心脏超声常规法及五切面法对超重孕妇胎儿心脏畸形的诊断价值及临床意义

Diagnostic Value and Clinical Significance of Routine Cardiac Ultrasonography and Five-section Ultrasonography for Fetal Heart Malformation in Overweight Pregnant Women

目的 探讨心脏超声常规法及五切面法对超重孕妇胎儿心脏畸形的诊断价值及临床意义。方法 选取2020年3月—2021年3月行胎儿心脏超声检查的超重孕妇300例,入院后先行胎儿心脏超声常规法筛查,再行五切面法检查,统计常规法、五切面法不同体位图像满意度视觉模拟评分法(VAS)评分,比较常规法、五切面法对胎儿心脏畸形诊断结果和诊断效能,并比较有无心脏畸形胎儿心脏超声参数。结果 常规法、五切面法侧卧位图像满意度VAS评分均高于平卧位(P<0.05);五切面法平卧位、侧卧位图像满意度VAS评分高于常规法(P<0.05)。五切面法诊断心脏畸形的准确度、特异度高于常规法,误诊率低于常规法(P<0.05);二者联合诊断心脏畸形的准确度、特异度高于常规法和五切面法,误诊率低于常规法和五切面法(P<0.05);二者联合诊断心脏畸形的敏感度高于常规法,漏诊率低于常规法(P<0.05);孕26~<28周胎儿心脏畸形检出率(10.87%)最高;与心脏正常胎儿比较,心脏畸形胎儿右心房横径、右心室横径较低,全心球形指数、二尖瓣环收缩期位移、Tei指数较高(P<0.01)。结论 心脏超声五切面法联合常规法可有效提高超重孕妇胎儿心脏畸形产前筛查诊断效能,于孕26~<28周进行产前筛查能最大限度提高检出率,为超重孕妇产前筛查、明确筛查时间提供可靠依据。

Objective To explore the diagnostic value and clinical significance of conventional cardiac ultrasonography and five-section ultrasonography in fetal heart malformation in overweight pregnant women.Methods A total of 300 overweight pregnant women who underwent fetal echocardiography from March 2020 to March 2021 were selected.After admission,conventional fetal echocardiography screening was performed,followed by five-section examination,and visual analog scale(VAS)was used to evaluate the satisfaction of different body positions with conventional method and five-section method.The diagnostic results and diagnostic efficiency of fetal heart malformation were compared between conventional method and five-section method,and the ultrasound parameters of fetal heart with or without cardiac malformation were compared.Results The VAS scores of satisfaction with lateral decubitus images by conventional method and five-section method were higher than those in supine position(P<0.05).The VAS score of five sections in supine and lateral decubitus position was higher than that of conventional methods(P<0.05).The accuracy and specificity of five-section method were higher than that of conventional method,and the misdiagnosis rate was lower than that of conventional method(P<0.05).The accuracy and specificity of the combined diagnosis of cardiac malformations were higher than those of conventional method and five-section method,and the misdiagnosis rate was lower than those of conventional method and five-section method(P<0.05).The sensitivity of the combined diagnosis of cardiac malformations was higher than that of conventional methods,and the rate of missed diagnosis was lower than that of conventional methods(P<0.05).The detection rate of fetal heart malformation was the highest at 26-<28 weeks of gestation(10.87%).Compared with normal heart fetuses,the right atrial transverse diameter and right ventricular transverse diameter of fetuses with heart malformations were lower,and the whole-heart spherical index,systolic displacement of mitral ring and Tei index were higher(P<0.01).Conclusion Five sections of cardiac ultrasonography combined with conventional methods can effectively improve the prenatal screening and diagnosis efficiency of fetal heart malformations in overweight pregnant women.Prenatal screening at 26-<28 weeks of gestation can maximize the detection rate,and provide a reliable basis for prenatal screening and screening time of overweight pregnant women.