早产儿其动脉导管未闭发病人数较女婴、足月儿明显增多(P<0.01);女婴房间隔缺损发病人数较男婴多(P<0.01);足月儿的室间隔缺损发病人数较早产儿多(P<0.01)。结论近5年来先天性心脏病在住院新生儿中的构成比为26.78%,未显示出该病的发生率有逐年下降的趋势;我院可能存在动脉导管未闭过度诊断的现象,故应积极推广新生儿心脏病筛查适宜的技术。
Objective:To investigate the diagnosis of congenital heart disease in inpatient neonates in Shanxi Province People′s Hospital.Methods:A retrospective cohort study was conducted.From January 2013 to December 2017,we enrolled neonates cases with congenital heart disease admitted to neonatology departments in ShanXi Province,China.the distribution a nd clinical characters were collected and analyzed.Result:From January 2013 to December 2017,we enrolled 9617 neonates admitted to neonatology departments in Shan Xi Province,and 2299 cases with congenital heart disease.In these cases male 1353(58.9%).The mean gestational age were(36.2±3.6)weeks.Preterm infant 1362(59.2%).The mean birth weight were(2636土571)g.The incidence of congenital heart disease were26.78%(From2013 to 2017 were19.43%,26.69%,30.09%,22.28%,21.84% respectively)The most common type of congenital heart disease is Patent Ductus Arteriosus(86.9%),Atrial Septal Defect(37.8%)、Ventricular Septal Defect(4.3%).Conclusion:From 2013 to 2017 the incidence of congenital heart disease were 26.78% these years the incidence of congenital heart disease were not decreasing.the Patent Ductus Arteriosus may be over diagnosis in our hospital.
Objective:To investigate the diagnosis of congenital heart disease in inpatient neonates in Shanxi Province People′s Hospital.Methods:A retrospective cohort study was conducted.From January 2013 to December 2017,we enrolled neonates cases with congenital heart disease admitted to neonatology departments in ShanXi Province,China.the distribution a nd clinical characters were collected and analyzed.Result:From January 2013 to December 2017,we enrolled 9617 neonates admitted to neonatology departments in Shan Xi Province,and 2299 cases with congenital heart disease.In these cases male 1353(58.9%).The mean gestational age were(36.2±3.6)weeks.Preterm infant 1362(59.2%).The mean birth weight were(2636土571)g.The incidence of congenital heart disease were26.78%(From2013 to 2017 were19.43%,26.69%,30.09%,22.28%,21.84% respectively)The most common type of congenital heart disease is Patent Ductus Arteriosus(86.9%),Atrial Septal Defect(37.8%)、Ventricular Septal Defect(4.3%).Conclusion:From 2013 to 2017 the incidence of congenital heart disease were 26.78% these years the incidence of congenital heart disease were not decreasing.the Patent Ductus Arteriosus may be over diagnosis in our hospital.
引文
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[2]国家卫生计生委妇幼健康服务司,全国妇幼卫生监测及年报通讯[c].2017,7:5.
[3]国家卫生计生委妇幼健康服务司,全国妇幼卫生监测及年报通讯[c].2018,2:7
[4]Van d L D,Konings E E,Slager M A,et al.Birth prevalence of congenital heart disease worldwide:a systematic review and metaanalysis.[J].Journal of the American College of Cardiology,2011,58(21):2241-2247.
[5]张蕾,安美玉,朱冰.重庆乡镇0~3岁儿童先天性心脏病筛查与随访[J].中国当代儿科杂志,2017,19(07):748-753.
[6]周亚玲.北京市怀柔区2011-2013年先天性心脏病监测资料分析[J].中国优生与遗传杂志,2015(5):94-94.
[7]刘凯波,张雯,徐宏燕,等.2007年-2012年北京市先天性心脏病监测资料分析[J].中国优生与遗传杂志,2013,12:127-128.
[8]莫兆冬,郭小玲,彭嘉恒,等.中山市14565例新生儿先天性心脏病筛查结果[J].现代医院,2015,1:152-154.
[9]申昆玲.儿科学[M].第2版,北京大学医学出版社,2009:229-238.
[10]安美玉.10005例0-3岁婴幼儿先天性心脏病筛查结果分析[D].重庆医科大学,2013.
[11]刘国英,曲亚明,李芳芳,等.维族、汉族活产新生儿先天性心脏病的筛查及危险因素初步比较分析[J].中国优生与遗传杂志,2015,10:84-85.
[12]李志海.昌宁县49 446例0~14周岁儿童先天性心脏病筛查结果分析[J].影像研究与医学应用,2018,11:218-219.
[13]Dray E M,Marelli A J.Changing Epidemiology of Congenital Heart Disease[M].Congenital Heart Disease and Adolescence.Springer International Publishing,2016.
[14]殷刚柱,傅苏林,邵子瑜,等.合肥市5026名婴儿先天性心脏病筛查的流行病学调查[J].中国妇幼保健,2015,30(26):4523-4525.
[15]陈尚徽,龙翔,胡冬香,等.铜陵市城区婴儿先天性心脏病流行病学调查[J].现代预防医学,2010,37(4):658-661.
[16]陈小丽,卢辉和,仲崇俊,等.南通地区婴幼儿先天性心脏病流行病学调查及相关因素分析[J].介入放射学杂志,2014,23(12):1095-1098.
[17]A new milestone in the history of congenital heart disease[J],The Lancet,2012,379:2401.
[18]Peake L K,Draper E S,Budd J L,et al.Outcomes when congenital heart disease is diagnosed antenatally versus postnatally in the UK:a retrospective population-based study[J].BMC Pediatrics,2015,15(1):58.