超声诊断胎儿单纯性肺动脉瓣狭窄产前、产后对照分析

Prenatal and postpartum ultrasonic features comparison of fetus idiopathic pulmonary stenosis

目的探讨超声检查应用于胎儿单纯性肺动脉瓣狭窄的临床诊断价值。方法选择本院于2012年1月至2017年1月收治的13例符合胎儿单纯性肺动脉瓣狭窄患儿作为研究对象,比较产前、产后超声声像图特征,评价超声检查的诊断价值。结果在产前经超声诊断的9例单纯性肺动脉瓣狭窄中,8例为中重度肺动脉瓣狭窄,狭窄处血流平均流速为(2.8±0.6)m/s,可见肺动脉主干扩张、右房增大,且可见卵圆孔开放及三尖瓣反流;1例为轻度肺动脉瓣狭窄,狭窄处血流流速为1.8 m/s,且肺动脉主干扩张不明显,右心无增大,伴三尖瓣反流,但卵圆孔持续开放并不明显。9例胎儿中,4例引产,余5例继续妊娠,出生后狭窄处血流平均流速为(3.5±0.2)m/s,高于初次超声检查峰值流速的(2.8±0.6)m/s(P<0.05)。产后超声检查确诊为单纯性肺动脉瓣狭窄的4例患儿中,狭窄处血流平均流速为(3.0±0.2)m/s,低于产前即经超声检查确诊为单纯性肺动脉瓣狭窄且分娩的患儿狭窄处平均流速的(3.5±0.2)m/s(P<0.05)。超声声像图特征为肺动脉主干稍微扩张,右心稍大,伴有三尖瓣反流。结论产前超声诊断中重度肺动脉瓣狭窄难度较低,但诊断轻度肺动脉瓣狭窄难度较大,临床应予以重视。

Objective To investigate the ultrasound value in the diagnosis of fetus idiopathic pulmonary stenosis. Methods Thirteen cases with fetus idiopathic pulmonary stenosis admitted in our hospital from January 2012 to January 2017 were selected as the research objects, the prenatal and postnatal ultrasonic ultrasonographic features were compared, and the ultrasound diagnostic value was explored. Results Of 9 cases of simple pulmonary stenosis diagnozed with prenatal ultrasound, 8 cases were moderately severe pulmonary stenosis, and the narrow place of mean velocity of blood flow was（2.8±0.6） m/s, it showed pulmonary artery dilatation, right atrial enlargement, and ovarian opening and tricuspid regurgitation. One case was mild pulmonary stenosis, the narrow place of mean velocity of blood flow was 1.8 m/s, and pulmonary artery trunk expansion was not obvious, the right atrium had no increase, with tricuspid regurgitation, oval foramen remained open but was not obvious; of the 9 cases of fetus, 4 cases were induced labor and the other 5 cases continued to pregnancy. After birth, the mean velocity of blood flow was（3.5±0.2） m/s, which was higher than（2.8±0.6） m/s of the ultrasound first peak velocity（P〈0.05）. Postpartum ultrasound diagnosis showed that there were 4 cases idiopathic pulmonary stenosis, the average velocity of stenosis blood flow was（3.0±0.2） m/s, which was lower than（3.5±0.2） m/s of the prenatal children with idiopathic pulmonary stenosis with the ultrasound diagnosis（P〈0.05）. Ultrasonographic features showed pulmonary artery trunk with slightly expansion, and the right heart slightly increased, with tricuspid regurgitation. Conclusion Prenatal ultrasound moderately has less difficulty in the diagnosis of severe pulmonary stenosis, but with more difficulty in the dianosis of mild pulmonary stenosis, which is worthy of clinical attention.