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目的探讨脉搏血氧仪筛查先天性心脏病的效果。方法选择2010年1月至2013年12月在我院新生儿科住院且无紫绀的足月新生儿,随机分为脉搏血氧仪组和体格检查组。脉搏血氧仪组应用脉搏血氧仪测量肢体的脉搏血氧饱和度筛查先天性心脏病,体格检查组由医生行心脏听诊筛查先天性心脏病。计算两组筛查的敏感度、特异度、阳性预测值和阴性预测值,记录筛查结果为假阴性的新生儿需行手术治疗的例数。结果脉搏血氧仪组完成随访4 277例,确诊先天性心脏病514例,其中筛查阳性407例,假阴性107例;体格检查组完成随访3 827例,确诊先天性心脏病663例,其中筛查阳性299例,假阴性364例。单纯房间隔缺损、房间隔缺损+动脉导管未闭、单纯动脉导管未闭脉搏血氧仪组筛查阳性率高于体格检查组,差异有统计学意义(P<0.05)。脉搏血氧仪组敏感度79.2%,特异度85.6%,阳性预测值42.9%,阴性预测值96.8%。体格检查组敏感度45.1%,特异度83.2%,阳性预测值35.9%,阴性预测值87.8%。两组筛查结果为假阴性的新生儿需行手术治疗的比例差异无统计学意义(2/107比4/364,P>0.05)。结论应用脉搏血氧仪筛查先天性心脏病简单方便、准确性高。
Objective To investigate the effect of pulse oximetry in screening congenital heart disease. Methods From January 2010 to December 2013 in our hospital neonatal hospitalized without cyanosis full-term newborns, were randomly divided into pulse oximeter group and physical examination group. The pulse oximeter was used to measure the pulse oximetry of the limbs to screen the congenital heart disease. The physical examination group was diagnosed as congenital heart disease by the doctor. The sensitivity, specificity, positive predictive value and negative predictive value of the two groups of screening were calculated. The number of cases requiring surgical treatment for the newborn with false negative results was recorded. Results A total of 4 277 cases of congenital heart disease were diagnosed in the pulse oximeter group, including 514 cases of positive congenital heart disease and 107 cases of false negative results. The follow-up of 3827 cases of physical examination group was confirmed and 663 cases of congenital heart disease were diagnosed There were 299 positive cases and 364 false negative cases. Atrial septal defect, atrial septal defect + patent ductus arteriosus, patent ductus arteriosus pulse oximetry positive rate higher than the physical examination group, the difference was statistically significant (P <0.05). The pulse oximeter group had a sensitivity of 79.2%, a specificity of 85.6%, a positive predictive value of 42.9% and a negative predictive value of 96.8%. The physical examination group had a sensitivity of 45.1%, a specificity of 83.2%, a positive predictive value of 35.9% and a negative predictive value of 87.8%. There was no significant difference in the proportion of surgical treatment between two groups of false-negative neonates (2/107 vs 4/364, P> 0.05). Conclusion The application of pulse oximetry to screen congenital heart disease is simple and convenient with high accuracy.