心臟超音波是有效篩檢結構性心臟病的工具，不僅僅新發現的潛在性 結構性心臟病達 54.63%，且整體的結構性心臟病盛行率達 17.79%，是過 去文獻報告的兩倍．雖然篩檢每位學童平均費用因手攜式心臟超音波儀器 費用的增加導致較常規理學檢查多需要 205 元，但發現率提升而能早期診 斷防止猝死的發生，所以每發現一名病例平均費用反而比常規理學檢查發 現病例費用減少 14,336 元，尤其在延遲診斷且具有高生命威脅風險的類 型中，單一病例平均診斷費用，心臟超音波篩檢反而只需要常規理學篩檢 費用的 10%，心臟超音波篩檢是早期診斷潛在性心臟病而達到減少醫療成 本的有效工具。
我們的建議為推動全面性心臟超音波篩檢就如同接受疫苗預防注射 防止重大疾病感染一樣，不僅是防止心因性猝死的最佳策略更可減少醫療 成本，值得作為推動全民健康篩檢的依據。
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參考文獻
1. Yu, C. H., et al. “Heart disease screening of schoolchildren in Taiwan”, Archives of Pediatrics & Adolescent Medicine, 163(3), pp 233-237, 2009.
2. Chen, F. L., Pai, J. Y. “The economic evaluation of a health screening
program on congenital heart disease for school children in Taichung,Taiwan.”, Asia Pacific Journal of Public Health, 20(4), pp 307-316, 2008.
3. van der Bom, T., et al. “The changing epidemiology of congenital heart disease.”, Natural Reviews Cardiology, 8(1), pp 50-60, 2011.
4. Yun, S. W. “Congenital heart disease in the newborn requiring early intervention.”, Korean Pediatric Society, 54(5), pp 183-191, 2011.
5. Knowles, R., et al. “Newborn screening for congenital heart defects : a systematic review and cost-effectiveness analysis.” , Health technology assessment, 9(44), pp1-152, 2005.
6. Sadoh, W. E., Nwaneri, D.U., Owobu, A.C. “The cost of out-patient
management of chronic heart failure in children with congenital heart disease.”, Nigerian Journal of Clinical Practice, 14(1), pp 65-69, 2011.
7. Juttmann, R. E., et al. “Evidence-based prevention requires evidence-based performance.” , European Journal of Public Health, 12(3), pp 198-202, 2002.
8. Riede, F. T., et al. “Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine- results from a prospective multicenter study.”, European Journal of Pediatric, 169(8), pp 975-981, 2010.
9. Marijon, E., et al. “Prevalence of rheumatic heart disease detected by
echocardiographic screening.” ,The New England Journal of Medicine, 357(5), pp 470-476, 2007.
56
10. Yi, M. S., et al. “Evaluation of heart murmurs in children:
cost-effectiveness and practical implications.” ,The Journal of Pediatric, 141(4),pp 504-511, 2002.
11. Alboliras, E. T., Hijazi, Z. M. “Comparison of costs of intracardiac echocardiography and transesophgeal echocardiography in monitoring
percutaneous device closure of atrial septal defect in children and adults.”, The American Journal of Cardiology, 94(5), pp 690-692, 2004.
12. Woods, W. G., et al. “Screening of infants and mortality due to neuroblastoma.” ,The New England Journal of Medicine, 346(16), pp 1041-1046, 2002.
13. Bettex, D. A., et al. “Cost-effectiveness of routine intraoperative transesophageal echocardiography in pediatric cardiac surgery: a 10-year experience.”, Society for Pediatric Anesthesia, 100(5), pp 1271-1275, 2005.
14. Gupta, B., Antia, A. U. “Incidence of congenital heart disease in Nigeria children.”, British Heart Journal, 29(6), pp 906-909, 1967.
15. Veasy, L. G. “Time to take soundings in acute rheumatic fever”, Lancet, 357, pp 1994-1995, 2001.
16. Pelech, A. N., Neish, S. R. “Sudden death in congenital heart disease.”, Pediatric Clinics of North America, 51(5), pp 1257-1271, 2004.
17. Tavora, F., Li, L., Burke., A. “Sudden coronary death in children.”, Cardiovascular Pathology, 19(6), pp 336-339, 2010.
18. Chang, R. K., Rodriguez, S., Klitzner, T. S. “Screening newborns for congenital heart disease with pulse oximetry: survey of pediatric
cardiologists.” , Pediatric cardiology, 30(1), pp 20-25, 2009.
57
19. Koppel, R. I., et al. “Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns.”, Pediatrics, 111(3), pp 451-455, 2003.
20. Griebsch, I., et al. “Comparing the clinical and economic effects of clinical examination, pulse oximetry, and echocardiography in newborn screening for congenital heart defects: a probabilistic cost-effectiveness model and value of information analysis.”, International Journal of Technology Assessment in Health care, 23(2), pp 192-204, 2007.
21. Galasko, G. I., Lahiri, A., Senior, R. “Portable echocardiography：an innovative tool in screening for cardiac abnormalities in the community.”
European Journal of Echocardiography, 4(2), pp 119-127, 2003.
