二维实时超声初筛胎儿心脏畸形的临床价值

Evaluation of Two-Dimensional Real-Time Ultrasound in Congenital Heart Disease Screening

目的:探讨产前诊断胎儿先天性心脏病简单、易行的筛查方法。方法:二维实时超声测量780例次(268例)16～41周正常胎儿(Ⅰ组)心脏长径和胎儿胸腔前后径并计算其比值;确定此比值的正常值范围并以该范围筛查1384例(Ⅱ组)16～41周胎儿心脏,且异常者行彩色超声多普勒胎儿超声心动图检查。结果:胎儿心脏长径和胸腔前后径比值平均为0.453±0.048,正常值高限为0.55;Ⅰ组胎儿心脏长径和胸腔前后径与孕龄呈线性正相关,而两者比值与孕龄无直线相关性。以心脏长径与胸腔前后径比值>0.55为标准,筛查Ⅱ组胎儿心脏异常,灵敏度83.33%,特异度95.79%。结论:二维实时超声常规扫查胎儿四腔心切面,测量胎儿心脏长径与胎儿胸腔前后径比值,可作为胎儿心脏异常的初筛手段。

Objective： To discuss a simple screening method of diagnosing congenital heart disease. Methods： Heart longitudinal diameter （HLD）, thorax anteroposterior diameter （TAPD） and HLD/TAPD radio of 780 times（268） normal fetus aged from 16 to 41 weeks （group Ⅰ） were examined by two-dimensional real-time ultrasonographic. One thousand three hundrad and eighty four fetus aged from 16 to 41 weeks （group Ⅱ） were screened according to the HLD/TAPD normal ratio confirmed in group Ⅰ. Color doppler fetal echocardiography was required in abnormal HLD/TAPD ratio fetus. Results： The average HLD/TAPD ratio was 0.453 ±0.048 and the normal high limit was 0.55. HLD and TAPD were positive linearly correlated with gostational age, and HLD/TAPD ratio was not linearly correlated with gestational age in group Ⅰ. HLD/TAPD ratio 〉0.55 was as screen standard, and the abnormal heart sensitivity was 83.33% and the specificity was 95.79% in group Ⅱ. Conclusion： Measuring HLD/TAPD ratio by two-dimensional real-time ultrasound is a simple method of screening out fetal heart abnormality.