孕早期胎儿心脏超声筛查在先天性心脏病检测中的应用价值

Application value of fetal echocardiography in the detection of congenital heart disease in early pregnancy

目的探讨孕早期胎儿心脏超声筛查对先天性心脏病的诊断价值。方法选择2014年5月至2017年5月在商洛市中医院超声科进行产前检查的1 800例孕妇为研究对象,均接受胎儿超声检查,比较超声对孕11周、12周及13+6周心脏各切面的显示情况;以随访结果为准,分析各切面超声检查对胎儿心脏畸形的诊断符合率,观察心脏畸形的类型、比例及其合并畸形情况。结果孕11~13+6周,超声对四腔心切面显示率均为最高,其次为左室流出道切面。不同孕周间比较,孕13+6周超声对胎儿心脏各切面显示率均明显高于孕12周及孕11周,差异均有统计学意义(P<0.05)。孕13+6周,四腔心切面对胎儿心脏畸形显示率最低,为60.0%,而四腔心+三血管-气管平面对胎儿心脏畸形显示率最高,为91.4%,各种切面间比较差异有统计学意义(P<0.05)。1 800例受检者中,共35例经随访证实存在心脏畸形,超声诊断准确32例,诊断准确率为91.4%。其中,法洛四联症比例最高,占42.9%,其次为右室双出口,占20.0%,静脉异位引流比例最低,为2.9%。最常见的合并症为唇腭裂。结论孕早期胎儿超声筛查能够早期显示胎儿心脏畸形,临床应用价值高。

Objective To investigate the value of fetal echocardiography in the screening of CHD in early pregnancy. Methods A total of 1 800 pregnant women from May 2014 to May 2017 for prenatal examination in Shangluo City of Traditional Chinese Medicine Hospital were selected as research subjects, which all underwent fetal echocardiography.The display of of heart sections at 11 weeks, 12 weeks and 13＋ 6 weeks of gestational age were compared. Taking the follow-up results as golden standard, the diagnostic accordance rate of each section of ultrasound for fetal heart malformation was analyzed, and the heart malformation type and malformation ratio were observed. Results At 11-13＋6 weeks of gestation, the display rate of four-chamber section was the highest, followed by the left ventricular outflow tract. The display rate of each section at 13＋ 6 weeks of gestation were significantly higher than those at 12 weeks of pregnancy and 11 weeks of pregnancy（P〈0.05）. At 13＋6 weeks of pregnancy, the display rate of four-chamber section was the lowest for fetal heart malformation（60.0%）, while the display rate of four-chamber heart＋three vascular trachea plane showed the highest rate for fetal heart malformation（91.4%）, with statistically significant difference between the different sections（P〈0.05）. Of the 1 800 subjects, 35 were confirmed to have cardiac malformation by follow-up, and 32 were diagnosed by ultrasound as cardiac malformation, with the diagnostic accuracy of 91.4%. Among them, the proportion of tetralogy of Fallot was the highest（accounting for 42.9%）, followed by double outlet of right ventricle（accounting for 20.0%）, and the proportion of venous heterotopic drainage was the lowest（2.9%）. The most common complication was cleft lip and palate. Conclusion Fetal echocardiography in early pregnancy can screen the fetal heart malformation early and is of high clinical value.