单中心358例胎儿先天性心脏病诊断分析及围生管理

Diagnosis analysis and perinatal management of the 358 fetal congenital heart diseases in single center

目的 探讨先天性心脏病（先心病）胎儿的诊断及围生期管理情况.方法 回顾性分析2006年1月至2013年12月在广东省人民医院经超声心动图检查诊断为胎（婴）儿先心病358例的临床资料,并分析产时情况.结果 出生或终止妊娠的先心病发生率1.85％（358/19338）.其中产前诊断297例,产后诊断61例.产前诊断中60.6％（180/297）为复杂先心病,产后诊断中90.2％（55/61）为简单先心病.复杂先心病中有96.8％在产前诊断（180/186）.297例产前诊断先心病胎儿活产203例,活产率68.35％,其中简单先心病活产率93.16％（109/117）,复杂先心病活产率52.22％（94/180）.产前诊断病例的阴道分娩率46.3％（94/203）,而产后诊断先心病阴道分娩率42.6％（26/61）,P〈0.001.结论 通过规范、标准化的筛查诊断,绝大部分复杂先心病及部分简单先心病可以在产前获得诊断.胎儿先心病除外产科指征均可阴道试产,分娩方式不影响预后.产后诊断先心病基本为简单先心病,预后良好.我院先心病产前诊断产后治疗＂一体化＂的诊疗模式可行.

 Objective To retrospectively analyze the diagnosis and perinatal management of fetal congenital heart disease （ CHD） in our hospital during the past eight years.Methods A retrospective analysis of 358 cases of CHD diagnosed by fetal echocardiography prenatal and/or postnatal was done in Guangdong General Hospital from Jan 2006 to Dec 2013,the delivery conditions of these fetus were analyzed.Results Incidence of CHD was 1.85%（358/19338）, 297 cases were prenatal diag-nosed, 61 cases were postnatal diagnosed.In the prenatal diagnosed group, 60.6%（180/297） were complex CHD.In the postnatal diagnosed group, 90.2%（55/61） were simple CHD.In the complex CHD, 96.8%（180/186） were prenatal diag-nosed.In the prenatal diagnosed group, the survival rate was 68.35%（203/297）, of which the simple CHD was 93.16%（109/117）, the complex CHD was 52.22%（94/180）.The vaginal delivery rate（46.3% vs 42.6%） in the prenatal diag-nosed group was higher than the postnatal diagnosed group, the difference was significant（P〈0.001）.Conclusion Through standardized screening and diagnosis methods, most of the complex CHD and part of simple CHD can be prenatal diagnosed . Except for obstetric indications, vaginal delivery was suggested for all of CHD, delivery way did not affect the prognosis.Most of postnatal diagnosed CHD were simple CHD, the prognosis was good.Integrated pattern of prenatal diagnosis and postnatal treatment was completely feasible .