Screening of Congenital Heart Disease at Different Time in Neonates in Anning Area by Auscultation Combined with Pulse Oximetry
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摘要:
目的 分析安宁地区新生儿出生后不同时间段采用心脏杂音听诊（MUR）联合脉搏氧饱和度（POX）筛查先天性心脏病（CHD）的价值。 方法 选取于2021年6月至2022年11月间安宁市第一人民医院产科出生的新生儿及转新生儿科住院的患儿共1833例为研究对象。根据日龄分为24～72 h组（575例）、2～4周组（1258例）均采用心脏杂音听诊（MUR）联合脉搏氧饱和度（POX）“双指标法”筛查CHD，并对研究对象进行心脏彩超检查，记录新生儿出生后不同时间段心脏杂音听诊联合脉搏氧饱和度筛查CHD情况及应价值。 结果 1833例新生儿中，经心脏超声确诊的先心病68例，发病率3.71%，位于前3位的疾病类型分别为室间隔缺损23例（33.82%），房间隔缺损22例（32.35%），卵圆孔未闭16例（23.53%）；24～72 h组心脏杂音听诊联合脉搏氧饱和度检测筛查阳性率为12.00%，漏诊率39.13%；2～4周组筛查阳性率为5.88%，漏诊率28.89%，筛查阳性率χ2 = 2.474，漏诊率χ2 = 3.441，P < 0.05；24～72 h组心脏杂音听诊联合脉搏氧饱和度检测筛查灵敏度60.87%，特异度90.04%，准确度为88.87%，假阳性率79.71%，假阴性率1.78%，阳性预测值20.29%、阴性预测值98.22%，约登指数0.5089；2～4周组筛查灵敏度71.11%，特异度96.54%，准确度为95.63%，假阳性率56.76%，假阴性率1.10%，阳性预测值43.24%、阴性预测值98.90%，约登指数0.6764，灵敏度χ2 = 8.325，特异度χ2 = 7.051，P < 0.05。 结论 对新生儿出生后采用心脏杂音听诊（MUR）联合脉搏氧饱和度（POX）筛查CHD，筛查时间段2～4周时准确率最高，漏诊率低，可提升新生儿出生质量，对促进安宁地区新生儿优生优育具有重要作用。 Abstract:Objective To study the value of heart murmur auscultation （MUR） combined with pulse oximetry （POX） in the screening of congenital heart disease （CHD） at different time periods after birth in Anning area. Methods A total of 1833 newborns born in the obstetrics department and referred to the Department of Neonatology of Anning First People’s Hospital from June 2021 to November 2022 were selected as the study subjects. According to the age, the subjects were divided into 24-72 hours group （575 cases） and 2-4 weeks group （1258 cases）. The double-index method of heart murmur auscultation （MUR） combined with pulse oxygen saturation （POX） was used to screen CHD. The value of heart murmur auscultation combined with pulse oxygen saturation in screening CHD at different time points after birth was recorded. Results Among the 1833 neonates, 68 were diagnosed with CHD by echocardiography, with an incidence rate of 3.71%.The top three types of CHD were ventricular septal defect （23 cases, 33.82%）, atrial septal defect （22 cases, 32.35%）, and patent foramen ovale （16 cases, 23.53%）. The positive rate of heart murmur auscultation combined with pulse oxygen saturation detection in 24-72 hours group was 12.00%, and the missed diagnosis rate was 39.13%. The screening positive rate of 2-4 weeks group was 5.88%, and the missed diagnosis rate was 28.89%, Screening positive rate χ2 = 2.474, missed diagnosis rate χ2 = 3.441, P < 0.05. In 24-72 hours group, the sensitivity of heart murmur auscultation combined with pulse oxygen saturation detection was 60.87%, and the specificity was 90.04%, the accuracy was 88.87%, the false positive rate was 79.71%, the false negative rate was 1.78%, the positive predictive value was 20.29%, the negative predictive value was 98.22%, and the Youden index was 0.5089. The screening sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value, negative predictive value and Youden index of 2-4 weeks group were 71.11%, 96.54%, 95.63%, 56.76%, 1.10%, 43.24%, 98.90% and 0.6764, respectively;sensitivity χ2 = 8.325, specificity χ2 = 7.051, P < 0.05. Conclusion For CHD screening of newborns after birth, heart murmur auscultation （MUR） combined with pulse oxygen saturation （POX） has the highest accuracy and low rate of missed diagnosis at 2-4 weeks of screening time, which can improve the birth quality of newborns and play an important role in promoting neonatal eugenic and eugenic care in Anning area. -
Key words:
- Heart murmur auscultation /
- Pulse oximetry /
- Congenital heart disease /
- Newborn
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表 1 患儿先心病分型及构成比情况
Table 1. Classification and constituent ratio of congenital heart disease in children
类型 n 构成比（%） 发病率（‰） 室间隔缺损 23 33.82 1.25 房间隔缺损 22 32.35 1.20 卵圆孔未闭 16 23.53 0.87 动脉导管未闭 3 4.41 0.16 室间隔缺损合并房间隔缺损 2 2.94 0.11 其他 2 2.94 0.11 
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表 2 不同时段筛查准确性比较[n（%）]
Table 2. Comparison of screening accuracy in different time periods[n（%）]
组别 阳性率 漏诊率 筛查人数（n） 心脏彩超（n） 灵敏
度特异
度假阳
性率假阴
性率阳性预
测值阴性预
测值阳性/阴性 阳性/阴性 24～72 h组（n = 575） 69/575（12.00） 9/23（39.13） 69/506 23/552 60.87 90.04 79.71 1.78 20.29 98.22 2～4周组（n = 1258） 74/ 1258（5.88） 13/45（28.89） 74/1184 45/1213 71.11 96.54 56.76 1.10 43.24 98.90
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