三节段分析法诊断胎儿先天性心脏病的临床应用研究

Clinical applied study of three-section analytical method in diagnosing fetus congenital heart disease

目的:探讨三节段分析法在胎儿心脏先天畸形(CHD)筛查中的临床应用价值。方法:自2006年6月起用此方法对5680例产前常规三维超声系统筛查的孕妇进行胎儿心脏筛查,首先确定胎儿心脏位置及心轴,然后用三节段分析法进行分析。二维超声显示四腔心、左右室流出道、心底短轴、主动脉弓、动脉导管弓及三血管切面,重点观察二尖瓣、三尖瓣、主动脉瓣、肺动脉瓣的启闭情况,再用彩色多普勒观察胎儿心脏各瓣膜的血流情况。结果:5680例行产前常规三维超声系统筛查的孕妇中,产前确诊28例,检出率为0.49%;产后超声心动图证实产前漏诊5例,漏诊率为0.09%。结论:①三节段分析法应用胎儿心脏超声检查,它能帮助发现许多胎儿心脏结构异常,对妊娠筛选、分娩处理及产后干预有重要意义;②三节段分析法对单纯性室缺有局限性;③胎儿四腔心切面能显示心脏许多解剖结构,是进行节段性分析检查的重要切面。

Objective： To study the clinical application value of three - section analytical method in fetus heart congenital malformation （CHD） . Methods： 5 680 antenatal pregnant women were attended fetus heart screening in the screening of conventional three - dimensional supersonic system in our hospital since June, 2006. Based on the screening result, it firstly defined fetus heart position and the spindle. And four cavity hearts, left and right ventricular outflow tract, moral nature minor axis, the arch of the aorta, the ductus arteriosus bow and three blood vessel section were indicated by two - dimensional supersonic system, especially observed the open and close situation in the area of mitral valve, tricuspid valves, aortic valves, pulmonary valves, and then observed the flooding condition in all valves in fetus heart separately in the way of Coloured Doppler Ultrasound. Results： In 5 680 cases, 28 cases were found with congenital heart malformation, detection rate was 0.49 % ; 5 cases antenatal missing diagnosis were confirmed by post partum ultrasound cardiogram, the rate was 0. 09%. Conclusion： （1）Three- section analytical method is applied to the ultrasound examination of fetus heart, which helps to find heart anomalous in more fetus and plays an important roll in pregnancy screening, childbirth processing and post partum intervention; （2）Three - section analytical method is limited to the retinitis simplex room; （3）Fetus four chambers cross section demonstrates many dissection structures, which is an important cross section in analysis and examination.