胎儿先天性心脏病产前超声筛查模式的比较

Evaluation of different ultrasonic modalities for prenatal screening congenital heart diseases

目的探讨二维超声及彩色多普勒超声采用胎儿四腔心切面、心室流出道切面及彩色多普勒超声心动图3种筛查方法在发现和诊断胎儿先心病中的作用及意义，寻找超声筛查先心病的适宜方法。方法采用流行病学筛检试验的方法回顾分析自2006年1月至2007年12月在北京妇产医院就诊的具有先心病高危因素的所有孕妇及胎儿产前超声检查结果，收集符合研究标准的病例的四腔心切面、流出道切面（四腔心切面＋左室流出道切面）及彩色多普勒超声心动图3种筛查方法的检查结果，分析3种检查方法阳性结果的图像特点，以胎儿心脏病理诊断或生后新生儿超声心动图诊断为金标准，评价以上3种方法的诊断符合率。结果符合研究标准的病例1310例，共筛查胎儿心脏异常52例。四腔心切面、流出道切面、彩色多普勒超声心动图筛查的敏感度为：61．5％、88．5％、96．1％。结论超声四腔心切面、流出道切面、彩色多普勒超声心动图扫查在各类胎儿常见先心病产前筛查与诊断中起重要作用；流出道切面筛查先心病的准确性相对较高，操作简便，易于掌握，建议推荐为胎儿先心病筛查的适宜方法。

Objective To evaluate the value of four chamber view, outflow tract view and color Doppler eehocardiosonography for detecting the fetal congenital heart defects among high-risk populations. And to discuss the significance of screening congenital heart defects by three methods and select the suitable method for wider applications. Methods The echoeardiographie records of all pregnant women performed at our hospital from January 2006 to December 2007 were reviewed retrospectively by screening of clinical epidemiology. All eases received ultrasonic examinations. The abnormal cases with postnatal confirmation by echoeardiogram or autopsy were included. The abnormalities detected in each view were analyzed and classified. Results A total of 52 fetuses with congenital heart defects were detected by gray scale sonography and color Doppler sonography in 1310 cases. Each specific cardiac defect had its typical finding in these three planes. The sensitivities of three methods were 61.5%, 88.5% and 96. 1% respectively. Conclusion Four chamber view, outflow tract view and color Doppler sonography have played an important role in screening fetal common congenital heart defects. Outflow tract view is easy to operate and it may be recommended as a suitable method.