先天性心脏病流行病学材料.ppt

Congenital heart malformation:Prevalence,severity,survival,and quality of life 先天性心脏病流行病学先天性心脏病流行病学 The lowest values/1000 live births Author Region Fyler 2.10 New England,USA Gardiner 2.17 Toronto,Canada Akman 3.20 Bogalusa,USA MacMahon 3.20 Birmingham,UK Mckeown 4.20 Birmingham,UK Bosi 4.60 Italy Bierman 4.70 Hawaii Prevalence of congenital heart malformation at birth the highest values/1000 births author Region Fischer 8.20 Tyrol,Austria Kerrebijn 8.26 Leiden ,Netherland Grech 8.80 Malta Hoffmann 8.82 San Francisco,USA Meberg 9.02 Norway Nakazawa 10.00 Japan Manetti 12.30 Florence,Italy Yerushalmi 11.70 California,USA Prevalence of congenital heart malformation at birth The oldest surveys/1000 live births Author Date Prevalence()Macmahon 194049 3.23 Carlgren 1941 50 6.35 Harris 194450 5.90 Pleydell 194457 3.20 Landtman 1945 63 8.00 Richards 194653 5.50 Gardiner 194849 2.17 Mustachi 194951 5.88 Prevalence of congenital heart malformation at birth Recent data/1000 live births Author Date Prevalence()Grech 1990-94 8.80 Robida 1984-94 12.23 Bosi 1992-93 4.60 Anderson 1987-90 10.20 Cerboni 1988-90 6.08 Ferencz 1981-89 4.23 Pexieder 1986-87 6.04 Meberg 1982-88 9.02 Prevalence of congenital heart malformation at birth Prevalence of congenital heart malformation at birth Regional differences/1000 live births Region Mean Range difference place Europe 6.67 3.20 Birmingham,UK 12.30 Florence,Italy USA 5.76 3.20 Bogalusa 8.56 San Francisco Canada 3.97 2.17 Toronto 5.54 Alberta Other countries 8.97 6.08 Guadeloupe Yearly fluctuation in Bohemian data from 1980 through 1989 Year No.of malformation Prevalence/1000 1980 646 7.04 1981 547 6.39 1982 568 6.77 1983 548 6.73 1984 566 6.97 1985 495 6.16 1986 436 5.53 1987 455 5.82 1988 402 5.11 1989 367 4.80 Prevalence of congenital heart malformation at birth The prevalence was highest in October,and lowest in December,June and July.The peak of the prevalence coincided with the epidemics of influenza in early pregnancy 8 and 9 months previously.There was a definite seasonal variation Ratio of boys to girls Boys to girls with CHD:51.9%to 48.1%A higher proportion of boys was found with:DORV(2.68:1);HLHS(2.25:1)cTGA (2.11:1);A higher proportion of girls was found with:PDA(1:1.66);Ebsteins malformation(1:1.57)Common arterial trunk(1:1.22)Distribution of congenital heart malformation VSD 41.59%ASD 8.67%Aortic stenosis 7.77%Pulmonary stenosis 5.81%cTGA 5.39%Aortic coarctation 5.29%PDA 5.07%Greater than 5%of the overall number of malformation Distribution of congenital heart malformation AVSD 4.00%HLHS 3.42%TOF 3.36%DORV,common arterial trunk and pulmonary atresia 1.05-1.37%TAPVC 0.80%Tricuspid 0.78%Ebstein malformation 0.44%Interrupted aortic arch 0.44%Spontaneous closure in 576 of 2092 recognized ventricular Septal defects,accounting for 27.5%of the cases Critical heart malformation in neonates,10 most frequent Number proportion of total Malformations number seen(%)cTGA 102 84 Pul atresia 39 74 Coarctation 34 49 HLHS 34 94 Tricuspid atresia 13 77 DORV 20 50 VSD 8 8 Common AT 8 50 TOF 7 28 Critical heart disease:which threaten life,which manifested by severve Congestive heart failure,deep cyanosis,or both symptoms 0%0%5%5%10%10%15%15%20%20%25%25%一个月以内一个月以内一岁以内一岁以内五岁以内五岁以内15岁以内15岁以内死亡率死亡率Death rate of children born with CHD Survival in most frequent cardiac malformation CHD Number survival(%)at age of 1 5 15yrs VSD 2097 91 90 89 ASD 436 94 93 93 Aortic stenosis 391 90 89 88 PS 292 96 96 96 cTGA 271 62 56 54 Coarctation 266 68 65 65 PDA 255 91 91 91 AVSD 201 62 55 54 HLHS 172 0 0 0 TOF 169 84 78 77 Questionnaires,1564例例8-13岁岁 先心病患儿生存先心病患儿生存质量调查质量调查 83.2%未用任何药未用任何药 3.2%体能差体能差 59.5%可参加娱乐消遣性活动可参加娱乐消遣性活动 6.7%可参加竞争性的运动可参加竞争性的运动 35.5%上学延迟上学延迟 6.9%学习差学习差 身高及体重与同龄人无区别身高及体重与同龄人无区别 先心病儿给父母造成心理紧张先心病儿给父母造成心理紧张 生活质量生活质量