摘要
目的通过应用7项先天性心脏病（简称先心病）筛查指标和超声心动图诊断技术，评价先心病筛查-诊断-评估体系在中国社区／乡镇医院的运行效果，为进一步推广和实现社区／乡镇医院先心病的早期发现治疗提供依据。方法①先心病的筛查：选取5个调查现场（上海市闵行区、江苏省昆山市、山东省宁阳县、重庆市涪陵区和北京市怀柔区），由经过培训合格的儿科和儿童保健科医生对0～3岁儿童进行筛查。筛查指标包括先心病家族史、呼吸急促、紫绀、特殊面容、心脏杂音、经皮血氧饱和度和其他先天性畸形等7项，≥1项阳性者为筛查阳性。②先心病的诊断：由培训合格的儿科超声心动图医生对上述筛查中发现异常的儿童进行诊断。③先心病的评估：由儿科心血管专科医生对诊断为先心病的儿童进行评估。④先心病的信息化管理：建立社区／乡镇医院先心病儿童的网络信息化管理系统，将上述筛查、诊断和临床评估的数据进行网络化填报，实现远程数据管理。结果①先心病的筛查：2011年8月1日至2012年8月1日，共对63839名儿童进行了先心病的筛查（应答率96．9％），筛查阳性者736名。②先心病的诊断：734／736名筛查阳性儿童接受了超声心动图检查，确诊为先心病278例（先心病发病率为4．4％0），其中，室间隔缺损138例、房间隔缺损77例、动脉导管未闭36例、肺动脉狭窄8例、法洛四联症7例、肺动脉闭锁3例、房室间隔缺损3例、肺静脉异位引流2例、主动脉缩窄2例、单心室2例。（驴项和3项（心脏杂音＋紫绀＋经皮血氧饱和度）筛查指标检出先心病的敏感度均为95．68％，特异度分别为99．26％和99．32％，7项和3项筛查指标阳性预测值和阴性预测值均在同一水平；④先心病的评估：278例诊断为先心病的患儿均接受了评估，至研究结束122例患儿接受了外科手术，均恢复良好，其余患儿均纳入随访。结论在中国社区／乡镇医院建立先心病筛查一诊断一评估体系可以实现先心病的早期发现、早期诊断，并可及时进行干预。
Objective To assess the feasibility of implementing screening-diagnosis-evalation system in the rural areas of China, and to provide evidence for widespread use of the system. Methods ①Screening for CHD ： Five survey sites （ Minhang, Kunshan, Ningyang, Fuling and Huairou） were selected. The children aged 0 - 3 years were screened by trained and qualified pediatricians and child care physicians. Positive-screened result was defined as one or more of the indicators including family history of CHD, difficulty in breathing, cyanosis, special face, heart murmur, abnormal pulse oximetry, and other congenital malformations. ②iagnosis of CHD： For children with positive result in screening, diagnosis was made by qualified pediatric echocardiographers who had taken standardized training. ③Evaluating for CHD： Assessment was made by qualified pediatriccardiologists. @ Information management of CHD： Network system for the children with CHD in rural areas was established. The data were filled in by network for remote management. Results @Screening for CHD： From August 1 st 2011 to August 1 st 2012, screening was performed for a total of 63,839 children, including 23 637 cases in Minhang, 16 338 in Kunshan, 10 031 in Ningyang, 9 833 in Fuling and 4 000 in Huairou. Among those, 736 cases had positive-screened results. @Diagnosing for CHD ： Echocardiographic diagnosis was performed in 734 cases of positive-screened children, among them, 278 cases were confirmed as CHD patients, accounting for 4.4%o of the screened population, including ventricular septal defect （ 138 cases）, atrial septal defect （77 cases）, patent ductus arteriosus （ 36 cases）, pulmonary stenosis （ 8 cases）, tetralogy of Fallot （7 cases）, pulmonaE atresia （3 cases）, atrioventricular septal defect （3 cases）, total anomalous pulmonary venous return （2 case）, aortic coarctation （2 case） and single ventricle （2 case）. ③7 and 3-indicator combination （ murmur ＋ cyanosis ＋ abnormal pulse oximetry） had the same sensitivity for screening CHD （95.68%） , the specificity was 99.26% and 99.32%, respectively. Positive predictive value and negative predictive value of 7 and 3-indicator combination had no significant difference. ④Evaluating for CHD ： All of＇ the 266 cases diagnosed as CHD were undertaken assessment. Among them, 122 cases received surgery and had good outcome, and the remaining were followed up without obvious symptoms. Conclusion Establishment of the screening-diagnosis-assessment system for CHD can achieve early detection, early diagnosis and timely intervention for the patients in the rural areas of China.
出处
《中国循证儿科杂志》
CSCD
2013年第5期321-325,共5页
Chinese Journal of Evidence Based Pediatrics
基金
卫生部卫生行业科研专项项目:农村地区儿童先天性心脏病的筛查和诊断技术应用(201002006)
作者简介
通讯作者黄国英，E—mail：gyhuang@shmu．edu．cn
