CAJ | 학술논문

目的回顾性分析胎儿先天性心脏病(先心病)分娩风险分级在先心病产前诊断、产后治疗一体化策略中的作用.方法依据美国费城儿童医院胎儿先心病分娩风险分级:Ⅰ级,分娩后血流动力学稳定的胎儿先心病;Ⅱ级,分娩后依赖动脉导管的胎儿心脏畸形;Ⅲ级,分娩后具有血流动力学不稳定高风险的胎儿先心病;IMPACT(分娩时立即心脏干预)级,脱离胎盘循环后血流动力学不稳定的胎儿心脏畸形.2006年8月至2010年5月,46例产前诊断先心病胎儿,其中Ⅰ级33例,Ⅱ级9例,Ⅲ级4例,无IMPACT级胎儿.结果分娩男婴39例,女婴7例,平均胎龄(38.0±1.4)孕周.出生后1周内,13例患儿接受心脏干预治疗,包括Ⅰ级2例、Ⅱ级7例、Ⅲ级4例,死亡1例.婴儿期心脏干预治疗7例,包括Ⅰ级5例,Ⅱ级2例,死亡1例.余26例Ⅰ级患儿随访到幼儿和学龄前期,外科手术7例,介入治疗17例,自愈2例,无死亡.结论胎儿先心病分娩风险分级将有利于细化产前诊断先心病胎儿出生后的治疗策略,使产前、产后一体化诊治的衔接更为紧密.其中产前确定的Ⅰ级胎儿大部分不需要过早的心脏干预治疗,Ⅱ级和Ⅲ级胎儿需要在新生儿科的配合下开展早期心脏治疗.
목적 회고성분석태인선천성심장병(선심병)분면풍험분급재선심병산전진단、산후치료일체화책략중적작용.방법 의거미국비성인동의원태인선심병분면풍험분급:Ⅰ급,분면후혈류동역학은정적태인선심병;Ⅱ급,분면후의뢰동맥도관적태인심장기형;Ⅲ급,분면후구유혈류동역학불은정고풍험적태인선심병;IMPACT(분면시립즉심장간예)급,탈리태반순배후혈류동역학불은정적태인심장기형.2006년8월지2010년5월,46례산전진단선심병태인,기중Ⅰ급33례,Ⅱ급9례,Ⅲ급4례,무IMPACT급태인.결과 분면남영39례,녀영7례,평균태령(38.0±1.4)잉주.출생후1주내,13례환인접수심장간예치료,포괄Ⅰ급2례、Ⅱ급7례、Ⅲ급4례,사망1례.영인기심장간예치료7례,포괄Ⅰ급5례,Ⅱ급2례,사망1례.여26례Ⅰ급환인수방도유인화학령전기,외과수술7례,개입치료17례,자유2례,무사망.결론 태인선심병분면풍험분급장유리우세화산전진단선심병태인출생후적치료책략,사산전、산후일체화진치적함접경위긴밀.기중산전학정적Ⅰ급태인대부분불수요과조적심장간예치료,Ⅱ급화Ⅲ급태인수요재신생인과적배합하개전조기심장치료.
Objective To explore the effects of delivery classification scale for fetal cardiac disease on the prenatal and postnatal integrated treatment strategies.Methods Delivery classification scale for fetal cardiac disease included:grade Ⅰ,no hemodynamics instability; grade Ⅱ,ducted-dependent lesions,stable hemodynamics anticipated;grade Ⅲ,possibility or likelihood of hemodynamic instability; IMPACT(delivery immediately heart intervention) level,hemodynamic instability is anticipated at separation from placental circulation.During August 2006 to May 2010,a retrospective study of 46 cases of prenatal diagnosis of congenital heart disease and delivery in one cardiac center was taken,in which 33 in grade Ⅰ,9 in grade Ⅱ,4 in grade Ⅲ,and no IMPACT.Results Thirty-nine boys and 7 girls were born at (38.0 ± 1.4) weeks of gestation and had consistent fetal diagnoses of mainly cardiac abnormalities with postnatal screen.Thirteen neonates underwent cardiac intervention within one week after birth with one death,including 2 in grade Ⅰ,7 in grade Ⅱ,4 in grade Ⅲ,of them 1 death.Seven infants including 5 in grade Ⅰ and 2 in grade Ⅱ underwent cardiac intervention with one death.The remaining 26 children in grade Ⅰ had uneventfully outcomes,in which 7 cases of surgical operation,17 cases of interventional therapy,2 cases of spontaneous healing.Conclusion Delivery classification scale for fetal cardiac disease should have some guiding significance for early treatment strategies and could enhance closely integration of prenatal diagnosis and postnatal treatment.The most fetuses in grade Ⅰ need not undergo cardiac interventions in neonatal stage.However,early cardiac intervention for fetuses in grade Ⅱ and Ⅲ should be carried out postnatally with the help of neonatologists.