海南省新生儿先天性心脏病筛查-诊断-评估适宜技术的应用研究  

Application of Appropriate Technology for Screening,Diagnosis and Evaluation of Congenital Heart Disease in Neonates in Hainan Province

作　　者：张笃飞 陈仁伟 莫泽来 羊玲 王亚洲 王海凡 ZHANG Dufei;CHEN Renwei;MO Zelai;YANG Ling;WANG Yazhou;WANG Haifan(Department of Cardiovascular Medicine,Hainan Women and Children's Medical Center/Hainan Provincial Children's Hospital,Haikou 570000,China;Department of Cardiac Surgery,Hainan Women and Children's Medical Center/Hainan Provincial Children's Hospital,Haikou 570000,China;Department of Ultrasound Medicine,Hainan Women and Children's Medical Center/Hainan Provincial Children's Hospital,Haikou 570000,China;Department of Neonatology,Hainan Women and Children's Medical Center/Hainan Provincial Children's Hospital,Haikou 570000,China)

机构地区：[1]海南省妇女儿童医学中心(海南省儿童医院)心血管内科,海南省海口市570000 [2]海南省妇女儿童医学中心(海南省儿童医院)心胸外科,海南省海口市570000 [3]海南省妇女儿童医学中心(海南省儿童医院)超声医学科,海南省海口市570000 [4]海南省妇女儿童医学中心(海南省儿童医院)新生儿科,海南省海口市570000

出　　处：《中国全科医学》2023年第25期3170-3177,共8页Chinese General Practice

基　　金：2019年海南省基础与应用基础研究计划(自然科学领域)高层次人才项目(2019RC392)。

摘　　要：背景先天性心脏病(CHD)为全球主要的出生缺陷类型之一,是导致儿童死亡的主要原因,然而CHD的延迟诊断现状不容乐观,CHD的“早发现、早诊断、早治疗”成为热点研究问题。目的在海南省建立与应用新生儿CHD筛查-诊断-评估适宜技术体系,评价此技术的运行效果,为进一步推广此技术提供依据。方法按照国家卫生健康委员会颁布的《新生儿先天性心脏病筛查项目工作方案》要求,回顾相关文献,建立新生儿CHD筛查-诊断-评估适宜技术体系:在海南省17个市(县)所有助产机构及当地新生儿科或新生儿重症监护病房(NICU),由筛查人员采用双指标联合法,即心脏杂音听诊联合经皮脉搏血氧饱和度(POX)测定法,于活产新生儿出生后6~72h对其进行CHD筛查。心脏杂音听诊和/或POX测定结果呈阳性为筛查阳性。由经海南省卫生健康委员会认证的31家诊断机构对筛查阳性的活产新生儿进行超声心动图诊断。经认证的6家三级甲等医院中具备相应资质的儿童心血管内、外科医生对诊断结果进行审核和必要的再评估,根据病情提出相应的医疗干预建议或实施治疗,并建议临床随访(3~12个月)。通过新生儿CHD筛查工作信息管理系统对网络化筛查、诊断、评估与治疗数据进行填报、上传及管理。2020-01-01至2021-12-31在海南省17个市(县)范围内评价此技术的运行效果。结果2020-01-01至2021-12-31,海南省活产新生儿数为206761名,204442名活产新生儿参加了本筛查项目,整体筛查率为98.88%;CHD筛查阳性患儿5847名,筛查阳性率为2.86%(5847/204442)。经超声心动图检查,共527名被确诊为CHD患儿,CHD患病率为2.58‰(527/204442),其中房间隔缺损为最常见的CHD病变[38.14%(201/527)];非显著型CHD患儿291名(55.22%),显著型CHD患儿142名(26.94%),严重型CHD患儿88名(16.70%),危重型CHD患儿6名(1.14%)。心脏杂音听诊法、POX测定法和双指标联合法在新Background Congenital heart disease(CHD)is one of the major types of birth defects in the world,which is the leading cause of death in children.However,the current situation of delayed diagnosis of CHD is not optimistic,making the early detection,diagnosis and treatment of children with CHD a hot research topic.Objective To establish and apply the appropriate technology system for screening,diagnosis and evaluation of CHD in neonates in Hainan Province,evaluate operational effect of the technology for its further promotion.Methods In accordance with the requirements of the Program of Neonatal CHD Screening Project issued by the National Health Commission,the relevant literatures were reviewed to establish the appropriate technology system for screening,diagnosis and evaluation of CHD in neonates,in which screening staff perform CHD screening on liveborn neonates within 6-72 hours after birth using integration of cardiac murmur auscultation and transcutaneous pulse oximetry(POX),in all midwifery institutions of 17 cities and counties in Hainan province,as well as the local neonatology departments or neonatal intensive care units(NICUs).Positive results of heart murmur auscultation and/or POX were considered positive for screening.31 diagnostic facilities authorized by Hainan Provincial Health Commission were responsible for the echocardiography examinations for liveborn neonates with positive screening results.The qualified cardiovascular physicians and cardiac surgeons in the 6 certified tertiary hospitals reviewed the diagnosis results and made necessary re-evaluations,suggested or implemented medical intervention and proposed suggestions on clinical follow-up(3 to 12 months)according to the conditions.Screening,diagnosis,evaluation and treatment data were filled,uploaded and managed online through the neonatal CHD screening information management network.The operational effectiveness of this appropriate health technology was evaluated in 17 cities(counties)in Hainan Province from 2020-01-01 to 2021-12-31.Result

关 键 词：先天性心脏病 筛查 经皮脉搏血氧饱和度 心脏听诊 超声心动图 卫生适宜技术 

分 类 号：R541[医药卫生—心血管疾病]