超声心脏轴测定在筛查胎儿先天性心脏病中的临床意义

Clinical significance of cardiac axis determination in the diagnosis of fetal congenital heart disease

目的探讨超声心动图测定在胎儿先天性心脏病产前超声诊断中的临床效果。方法采用LOGIQ 7超声诊断仪检查528例先心病高危胎儿,在心脏超声四腔观基础上测定胎儿心脏轴,并从多切面观察胎儿心内结构,以确定胎儿有无先心病。结果在528例先心病高危胎儿中,单纯四腔观检测有先天性心脏病胎儿29例,正常胎儿499例;而心脏超声四腔观加心脏轴测定共检测有先天性心脏病胎儿43例,正常胎儿485例,差异有统计学意义(P<0.01)。经过引产儿尸体解剖、新生儿超声检查以及随访手术结果确诊后,确诊胎儿先天性心脏病者46例,单纯四腔观检测胎儿先心病的敏感性为63.04%(29/46),应用心脏超声四腔观加心脏轴测定检测胎儿先心病的敏感性为93.48%(43/46),差异有统计学意义(P<0.05)。结论应用超声心脏轴测定在筛选胎儿先天性心脏病中可操作性强,且具有十分重要的临床意义。

Objective To investigate the clinical significance of cardiac axis determined by echocardiography in the diagnosis of fetal congenital heart disease （CHD）.Methods 528 high risk fetuses for CHD were examined by echocardiography.Cardiac axis was measured on four chamber view and fetal cardic anatomical structure was examined in multiple views to determine CHD.Re-sults 29 cases of fetal congenital heart disease and 499 cases of normal fetus were detected by four chamber view in 528 cases of congenital heart disease risk in the fetus pure.However,43 cases of fetal congenital heart disease and 485 cases of normal fetus were detected by combination of four Chamber view and cardiac axis determination in 528 cases of congenital heart disease risk in the fetus pure（P 〈0.01）.Finally,46 cases of fetal congenital heart diseas were diagnosed through perinatal autopsy,newborn ultrasound examination or the results after diagnosis.Sensitivity of CHD diag-nosed by four chamber view alone was 63.04%.However,it was elevated to 93.48% by combina-tion of four Chamber view and cardiac axis determination （P 〈0.05）.Conclusion Cardiac axis plays a key role in fetal echocardiographic screening for CHD.