900例胎儿超声心动图诊断胎儿先天性心脏病的体会

The experience of diagnosing congenital heart disease by fetal echocardiography on 900 fetuses

目的 探讨胎儿超声心动图对胎儿期先天性心脏病的诊断方法及应用价值。方法 1989年 11月～ 2 0 0 0年 11月对 90 0名高危孕妇行胎儿超声心动图检查。孕妇年龄 2 2～ 39岁 (2 7 9岁± 3 9岁 ) ,孕期 2 0～ 42周 (33 4周± 4 8周 )。首先应用二维超声心动图 (2DE)探察 ,横切胎儿胸部取标准四腔切面作为基础切面 ,旋转探头方向获取五腔心、大动脉短轴、左室长轴、主动脉弓长轴、下腔静脉长轴等切面 ,在清晰的切面图像上叠加彩色多普勒信号 ,观察心内有无异常血流 ;以脉冲多普勒记录主、肺动脉瓣及二、三尖瓣血流频谱或异常湍流频谱。结果 胎儿期先天性心脏病发病率3 78% (34 / 90 0 ) ,胎儿超声心动图诊断胎儿先天性心脏病的敏感性 92 %、特异性 95 %、阳性预测值 91%、阴性预测值96 %。结论 胎儿超声心动图诊断胎儿先天性心脏病的敏感性、特异性高 ,为妇产科及儿科医生提供有价值的资料 。

Objective To explore the methods and clinical value of fetal echocardiography to diagnose congenital heart disease. Methods From Nov. 1989 to Nov.2000, 900 fetuses of high risk pregnant women were offered careful examinations of the fetal heart. At a median age of 27.8 years (with a range of 22～39 years) the examination were performed, and a median fetal gestational age at diagnosis was 33.4 weeks (a range of 20～49 weeks). We performed Two dimensional of fetus first and took four charmber as the basic view, and got five chamber、great vessel/short axis、left and right ventricular outflow tract/long axis、and aortic arch et al. If there was existence of anatomic or physiologic abnormality, we would perform colour doppler.Results In this group, there are reports of a 3.78%(34/900) incidence of congenital heart disease, fetal echocardiography diagnostic of congenital heart disease sensitivity is 92%, specificity is 95%. PV(+)91% and PV(-)96%. Conclusion AS a harmless examination method, fetal echocardiography could find congenital heart disease exactly, it can play an important role in decreasing the born rate of complex abnormal heart and improving the health level of population.