胎儿肺发育不良的产前超声诊断

Clinical study of prenatal ultrasonographic diagnosis of fetal pulmonary hypoplasia

目的探讨正常孕中晚期胎儿肺面积、肺面积与胎儿质量之比的变化规律，及其产前诊断肺发育不良的临床价值。方法超声检查244例正常胎儿和29例肺发育不良高危胎儿，心脏四腔心水平胸廓横切面上测定胎肺面积，计算左、右肺面积及总肺面积与胎儿质量之比评价肺发育状况，并与尸体解剖及追踪结果对照。结果胎儿肺面积随孕周、胎儿质量增加而增加，肺面积与胎儿质量之比随孕周增加而减少，二者存在显性线性关系。29例肺发育不良高危胎儿中，产前超声诊断肺发育不良合并肺外畸形19例，并经尸体解剖证实；诊断为阴性的10例胎儿中，1例产后出现非梗阻性呼吸功能不全，2例因肺外畸形引产后尸检证实无肺发育不良，7例分娩后无呼吸功能不全。结论肺面积与胎儿质量之比能较好地预测肺发育不良。

Objective To investigate the variation of lung area and lung area/body weight ratio during the second and third trimester of pregnancy and to evaluate the clinic value of lung area/body weight ratio for prenatal diagnosis of pulmonary hypoplasia. Methods With Acuson Sequoia 512 ultrasound system,244 normal sigleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish reference range of lung area/body weight ratio. The left and right lung areas were measured on the corss-sectional plane of the thorax, used for examination of the four-chamber view of the heart. Twenty-nine pregnancies with risk factors for pulmonary hypoplasia were studied to evaluate the clinic value of lung area/body weight ratio, 2 or more standard deviations below the mean control group measurement were considered abnormal. The prenatal ultrasonic diagnosis of fetal pulmonary hypoplasia were confirmed at neonatal follow-up,autopsy and pathologic findings. Results Lung area increased with gestational age,lung area/body weight ratio decreased with gestational age,and there was obvious linear correlation between the ratio and gestational age. Of 29 hight risky fetus, 19 cases were prenatally diagnosed pulmonary hypoplasia by lung area /body weight ratio and were confirmed by lung weight/ body weight ratio and radial alveolar count in autopsy. Of 10 cases dignosed negtive, 1 presented with severe repiratory distress after birth,2 were diagnosed no pulmonary hypoplasia in autopsy because of other anomalies,7 born without respiratory insufficiency. Conclusions Lung area/body weight ratio is a good predictor of fatal pulmonary hypoplasia.