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目的:探讨孕早期环境因素对儿童先天性心脏病(CHD)的影响。方法:收集2011年6月~2013年12月在深圳市妇幼保健院出生的汉族CHD患儿100例作为病例组,按照配对(1∶1)病例对照研究选取同期同医院同民族体检正常的儿童100例作为对照组,通过问卷调查及多因素Logistic回归分析方法,分析CHD可能的危险因素。结果:病例组患儿CHD的主要类型有室间隔缺损51例(51.0%)、房间隔缺损32例(32.0%)、动脉导管未关闭12例(12.0%)、其他5例(5.0%)。应用卡方检验筛选其中孕前6个月慢性病史、严重早孕反应、孕早期感冒、孕妇职业危险因素接触史、孕妇异常生育史、孕妇流产史、孕早期服药史、母亲被动吸烟、丈夫职业危险因素接触史、丈夫饮酒史、孕前补充维生素和补充微量元素等因素,两组间差异具有统计学意义(P<0.05);多因素Logistic回归分析发现,孕前补充维生素和微量元素与CHD发生呈现负相关关系;孕前6个月慢性病史、孕妇职业危险因素接触史、孕早期感冒、孕妇异常生育史、母亲被动吸烟和丈夫职业危险因素接触史与CHD发生呈现正相关关系。结论:儿童发生CHD与父母双方的某些习惯或者孕前的某些状况都有关系,应加强父母双方怀孕的整个过程的健康教育,保健服务以及减少对危险因素接触,从而减少和预防CHD的发生。
Objective: To investigate the influence of environmental factors in early pregnancy on children with congenital heart disease (CHD). Methods: 100 CHD children born in Shenzhen MCH from June 2011 to December 2013 were selected as the case group. According to the matched case-control study (1: 1), the children with CHD 100 cases as the control group, through questionnaires and multivariate Logistic regression analysis, the possible risk factors for CHD were analyzed. Results: The main types of children with CHD were 51 cases of ventricular septal defect (51.0%), 32 cases of atrial septal defect (32.0%), 12 cases (12.0%) of patent ductus arteriosus without closure and 5 cases (5.0%) of other cases. Chi-square test was used to select 6 months before pregnancy, chronic disease history, severe early pregnancy reaction, early pregnancy cold, exposure history of occupational risk factors of pregnant women, pregnant women abnormal birth history, abortion history of pregnant women, early pregnancy medication, passive smoking mothers, husband occupational risk factors (P <0.05). Logistic regression analysis showed that there was a negative correlation between pre-pregnancy supplementation of vitamins and trace elements and the occurrence of CHD Relationship between CHD incidence and history of chronic occupational diseases, exposure history of occupational risk factors of pregnant women, history of common cold, abnormal pregnancy history of pregnant women, passive smoking of mother and occupational risk factors of husband were positively correlated. CONCLUSIONS: CHD in children is associated with certain habits of both parents and prenatal conditions. Health education and health care services should be strengthened throughout the pregnancy, and exposure to risk factors should be reduced to reduce and prevent the occurrence of CHD .