22. Lipczynska, M., et al. “Hand-carried echocardiography in heart failure and heart failure risk population: a community based prospective study.” Journal of the American Society of Echocardiography, 24(2), pp 125-131, 2011.
23. Wheeler, M. T., et al. “Cost effectiveness of pre-participation screening for prevention of sudden cardiac death in young athletes.” Annals of internal medicine,152 (5), pp 276-286, 2010.
24. Lim, T. K., et al. “Cost effectiveness of the B type natriuretic peptide, electrocardiography, and portable echocardiography for the assessment of patients from the community with suspected heart failure.”,
Echocardiography,24(3), pp 228-236, 2007.
25. Hoffman, J. I., Kaplan, S. “The incidence of congenital heart disease.” , Journal of the American College of Cardiology, 39(12), pp 1890-1990, 2002.
58
26. Mitchell, S. C., Korones, S. B., Berendes, H. W. “Congenital heart disease in 56,109 births. Incidence and natural history.”, Circulation, 43(3), pp
323-332, 1971.
27. Trambaiolo, P., et al. “A hand-carried cardiac ultrasound device in the
outpatient cardiology clinic reduces the need for standard echocardiography.”, Heart, 93(4), pp 470-475, 2007.
28. Lucas, B.P., et al. “Hand-carred echocardiography by hospitalists: a randomized trial.”, The American Journal, 124(8), pp 766-774, 2011.
29. Dalla Pozza, R., et al. “Hand-carried ultrasound devices in pediatric cardiology: clinical experience with three different devices in 110 patients.”
Journal of the American Society of Echocardiography, 23(12), pp 1231-1237, 2010.
30. Galasko, G. I., Lahiri, A., Senior, R. “Portable echocardiography: an innovative tool in screening for cardiac abnormalities in the community.”, European Journal of Echocardiography, 4(2), pp 119-127, 2003.
31. Quiles, J., García-Fernández, M.A., Almeida, P. B., Pérez-David, E., Bermejo, J., Moreno, M., Avanzas, P. “Portable spectral Doppler
echocardiographic device: overcoming limitations.”, Heart, 89(9), pp 1014-1018, 2003.
32. Coletta, C., et al. “Reliability of cardiac dimensions and valvular regurgitation assessment by sonographers using hand-carried ultrasound devices.”, European Journal of Echocardiography, 7(4), pp 275-283, 2006.
33. Campbell, J. D. “Straight-line method of depreciation.”, The Accounting Review, 26(1), pp 40-42, 1951.
34. Jackson, S. B., Liu, X. K., Cecchini, M. “Economic consequences of firms’
depreciation method choice: Evidence from capital investment.” Journal of
59
Accounting and Economics, 48(1), pp 54-68, 2009.
35. Jackson, S. B., Rodgers, T. C., Tuttle, B. “The effect of depreciation method choice on asset selling prices.”, Accounting, Organizations and Society, 35(8), pp 757-774, 2010.
36. Wu, M. H., et al. “Prevalence of congenital heart disease at live birth in Taiwan.” The Journal of Pediatrics, 156(5), pp 782-785, 2010.
37. Kao, C.C., et al. “Physical activity levels of school-age children with congenital heart disease in Taiwan.” Applied nursing research, 22(3), pp 191-197, 2009.
38. Tzilas, V., Koti, A., Tsoukalas, G. “A rare cause of dysphagia – aberrant right subclavian artery.” European review for medical and pharmacological sciences, 13(4), pp 313-316, 2009.
39. Murzi, M., et al. “Aberrant right subclavian artery aneurysm in coexistence with a common carotid trunk.” The annals of thoracic surgery, 88(1), pp e8, 2009.
40. Chaoui, R., et al. “Aberrant right subclavian artery as a new cardiac sign in second- and third- trimester fetuses with down syndrome.” American Journal of Obstetrics and Gynecology, 192(1), pp 257-263, 2005.
41. Koenigsberg, R. A., et al. “Unusual vertebral artery origins: Examples and related pathology.” Catheterization and Cardiovascular Interventions, 59(2), pp 244-250, 2003.
42. van Aalderen, W. M., et al. “Respiratory infections and vascular rings.”
Acta Paediatrica Scandinavica, 79(4), pp 477-480, 1990.
43. Wren, C. “Screening for potentially fatal heart disease in children and teenagers.” Heart, 95(24), pp 2040-2046, 2011.
60
44. Chen, F. L., et al. “Real time three-dimensional transthoracic
echocardiography for guiding amplatzer septal occluder device deployment in patients with atrial septal defect.” Echocardiography, 23(9), pp 763-770.
45. Chen, F. L., et al. “Real time three-dimensional echocardiography in
assessing ventricular septal defects: An echocardiographic-surgical correlative study.” Echocardiography, 23(7), pp 562-568.
46. Yu, J. M., et al. “The prevalence and clinical impact of pulmonary artery sling on school-aged children: A large-scale screening study.” Pediatric Pulmonology, 43, pp 656-661.
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附錄四 國小及國中一年級新生入學學童心臟健康篩檢相關照片
向學童解釋篩檢過程及注意事項 由心臟專科醫師為學童進行理學檢查（聽診）
由專業心臟超音波技術員進行學童心臟篩檢 向學童宣導心臟篩檢的重要性