超声心动图筛查高原地区新生儿先天性心脏病及其自然转归

摘要

目的 利用超声心动图对高原地区新生儿先天性心脏病(CHD)进行筛查,了解CHD发病率并探讨其畸形类型特点并随访其自然转归.方法 纳入2015年5月至2016年8月在青海省妇女儿童医院出生的所有无症状新生儿,于出生后3～5d行超声心动图检查.同一时期,对在青海省妇女儿童医院出生后2d内转入新生儿重症监护室(NICU)的新生儿行超声心动图检查.确诊CHD患儿于出生后1～3、6及12 ～18个月进行随访.结果 1 002例无症状新生儿CHD发病率为27.8％(279例),其中单纯房间隔缺损(ASD) 175例,单纯动脉导管未闭(PDA)61例,单纯室间隔缺损(VSD)8例,合并多种CHD 35例.335例转入NICU新生儿CHD发病率为19.4％(65例),其中左向右分流型简单CHD 63例,复杂CHD2例.随访18个月时,11例患儿发展为肺动脉高压,其中肺动脉压力最高的患儿发展为艾森曼格综合征.结论 高原地区新生儿CHD发病率较高,主要为简单左向右分流型CHD,合并极少复杂CHD.有必要对高原出生的所有新生儿常规实施超声心动图筛查,并加强随访工作,以便及早干预,防止CHD并发反复肺炎、肺动脉高压甚至死亡.%Objective To investigate the incidence of congenital heart disease (CHD) in newborns at plateau area through echocardiography screening;to analyze the characteristics of cardiac deformities and the natural outcomes.Methods From May 2015 to August 2016,all asymptomatic newborns in Women and Children's Hospital of Qinghai Province were examined by echocardiography at 3-5 days after birth;the newborns who were admitted in neonatal intensive care unit (NICU) within 2 days after birth were examined by echocardiography.Neonates diagnosed of CHD were followed up at 1-3,6,12-18 months after birth.Results In 1 002 asymptomatic newborns,incidence of CHD was 27.8％ (n =279);types of CHD included 175 atrial septal defect,61 patent ductus arteriosus,8 ventricular septal defect and 35 complicated CHD.In 335 newborns in NICU,incidence of CHD was 19.4％ (n =65);types of CHD included 63 simple left-to-right shunt and 2 complicated CHD.During 18 months of follow-up,11 infants developed into pulmonary artery hypertension,among them there was one with the highest pulmonary artery pressure developing into Eisenmenger syndrome.Conclusion Incidence of CHD in newborns is high at plateau area;simple left-to-right shunt is the common CHD type;complex CHD is rare.