北京市上地医院1年出生新生儿先天性心脏病筛查分析

目的研究北京市上地医院1年出生新生儿先心病的流行情况，探索先心病在基层医院筛查和管理方法。方法选择2006年7月1日～2007年6月30日北京市上地医院出生全部新生儿，住院期间每日均予体格检查、详细心脏听诊，出生第二天心电图检查，对有病理性杂音、青紫、气促等不能用呼吸神经等疾病解释及心电图提示先心病者，进一步心脏彩超检查，出院随访6月-1年。结果筛查5581例，发现听诊异常51例，其中彩超确诊先心病41例，诊断率80．4％，非先心病10例，为瓣膜返流或假腱索；2例新生儿除外心脏外原因青紫、气促，听诊异常，均确诊复杂心脏畸形；EKG提示先心病者4例，均确定诊断；X线诊断右位心2例。心脏彩超确诊先心病43例：室间隔缺损15例，占34．9％；房间隔缺损10例，占23．2％；单纯动脉导管未闭12例，占27．9％；镜像右位心2例，占4．7％；原发性肺动脉高压1例，占2．3％；复杂心脏畸形3例，占7．0％。死亡共4例，占9．3％。结论在基层医院做好新生儿体格检查、心脏听诊，合理选择心脏超声等检查，出院随访半年以上，能够廉价高效地早期发现先天性心脏病并降低婴儿死亡率。

Screening for Newborn Congenital Heart Disease: A one- year Analysis in Shangdi Hospital of Beijing

Objective To investigate the prevalence of newborn congenital heart disease (CHD) in 1 year in Shangdi hospital of Beijing and explore methods for screening and manage this disease in primary hospital.Methods All neonates born in shangdi hospital from July 1,2006 to June 30,2007 were collected.Each newborn accepted physical examination and careful cardiac auscultation and EKG the day after birthday.Ultrasoundcardiogram was used in those with abnormal heart mur- murs,cyanose and tachypnea which could not be explained by lung and brain masons,and be presumed to be CHD by EKG.All these cases were followed - up for 6 months to 1 year.Results A total of 5 581 cases were collected,of which 51 cases were found with abnormal auscultation.Of the 51 cases,41 were diagnosed with CHD by Ultrasound cardiogram (with diagnosis rate of 80.4%),and 10 with valve regurgitation.Two cases without murmurs and with cyanose and tachypnea that could not be ex- plained by lung and brain reasons were diagnosed with complex cardiac anomalies by ultrasoundcardiogram.Four cases was con- firmed with CHD by uhrasoundcardiogram because of abnormal EKG.Two cases were diagnosed with dextrocardia by X-ray.In all 43 eases diagnosed with CHD by ultrasoundcardiogram,there were 15 cases of interventricular septal defect (34.9%),10 eases of atrial septal defect (23.3%),12 cases of patent ductus arteriosus (27.9%),2 cases of mirror-image dextrocardia (4.7%),1 case of primary pulmonary hypertension (2.3%),3 cases of complex cardiac anomalies (7.0%),4 cases died (9.3%).Conclusion Physical examination,careful cardiac auscultation,reasonable use of ultrasoundcardiogram and a more than 6-month follow-up in newborns are cheap and effective methods for early diagnosis of CHD,and can decrease infant mortality rate.