产前超声筛查胎儿先天性心脏病的临床分析

Clinical Analysis of Antepartum Ultrasound Screening of Fetal Congenital Heart Diseases

目的:分析产前超声筛查胎儿先天性心脏病的意义与价值。方法:整理和分析本院产科2007年9月至2011年2月期间行产前胎儿超声心动图检查(FECG)的孕妇和胎儿资料共4 296例。本组病例均为孕20～41周,部分分娩前有高危倾向。超声筛查切面包括四腔心切面、左室流出道切面、右室流出道切面、三血管切面,计算不同切面诊断先天性心脏病的敏感性及特异性。以引产病理或产后新生儿超声心动图(ECG)作为对照标准。结果:4 296例产前胎儿超声心动筛查共发现先天性心脏病胎儿22例,其中复杂先天性心脏病合并心外畸形2例、单心室(SV)2例、心内膜垫缺损(ECD)2例、肺动脉狭窄(SP)3例、室间隔缺损(VSD)3例、肺动脉闭锁4例、三尖瓣下移畸形(Ebstein's)4例、法洛氏四联征(ToF)2例,阳性检出率为0.51%(22/4 296)。结论:采用胎儿超声心动图行产前筛查方法简便可靠,四腔心切面+三血管切面对胎儿先天性心脏病的产前超声筛查率较高,是检测胎儿先天性心脏病最主要的影像诊断方法。

Objective To analyze the significance and value of antepartum ultrasound screening of fetal congenital heart diseases. Metheda There were 4296 cases of pregnant women and fetus who undertook antepartum fetal echoeardiograms （FECG） in the period from September 2007 to February 2011 were sorted and analyzed in the maternity department of the Affiliated Hospital of Logistics University of CAPF. These pregnant women were then in their 20 to 41 gestational weeks, some of them demonstrated a tendency of high risk. The tangent planes undertaking ultrasound screening included the heart＇s four cavums, outflow tracts of left and right ventricular, and three blood vessels. By calculating these distinct planes, the sensitivity and specificity of congenital heart disease were diagnosed with pathology after induced pathology of abortion or neonatal echocardiogram（ECG） as the control standard. Results Through antepartum fetal ultrasound screening of 4 296 cases, 22 foetus were detected suffering from congenital heart diseases with complications including 2 cases of complex congenital heart diseases combined with extracardiac deformity, 2 cases of single ventricle（SV）, 2 cases of endocardial cushion defect（ECD）, 3 cases of pulmonary artery stenosis（P）, 3 cases of ventricular septal defect（VSD）, 4 cases of pulmonary artery atresia, 4 cases of Ebstein＇s malformation（Ebstei＇s）, 2 cases of tetralogy of Fallot（ToF）. The detection rate of positive characteristics turned out to be 0.51%（22/4 296）. Conclusion The fetal echocardiography is a simple and reliable method for antepartum screening. The tangent planes of heart＇s four cavums with three blood vessels have a higher antepartum ultrasound screening of fetal congenital heart diseases. So it is an overriding imaging diagnostic method for detecting fetal congenital heart diseases.[Chinese Medical Equipment Journal,2013,34（ 1 ） ：65-66,73]