先天性心脏病产前产后一体化诊疗模式效果初步评估

摘要

目的 探讨产前胎儿超声心动图诊断-产后及时诊治先天性心脏病(先心病)的一体化诊疗模式对先心病的救治效果.方法 回顾性收集2011年1月1日至2013年6月30日在广东省人民医院通过产前、产后一体化诊疗模式救治的先心病患婴资料,共172例,随访至2013年8月30日.通过广东先心网建立的绿色通道,对网络内医院筛查的先心病患婴提供明确、便捷的胎儿期早期诊断及出生后及时救治.结果 平均随访13个月,随访率95.8％,婴儿期病死率8.8％ (11/125).产前检查孕周18～38周.妊娠胎儿结局:保留125例(72.7％),引产45例(26.2％),宫内死亡2例(1.2％).新生儿期死亡3例.产后外科手术22例,中位手术日龄8.5天,术后死亡3例.早期手术的主要病种为:大动脉转位、主动脉缩窄、主动脉离断、全肺静脉异位引流等.结论 通过多学科合作、建立广东先心网绿色通道,对胎儿先心病形成一个顺畅的诊治流程,可缩短诊疗时间,提高救治成功率,减少婴儿死亡.%Objective To evaluate the curative effect of the prenatal diagnosis-postpartum treatment integration model for congenital heart disease(CHD).Methods Data were reviewed and collected retrospectively from 1 January,2011 to 30 June,2013 on neonates who were diagnosed and treated through the prenatal diagnosis-postpartum treatment integration model at Guangdong General Hospital.A total of 172 cases were included and followed up till August 30,2013.Through the establishment of Green channel based on Guangdong congenital heart disease prevention and treatment network to provide a definite prenatal diagnosis and timely postpartum treatment to the CHD fetus and infants.Results The follow-up rate was 95.8％ of the entire cohort with a median follow-up period of 13 months.The total infant mortality was 8.8％ (11/125).Prenatal gestational age ranged from 18 to 38 weeks.The outcome of all the CHD included fetus:livebirth in 125 cases(72.7％),abortion in 45 cases(26.2％),intrauterine death in 2 cases(1.2％).Among the 125 livebirth cases,3 cases died at neonate period ;22 cases received cardiac operation during the first postpartum hospitalization with a median age of 8.5 days,3 cases of whom demised after surgery.Major defects underwent early-stage surgery covered transposition of the great arteries,coarctation of aorta,interrupted aortic arch and total anomalous pulmonary venous connection,etc.Conclusion The prenatal diagnosis-postpartum treatment integration model basing on the multidisciplinary cooperation and the CHD Green channel may shorten the treatment time and improve treatment success rate for congenital heart disease,which may ultimately reduce infant mortality.