超声检测卵圆孔面积联合血流动力学在新生儿房间隔缺损诊断中的应用

The application of ultrasonic detection of oval areacombined with hemodynamics in the diagnosis of neonatal atrial septal defect

目的探讨超声检测卵圆孔面积(FOA)联合血流动力学在新生儿房间隔缺损(ASD)诊断中的应用。方法回顾性选取2014年12月至2017年12月本院收治的ASD新生患儿597例,以产后超声或手术证实为对照,依据是否发生ASD分为ASD组(48例)和正常组(549例),所有新生儿均于分娩前给予超声检测FOA、血流动力学[分流速度(DV)]水平,分析卵圆孔面积联合血流动力学对新生儿ASD的诊断价值。结果 ASD组房缺组患儿卵圆孔直径、面积、分流速度明显高于正常组,有显著性差异(P<0.05);ROC曲线分析结果显示,在诊断胎儿ASD的敏感度、特异度、准确度方面,FOA以13mm2为临界值时分别为79.17%、90.16%、89.29%,DV以0.7m/s为临界值时分别为77.08%、89.07%、88.11%,二者联合时分别为93.75%、95.99%、95.81%在诊断新生儿房缺的敏感性、特异性和准确性方面,二者联合明显高于二者单独时,差异有统计学意义(P<0.05),二者单独时基本相同,差异无统计学意义(P<0.05)。结论 FOA、血流动力学DV水平变化与新生儿ASD的发生有关,检测二者水平可作为诊断新生儿ASD的重要参考指标,且二者联合时具有更佳的诊断效能,值得临床作进一步推广。

Objective：To discuss the application of ultrasonic detection of oval area（FOA）combined with hemodynamics in the diagnosis of neonatal atrial septal defect（ASD）. Methods：Retrospective study of 597 newborn children with ASD from December 2014 to December 2017 in our hospital was reviewed,comparison of postpartum ultrasound or surgery. According to whether ASD was divided into group ASD（48 cases）and normal group（549 cases）.All newborns were given FOA,hemodynamics [shunt speed（DV）] before delivery,and to analyze the value of oval hole area combined with hemodynamics in the diagnosis of neonatal ASD. Results：The diameter,area and diffluence rate of the oval foramen in the ASD group were significantly higher than that in the normal group,the difference was statistically significant（P〈0.05）. ROC curve analysis showed that the sensitivity,specificity and accuracy of predicting the diagnosis of fetal ASD.The critical value of FOA with 13 mm2 was 79.17%,90.16%,and 89.29%,respectively. The critical value of DV with 0.7 m/s was 77.08%,89.07%,and 88.11%,respectively. The combination of the two were 93.75%,95.99%,and 95.81%,respectively.In predicting the sensitivity,specificity and accuracy of neonatal atrial septal defect,the combination of the two was significantly higher than that of the two,the difference was statistically significant（P〈0.05）. The two are basically the same when they are alone,the difference was not statistically significant（P〈0.05）. Conclusion：The changes of FOA and hemodynamic DV were related to the occurrence of ASD in the newborn. The detection of two levels can be used as an important reference index for predicting ASD in newborn infants.And the combination of the two has a better diagnostic efficiency,it′s worth for further clinical promotion.