【摘要】 目的探讨急诊床旁超声心动图(EB-Echo)在新生儿青紫的诊断、鉴别诊断及临床处置中的应用价值。方法回顾性分析复旦大学附属儿科医院2010年4月1日至2014年3月31日收治的因临床表现为吸氧不能缓解的青紫而进行EB-Echo检查的新生儿,共218例。其中男148例,女70例。首次接受超声心动图检查的年龄为1~28 d,平均(4.3±5.2)d。结果 218例新生儿中,129例(59.2%)患儿为心脏原因引起的青紫,心脏占位1例和复杂性先天性心脏病128例。包括大动脉转位(TGA)41例,完全性肺静脉异位引流(TAPVD)16例,肺动脉闭锁(PA)21例,极重度肺动脉瓣狭窄(PS)8例,重度法洛四联症(TOF)5例,左心发育不良综合征(HLHS)4例,其他复杂先天性心脏病33例。TGA 23例、TAPVD 7例、PA 5例和PS 8例进行了手术或介入治疗,除了2例TGA和1例TAPVD术后死亡外,均恢复良好。89例(40.8%)患儿为非心脏原因引起的青紫,包括40例肺源性和49例持续胎儿循环(PPHN),给予积极治疗后3例死亡,其余均好转。结论 EB-Echo可在床旁快速准确地对青紫新生儿做出诊断和鉴别诊断,对于制订合理的处理方案、降低青紫新生儿后遗症发生率和病死率具有重要意义。更多还原

【Abstract】 Objective To discuss the clinical practice of emergency bedside-echocardiograph Y in cyanosis neonates.Methods We analyzed cyanosis neonates in Neonatal Intensive Care Unit(NICU)who received EB-Echo from 2010 Apr.1to 2014 Mar.31 retrospectively. We enrolled 218 cases,male∶female=148∶70,aged from 1 day to 28 days,with an average age of 4.3±5.2 days. Analyze the echocardiography diagnosis and other clinical diagnoses and treatments. Results In 218 cases,129(59.2%)cases were due to cardiogenic reasons:1 case was cardiac tumor and the other 128 cases were complex congenital heart disease,including 41 cases of transposition of the great arteries(TGA),16 cases of total anomalous pulmonary venous drainage(TAPVD),21 cases of pulmonary atresia(PA),8 cases of severe pulmonary stenosis(PS),5 cases of severe tetralogy of Fallot(TOF),4 cases of hypoplastic left heart syndrome(HLHS),and 33 cases of other kinds of complex congenital disease. Totally 23/41 cases of TGA,7/16 cases of TAPVD,5/21 cases of PA and 8/8 cases of PS received operation or interventional therapy,followed-up by echocardiogram. Only 2 cases of TGA and 1 case of TAPVD died during perioperative period,others had good recovery. Totally 89(40.8%)cases were due to non-cardiogenic reasons,including 40 pulmonary disease cases and 49 cases of persistent pulmonary hypertension of neonate(PPHN). Three died after appropriate treatment,and the rest became better. Conclusion EB-Echo is safe and convenient. It can make rapid and accurate diagnosis and differential diagnosis of newborn cyanosis by bedside,which had important significance in establishing the reasonable treatment and reducing the sequelae and mortality of newborn cyanosis.更多还原