四腔心联合三血管切面在孕中-晚期筛查胎儿先天性心脏病的应用价值

Value of four chamber view with three vessels view preliminary screening for fetal heart disease in the second and third trimester pregnancy

目的探讨四腔心切面(four chamber view,FCV)+三血管切面(three vessels view,3V)在产前超声初步筛查妊娠中-晚期(18~40周)胎儿心脏病的应用价值。方法应用彩色多普勒超声诊断仪,检查妊娠中晚期(18~40周)5 395例经追踪随访的胎儿,比较单纯FCV、左或右心室流出道切面(ventricular outflow tract view,VOTV)、3V的所费时间及显示率,通过病理或产后超声心动图诊断比较以上切面组合初步筛查中晚期胎儿心脏病的敏感性。结果耗费时间:FCV<3V<VOTV;显示率:FCV>3V>VOTV;敏感性:FCV+3V为82.9%(34/41)、FCV+VOTV为68.3%(28/41)、FCV为46.3%(19/41);FCV+3V敏感性明显高于其他二者,差异有统计学意义(P<0.05)。结论 FCV+3V能简单、快速、有效地提高中-晚期胎儿心脏病检查的敏感性,是初步筛查胎儿心脏病的首选方法。

Objectives To analyze the significance of four chamber view （FCV） with three vessels view （3V） pre- liminary screening for fetal heart disease in the second and third trimester pregnancy. Method The FCV alone, left and right ventricular outflow tract view （VOTV） and 3V of 5 395 consecutive fetuses aged from 18 to 40 week were examined to preliminary screen for fetal heart disease with ultrasound diagnostic system. Suspected fetal cardiac disease was confirmed by postmortem and postnatal echocardiography. Then, the sensitivities of screening tests were compared among the four methods. Result The time-consuming was FCV〈3V〈VOTV. The show rate was FCV〉3V〉VOTV. The sensitivity of FCV alone, FCV＋3V, FCV＋VOVT was 46.3% （ 19/41 ）, 82.9% （34/41）, 68.3% （28/41）, respectively. FCV＋3V was significantly superior to the other screening methods （P〈0.05）. Conclusions The screening method of FCV＋3V is simple, convenient, reliable, and has the satisfactory sensitivity for fetal heart cardiac malformation in the second and trimester pregnancy.