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7105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.
展开▼
