Verheijen P M, Lisowski L A, Stoutenbeek P, Hitchcock J F, Brenner J I, Copel J A, Kleinman C S, Meijboom E J, Bennink G B
Departments of Obstetrics, Pediatric Cardiology, and Thoracic Surgery, University Medical Center, 3508 AB Utrecht, The Netherlands.
J Thorac Cardiovasc Surg. 2001 Apr;121(4):798-803. doi: 10.1067/mtc.2001.112825.
Congenital heart disease is the leading cause of death in the first year after birth. Prenatal diagnosis of the disease can optimize the preoperative condition of the patient and may help in the prevention of acidosis. In this retrospective study we compared the occurrence of metabolic acidosis in patients with and without prenatal diagnosis of a congenital heart disease.
Data of 408 patients who needed an operation for congenital heart disease within 31 days of life were analyzed retrospectively. Arterial blood gases at fixed time intervals and worst blood gas of 81 patients with and 327 patients without a prenatal diagnosis were compared, categorizing the patients on ductus dependency, anticipated univentricular or biventricular repair, and left-sided, right-sided, or no heart obstruction.
In the overall group significant differences in lowest pH, lowest base excess, and highest lactate level were found, with metabolic acidosis more common among the patients with a postnatal diagnosis. In the group of patients with ductus-dependent congenital heart disease, the difference between patients receiving a prenatal and those receiving a postnatal diagnosis was more significant than in the group with non-ductus-dependent lesions. Analyzing patients with right-sided, left-sided, and no obstruction separately, significant differences were found in the group with left-sided heart obstruction for lowest pH and base excess and in the group with right-sided heart obstruction for lowest base excess.
Prenatal diagnosis of congenital heart disease minimizes metabolic acidosis in patients with congenital heart disease and may be associated with improved long-term outcome and prevention of cerebral damage among this fragile group of patients, although no significant effect on direct surgical outcome was encountered.
先天性心脏病是出生后第一年的主要死因。该疾病的产前诊断可优化患者的术前状况，并有助于预防酸中毒。在这项回顾性研究中，我们比较了产前诊断为先天性心脏病和未产前诊断为先天性心脏病的患者中代谢性酸中毒的发生率。
回顾性分析408例在出生后31天内需要进行先天性心脏病手术的患者的数据。比较了81例产前诊断患者和327例未产前诊断患者在固定时间间隔的动脉血气和最差血气，并根据动脉导管依赖性、预期的单心室或双心室修复以及左侧、右侧或无心脏梗阻对患者进行分类。
在总体组中，发现最低pH值、最低碱剩余和最高乳酸水平存在显著差异，产后诊断的患者中代谢性酸中毒更为常见。在动脉导管依赖性先天性心脏病患者组中，产前诊断患者与产后诊断患者之间的差异比非动脉导管依赖性病变组更为显著。分别分析右侧、左侧和无梗阻的患者，左侧心脏梗阻组在最低pH值和碱剩余方面存在显著差异，右侧心脏梗阻组在最低碱剩余方面存在显著差异。
先天性心脏病的产前诊断可使先天性心脏病患者的代谢性酸中毒降至最低，并且可能与改善这一脆弱患者群体的长期预后和预防脑损伤有关，尽管未发现对直接手术结果有显著影响。
