实时三维超声心动图对法洛四联症胎儿心功能的评估价值

Evaluation value of real-time three-dimensional echocardiography on fetal cardiac function in tetralogy of Fallot

目的探讨实时三维超声心动图在法洛四联症胎儿心功能评定中的应用效果。方法选择2016年1月至2018年1月于郑州市妇幼保健院实施产前检查并分娩的101例年龄大于35岁的高危产妇为研究对象,对其实施产前实时三维超声心动图检测,按其分娩后检查确诊胎儿是否合并法洛四联症将胎儿分为健康组(n=79)和法洛四联症组(n=22),回顾性分析其产检时胎儿实时三维超声心动图特征,并与二维超声检测结果进行对比,分析实时三维超声心动图对法洛四联症胎儿心功能评估的价值。结果健康组胎儿左肺动脉内径、右肺动脉内径与法洛四联症组比较差异无统计学意义(P> 0.05),但健康组胎儿肺动脉指数(PAI)高于法洛四联症组(P <0.05)。法洛四联症组胎儿右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、每搏输出量(SV)均高于健康组,右心室射血分数(RVEF)低于健康组(P <0.05)。实时三维超声心动图检测洛四联症组胎儿RVEDV、RVESV、SV均高于二维超声,RVEF低于二维超声(P <0.05)。二维超声诊断法洛四联症胎儿的敏感度、特异度和准确度分别为80.34%、86.73%和85.27%,实时三维超声心动图诊断法洛四联症胎儿的敏感度、特异度和准确度分别为92.54%、98.78%和97.75%,二维超声诊断法洛四联症胎儿的敏感度、特异度和准确度均低于实时三维超声诊断(P <0.05)。结论实时三维超声心动图检测能够较好的区分健康胎儿与法洛四联症胎儿,同时还可以对法洛四联症胎儿心功能进行更灵敏准确的评定。

Objective To explore the evaluation value of real-time three-dimensional echocardiography on fetal cardiac function in tetralogy of fallot.Methods A total of 101 high-risk pregnant women over 35 years old who underwent antenatal examination and delivered in Women&Infants Hospital of Zhengzhou City from January 2016 to January 2018 were selected as the study subjects.Prenatal real-time three-dimensional echocardiography was performed on the fetus,and the fetus was divided into healthy group(n=79)and tetralogy of Fallot group(n=22)according to whether the fetus was diagnosed with tetralogy of Fallot after delivery.The characteristics of real-time three-dimensional echocardiography of fetuses during labor examination were analyzed retrospectively,and it was compared with the results of two-dimensional echocardiography,and the value of real-time three-dimensional echocardiography in evaluating the fetal cardiac function in tetralogy of Fallot was analyzed.Results There was no significant difference in the left pulmonary artery diameter and right pulmonary artery diameter between the healthy group and the tetralogy of Fallot group(P<0.05).However,the fetal pulmonary artery index of the healthy group was higher than that of the tetralogy of Fallot group(P<0.05).The right ventricular end diastolic volume(RVEDV),right ventricular end systole volume(RVESV)and stroke volume(SV)in the tetralogy of Fallot group were higher than those in the healthy group,but the right ventricular ejection fraction(RVEF)in the tetralogy of Fallot group was lower than that in the healthy group(P<0.05).The RVEDV,RVESV and SV which detected by real-time three-dimensional echocardiography was higher than those detected by the two-dimensional ultrasound,and the RVEF which detected by real-time three-dimensional echocardiography was lower than that detected by the two-dimensional ultrasound(P<0.05).The sensitivity,specificity and accuracy of two-dimensional ultrasound in diagnosing the tetralogy of Fallot fetus was 80.34%,86.73%and 85.27%,respectively.The sensitivity,specificity and accuracy of real-time three-dimensional echocardiography in diagnosing the tetralogy of Fallot fetus was 92.54%,98.78%,97.75%,respectively.The sensitivity,specificity and accuracy of real-time three-dimensional echocardiography in diagnosing the tetralogy of Fallot fetus was higher than that of two-dimensional ultrasound(P<0.05).Conclusion Real-time three-dimensional echocardiography can distinguish healthy fetuses from fetuses with tetralogy of fallot,and it can also evaluate the cardiac function of fetuses with tetralogy of Fallot more sensitively and accurately.