超声在产前筛查胎儿先天性心脏病中的应用

Application of ultrasound in screening for fetal congenital heart disease

目的探讨超声在产前筛查胎儿先天性心脏病中的应用,以提高胎儿先天性心脏病的检出率。方法采用二维超声、彩色多普勒技术筛查胎儿心脏病。主要取四腔心、左室流出道、右室流出道为主要切面,对3 986例孕18周以上孕妇的胎儿心脏进行初步筛查,发现259例胎儿心脏异常。结果259例胎儿中,经产后复查或引产后尸检证实,发现先天性心脏病36例,其中33例有先天性心脏畸形,占91.67%;漏诊3例,占8.33%。敏感性86.84%,特异性100%,准确性99.49%。结论二维超声和彩色多普勒技术是产前筛查胎儿先天性心脏病的首选方法,能够发现大多数胎儿心脏畸形,是预防和控制先天性心脏病胎儿出生的有效措施,也可作为初步筛查复杂先天性心脏病的方法。

Objective To evaluate the application of ultrasound in the prenatal monitoring screening for fetal congenital heart disease （CHD） and to improve diagnostic ratio of this kind of defects. Methods Two-dimension ultrasound and CDFI,monitoring fetal congenital heart disease. （1）The position of heart, the size of atrium and ventricle chambers, the atrioventricular septum and the atrioventricular valves were observed on the four-chamber view. （2）The position and crossing relationship of aorta and pulmonary artery,and the size of their calibers were shown on the short-axis view. （3）The consecution of ventricular septum and aorta were observed on the left ventricle long-axis view. The neonates whose hearts had murmur were checked by echocardiogram. If CHD was found,wetraced the ultrasound result during pregnancy and conformed the type of CHD. Of 3 986 fetuses that were beyond 18 week. we found 259 heart malformations. Results Of 259 cases fetuses. 36 cases could be diagnosed as congenital heart disease（CHD）according to the autopsy of fetal specimens after pregnancy termination and neonatal screening. 33 cases were identified to be congenital cardiac abnorm alities which was 91.67 %,while 3 cases were appeared approximately normal besides existing congenital cardiac abnorm alities which was 8.33% . The sensitivity,specificity and accuracy of fetal congenital cardiac abnorm abties were 86.84%, 100% and 99.49%, respectively. Conclusion Two-dimensional ultrasound, CDFI is a method of prenatal monitoring screening for fetal congenital heart disease and can discover most fetal heart deformations.