先天性心臟病的臨床觀察

Clinical Observation of Congenital Heart Diseases

呂鴻基(Hung-Chi Lue) ； 單克敏(Mary K. M. Shann) ； 陳烱霖(Ching-Lin Chen)

《Acta Paediatrica Sinica》 9卷1期 (1968/03) Pp. 1-13

摘要

民國47年至56年的10年間，在臺大醫院小兒科住院的先天性心臟病人共有600名，佔全部住院病兒總數的3.6%。每年的先天性心臟病例數，隨著住院病兒總數的增加而增加，尤以最近一年的增加為特別顯著。
先天性心臟病的病發數，不因出生胎別或季節而不同。主要的種類及發生頻度與美國及加拿大的報告相似，唯大動脈瓣膜狹窄及大動脈縮窄的病發數比較少。按泰國的報告亦然，是否此類大動脈畸型東亞人特別少，需待以後的研究來證實。最常見的先天性心臟病爲心室中隔缺損，佔33.4%，其次是法洛氏四徵症，佔 19.8%，第三位是存開性動脈管，佔11.3%，第四位是心房中隔缺損，佔6.5%，第五位是肺動脈瓣膜狹窄，佔3.2%，第六位是大血管轉位，佔3.0%，第七位是大動脈縮窄，佔2.8%，第八位是三尖瓣閉鎖，佔1.7%，第九位是大動脈瓣膜狹窄，佔0.2%。
存開性動脈管以女孩為較多，大動脈縮窄及大動脈轉位以男孩爲較多，心房中隔缺損的男女發生頻率則沒有顯著的差別。600例中存有心臟衰竭症狀者149例，佔24.8%。心臟衰竭發生年齡在生後6個月以內者最多，佔50.2%，在生後1年以內發生者佔69.8%。心臟衰竭初期症狀為呼吸促迫，食慾減退，及肝腫大。發病經過緩慢，不容易做到早期診斷。600例中有發紺者168例，佔28%。在生後1個月以內發紺者90例，佔53.3%，在出生後1年以內出現者153例，佔90.6%。
住院時有併發症者299例，佔49.8%，以肺炎爲最多。600例中接受外科手術治療者僅78例，大部分爲閉心式手術，利用人工心肺施行開心式手術者有9例。住院期間或直後死亡者有125例，其病例死亡率爲21.0%。出生後6個月以內死亡者69例，佔全部死亡例的55.2%。在生後1年以內死亡者95例，佔76.0%。
著者並參考有關文獻，論及先天性心臟病的發生頻率，病因，臨床經過，以及內外科治療術策，且認爲先天性心臟病已不再是難治之病，如果及時施以現代醫學的恩惠，即不難將不治死去的大半的病兒救回。

並列摘要

During the past 10 years from 1958 to 1967, a total of 600 cases of congenital heart disease were admitted to the Department of Pediatrics of the National Taiwan University Hospital. The ratio of the number of patients of congenital heart disease to the total number of patients of 16,658 admitted to the Pediatric Ward of the hospital during the same period was 36 per 1,000 admissions.
The number of cases of congenital heart disease admitted have been increasing every year at a similar rate as that of the increase of the total number of admissions. Birth rank and season seemingly bore no causative relevance to the number of births with congenital heart disease.
The frequencies and types of congenital heart diseases were quite comparable to those reported by the Toronto and Boston groups, except that the frequencies of aortic stenosis and coarctation of the aorta were found much smaller, the reasons for which remain to be studied. In 460 cases the cardiac anomalies were studied by cardiac catheterization, operation, postmortem examination, and/or in a few cases by clinical means including detailed physical examination, chest X-ray films and electrocardiography. The ratios of the 9 leading anomalies were: ventricular septal defect 32.4%, tetralogy of Fallot 19.8%, patent ductus arteriosus 11.3%, atrial septal defect 6.5%. pulmonic stenosis with intact ventricular septum 3.3%, transposition of the great vessels 3.0%, coarctation of the aorta 2.8%, tricuspid atresia 1.7%, and aortic stenosis 0.2%.
There was a preponderance of males in transposition of the great vessels and coarctation of the aorta. Females predominated in patent ductus arteriosus but not in atrial septal defect.
Among 600 cases, 149 cases or 24.8 % were admitted to the hospial with congestive heart failure, of which 50.2% occurred between birth and 6 months of age, and 69,8% before the first year of life. Of 600 cases, 168 cases or 28.0% were noted to have generalized cyanosis, of which 53.3% developed within 1 month after birth and 90.6% had developed before the first year of life. In 299 cases or 49.8%, one or more complications were noted at the time of admission. Pneumonia' was the most common complication.
Death occurred in 125 cases during admission or soon after discharge. Of these fatal cases 55.2% died before 6 months and 76.0% before 1 year of age. Among 600 cases of congenital heart disease, only 78 cases were operated upon, of which 69 by closed heart surgery and 9 by open heart surgery.