Chen Gang,Guan Li,Chen Weicheng,et al.Preliminary management experience of integrated congenital heart disease diagnosis and treatment during perinatal period[J].Journal of Clinical Pediatric Surgery,2021,20(06):525-531.[doi:10.12260/lcxewkzz.2021.06.005]
先天性心脏病产前产后诊治一体化管理初步经验
- Title:
- Preliminary management experience of integrated congenital heart disease diagnosis and treatment during perinatal period
- Keywords:
- Heart Diseases/CN; Heart Defects; Congenital/SU; Heart Defects; Congenital/DI; Peripartum Period; Integrated Diagnosis and Treatment
- 分类号:
- R541;R493.28;R541.92
- 摘要:
- 目的 探索先天性心脏病（简称先心病）产前及产后诊断治疗一体化管理初步经验。方法 本研究为前瞻性临床队列研究，纳入2018年1月至2019年12月在孕早期建卡并在孕早中晚期规律产检、分娩或终止妊娠及进行产后新生儿先心病筛查的孕妇作为研究对象，共计70 805例。对产前诊断胎儿先心病的孕妇提供多学科咨询，并用双指标法对全组分娩新生儿进行产后先心病筛查，对危重先心病在新生儿期进行治疗。结果 70 805例建卡孕妇中，新发现心脏筛查阳性早、中、晚孕期分别为41例（41/70 805）、729例（729/70 433）和22例（22/70 023），引产318例（318/792）。双指标法先心病筛查率99.98%（69 996/70 023），筛查阳性率2.1%（1 470/70 023）。其中1 396例进行了超声心动图检查评估。共220人次进行围产期先心病产前咨询，进行咨询后未引产人数为164人次，保留率为74.5%，同期未咨询者保留率为54.2%，差异有统计学意义（χ2=27.38，P<0.001）。宫内转运先心病胎儿孕妇13例，出生后新生儿转运37例，无一例转运中发生死亡。13例宫内转运危重患者均接受急诊/亚急诊手术治疗。体重2.3~3.6 kg，手术年龄16 h至4天，手术方式：大动脉调转术4例，肺静脉异位引流纠治术3例，主动脉弓重建术1例，肺动脉瓣经皮穿刺球囊扩张术5例。37例产后转运的新生儿中，25例进行了亚急诊手术治疗，包括13例外科主动脉缩窄纠治术，9例主动脉缩窄球囊扩张术，3例肺动脉瓣狭窄球囊扩张术。25例亚急诊手术患者手术年龄7~14 d，全组无手术死亡病例，住院14~32 d，无严重手术并发症。结论 探索符合中国国情的先心病围产期一体化管理策略，标准化先心病产前诊断筛查流程，提高围产期先心病的产前产后诊断一致性，可以进一步降低严重出生缺陷的发生率，切实改善危重复杂先心病的手术预后。
- Abstract:
- Objective To explore the preliminary management experience of integrated congenital heart disease (CHD) diagnosis and treatment during perinatal period.Methods For this prospective cohort clinical trial,a total of 70,805 pregnant women were recruited from January 2018 to December 2019.Ever since early pregnancy registration,all participants received regularly antenatal examinations,delivery or termination of pregnancy.Their offspring was screened for congenital heart disease after delivery.Prenatal multidisciplinary counseling was provided for pregnant women with CHD fetuses.After delivery,pulse oximetry plus clinical evaluations were employed for CHD screening.Critical CHD was intervened during the neonatal period.Results Among them,41/70805,729/70433 and 22/70023 cases of cardiovascular malformation were detected in early,middle and late pregnancy respectively.And 318/792 cases underwent induced abortion,99.98% of neonates received postnatal CHD screening with a positive rate of 2.1%(1470/70023) and 95% of screening positive cases received echocardiography to make a definite diagnosis.Antenatal counseling was offered to 220 prenatal examination positive cases.And 164 cases had no induced abortion and it showed a higher rate of non-abortion compared with those without counseling (74.5% vs. 54.2%, χ2=27.38,P=0.000).Thirteen intrauterine fetuses and 37 neonates were transferred non-eventfully to qualified delivery facilities and cardiovascular centers.All 13 critical CHD neonates received emergency or sub-emergency operation,their weight range was 2.3 to 3.6 kg and operative age 16 hours to 4 days.The classification of operation was arterial switch (n=4),TAPVC correction (n=3),aorta arch reconstruction (n=1) and percutaneous balloon pulmonary valvuloplasty (n=5).And 25/37 neonates underwent sub-emergency operations of aortic arch reconstruction (n=13),percutaneous aortic balloon angioplasty (n=9) and percutaneous balloon pulmonary valvuloplasty (n=3).The hospitalization stay of 38 cases was (14-32) days.There was no operation-related mortality or severe complications.Conclusion Integrated perinatal management strategy is feasible and effective for CHD children.Prenatal screening and diagnostic process enhance the consistency of prenatal and postpartum diagnosis,reduce the incidence of severe birth defects and improve the prognosis of complex surgical repairs of CHD.
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备注/Memo
收稿日期:2021-03-31;。
通讯作者:贾兵,jiabing2012@hotmail.com