糖尿病孕妇转诊胎儿超声心动图的最小成本分析  

Cost minimization analysis of diabetic pregnancies referred for fetal echocardiography

作　　者：孟卓[1,2] 王鉴 武育蓉[2] 陈笋[2] 孙锟[1,2] MENG Zhuo;WANG Jian;WU Yurong;CHEN Sun;SUN Kun(Department of Pediatric Cardiology,The Second Affiliated Hospital and Yuying Children’s Hospital,Wenzhou Medical University,Wenzhou 325000,Zhangjiang,China;Department of Pediatric Cardiology,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿心血管科,浙江温州325000 [2]上海交通大学医学院附属新华医院儿心血管科,上海200092

出　　处：《临床儿科杂志》2020年第8期626-630,共5页Journal of Clinical Pediatrics

基　　金：国家自然科学基金(No.81800281,81720108003);上海市卫生和计划生育委员会青年项目(No.20184Y0062)。

摘　　要：目的评估糖尿病孕妇胎儿心脏筛查策略的成本与效果。方法对199例因孕母糖尿病转诊胎儿超声心动图检查的孕妇进行理论最小成本分析,评估此类孕妇进行常规筛查和胎儿超声心动图筛查的成本与效果。结果199例糖尿病孕妇最终筛查出9例先天性心脏病患儿。目前的筛查策略是对所有糖尿病孕妇进行孕中期胎儿畸形筛查和胎儿超声心动图检查,以及对产前发现先天性心脏病或即使只有良性发现的病例均进行生后超声心动图检查,每产前检出一例先天性心脏病的费用为13045.67元;若筛查策略仅对拥有其他转诊因素的糖尿病孕妇进行胎儿超声心动图检查,且仅对有产前发现先天性心脏病或其他良性发现的病例进行生后超声心动图检查,每产前检出一例先天性心脏病的费用会降低至8475.22元。结论在完成孕中期胎儿畸形筛查后,对伴有其他转诊指征的糖尿病孕妇行选择性的胎儿超声心动图检查,并对有产前心脏异常的病例选择性进行生后超声心动图检查的心脏筛查策略相比其他筛查策略性价比更高。Objective To assess the cost and effectiveness of the referral efficiency in the fetal cardiac screening of diabetic pregnancies.Method Theoretical minimized cost analysis was performed in 199 diabetic pregnancies,to evaluate the cost and effectiveness of the screening strategy for these referrals.Results In pregnancies referred for diabetes mellitus,nine children with congenital heart disease were finally screened out.The current cardiac screening strategy of anatomic survey and fetal echocardiography for all diabetic pregnancies,and postnatal echocardiography only for cases with prenatal detection of congenital heart disease or even benign findings as indicated,would cost 13045.67 CNY for each prenatal detection of congenital heart disease.If fetal echocardiography was performed in diabetic pregnancies with other referral indications and postnatal echocardiography were performed only in cases with prenatal detection of congenital heart disease or other benign findings,the cost of each prenatal detection of congenital heart disease would decrease to 8475.22 CNY.Conclusion The economic analysis of diabetic pregnancies indicated that,the cardiac screening strategy of selective fetal echocardiography for diabetic pregnancies with other referral indications for fetal echocardiography after fetal anatomic survey and selective postnatal echocardiography only for cases with prenatal cardiac findings,was more cost-effective.

关 键 词：胎儿超声心动图 转诊指征 糖尿病 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]