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目的:分析68例0~6岁儿童保健体检出心脏杂音特征对心脏病诊断的重要性和筛查心脏病的意义。方法:抽选社区2012~2014年进行0~6岁儿童保健体检且听诊到心脏有杂音的68例儿童做专案管理,并转诊至上级医院做心肌酶和心脏彩超等方面检查确定心脏产生杂音的原因和疾病。结果:经上级医院诊断后,生理性杂音占比54%,高于病理性杂音的46%;病理性杂音中先天性心脏病占比68%,高于继发性心脏病的32%;年龄在1岁以下的儿童诊断出先天性心脏病的占比86%,高于1~6岁儿童的14%,而该年龄段诊断出继发性心脏病和生理性杂音的占比(30%和14%)却明显低于1~6岁儿童对应疾病(70%和86%)。因此,在1岁以下的儿童,其心脏杂音诊断中属于先天性心脏病的比例高于继发性心脏病和生理性杂音。结论:经过社区初步保健体检和上级医院的明确诊断后发现引发心脏出现杂音的主要原因就是先天性心脏病和继发性心脏病,即病理性杂音。因此,社区应对0~6岁儿童进行定期免费保健体检,及时筛查出影响儿童生长和发育的疾病,做好基层社区儿童的保健工作,及时的发现儿童所患疾病,并做好早期的治疗工作。
OBJECTIVE: To analyze the importance of heart murmur characteristics in diagnosis of heart disease in 68 children aged 0-6 years old and the significance of screening heart disease. Methods: A total of 68 children aged from 6 to 6 years old with health examination and auscultation to heart murmur from 2012 to 2014 were selected to do project management, and were referred to higher level hospitals for cardiac enzymes and echocardiography examination to confirm heart murmur Cause and disease. Results: Physiological murmurs accounted for 54% of the total, accounting for 46% of the pathological murmurs. Pathological murmurs accounted for 68% of congenital heart diseases, 32% higher than those of secondary heart diseases. Age 86% of children under 1 year of age diagnosed with congenital heart disease, compared with 14% of children aged 1 to 6 years old, and diagnosed secondary heart disease and physiological noise in this age group (30% And 14%) were significantly lower than those of children aged 1 to 6 (70% and 86%, respectively). Therefore, in children under 1 year of age, the diagnosis of heart murmur is higher than the proportion of congenital heart disease secondary to heart disease and physiological noise. Conclusion: After the community primary health examination and a clear diagnosis of superior hospitals found that the main cause of heart murmur is congenital heart disease and secondary heart disease, that is, pathological murmur. Therefore, the community should conduct regular free health checkups for children aged 0-6, timely screening out diseases that affect the growth and development of children, do well in the health care of children in grass-roots communities, timely find out the diseases in children and make early treatment jobs.