孕11-13+6週胎兒心臟畸形超聲篩查價值探討

To study the value of ultrasound screening for cardiac defects in 11-13+6 weeks of pregnancy

目的探討孕11-13^(+6)週進行超聲掃描篩查嚴重心臟畸形發現的價值。方法選取從2016年1月~2018年6月期間,鏡湖醫院對1600例孕婦在11-13^(+6)週期間進行超聲波檢查,記錄胎兒對頸項透層、三尖瓣反流及靜脈導管血流a波倒置及對胎兒心臟進行掃描。結果在1600例胎兒掃描中,139胎(佔8.7%)NT測量數值≥3.5mm,102胎(佔6.9%)靜脈導管血流a波倒置,87胎(佔5.4%)存在三尖瓣反流。同期初步診斷心臟異常23例,14胎(14/23,60.87%)伴有NT增厚,11胎(11/23,47.83%)DV a波倒置,10胎(10/23,43.48%)TR異常。並對這23例胎兒在孕中期(18-22週)跟蹤檢查,確診存在胎兒心臟異常8例。這8例胎兒中,孕11-13週檢查中存在NT增厚的有7例,DV a波倒置5例,TR的有4例。結論11-13^(+6)週對胎兒進行四腔心切面及三血管氣管切面掃描對早期發現胎兒心嚴重臟畸形具有一定價值,結合NT值、DV a波倒置及TR等指標異常,有望將部份心臟畸形的檢查時間窗提前至早孕期。

Objective To explore the value of ultrasonographic scanning to detect major cardiac defects at 11-13^(+6) weeks of pregnancy.Methods From January 2016 to June 2018,1600 pregnant women during 11-13^(+6) weeks underwent the ultrasound examination in Kiang Wu Hospital.They were recorded Nuchal translucency(NT),tricuspid regurgitation(TR),and ductus venous(DV)in fetuses showed a wave reserved or absented,they also had scanned the fetuses heart.Results In 1600 cases,139 cases(8.7%)had NT measurements≥3.5 mm,102 cases(6.9%)had DV a wave inversion,and 87 cases(5.4%)had tricuspid valve reflexes.flow.During the same period,23 cases of cardiac abnormalities were initially diagnosed,14(14/23,60.87%)with NT thickening,11(11/23,47.83%)DV a wave inversion,and 10(10/23,43.48%)TR abnormal.And follow-up examination of these 23 cases.During the second trimester(18-22 weeks),8 cases of fetuses cardiac abnormalities were confirmed.Among these 8 cases,7 cases had NT thickening in 11-13+6weeks of pregnancy,5 cases had DV a wave inversion,and 4 cases had TR.Conclusion The four-chamber cardiac section and three-vessel tracheal section scan of the fetus at 11-13^(+6) weeks are of certain value for early detection of major cardiac defects.Combined with abnormalities such as NT value,DV a wave inversion,and TR,it is hopeful that the examination window of some major cardiac defects is advanced to early pregnancy.