基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值

Construction and application value of the decision-making tree model for the fetal congenital heart defect based on multimodal ultrasound

目的:分析基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值。方法:随机选取2021年4月-2023年7月在本院产前超声检查孕中期孕妇300例,常规产科超声检查确定胎儿生长程度,核实孕周,采用超声多断面模式方法对胎儿心脏进行多断面检测,包括四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面。对正常分娩的新生儿进行心脏多断面超声检测。对300例胎儿进行多断面模式超声检测,分析胎儿是否伴有先天性心脏畸形,对比超声检查与随访结果符合情况。结果:超声检出21例先天性心脏畸形胎儿,8例选择引产,余13例正常分娩。超声诊断与随访结果对比,卵圆孔直径增大、法洛四联症、完全型心内膜垫缺损、二尖瓣闭锁、右室发育不良综合征、左室发育不良综合征、大动脉转位、永存动脉干、单心室、三尖瓣下移符合率均为100%,超声诊断室间隔缺损7例,随访发现室间隔诊断5例,诊断符合率71.4%。279例超声诊断无先天性心脏畸形胎儿出生后经超声诊断发现有1例卵圆孔未闭、3例室间隔缺损,共4例漏诊患儿,漏诊率0.54%。四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面诊断胎儿畸形率分别为3.95%、0.63%、2.76%、3.27%、3.25%。由决策树模型可得,产前超声检查发现胎儿心脏可疑异常、高龄孕妇、孕妇接受药物治疗或射线暴露、孕妇有先天性心脏病家族史是胎儿存在先天性心脏病的独立危险因素,其中产前超声检查发现胎儿心脏可疑异常的影响最为显著。结论:孕中期胎儿产前超声多断面模式筛查胎儿先天性心脏病,能够对多数胎儿先天性心脏病进行诊断。

Objective:To analyze the construction of the decision-making tree model for the fetal congenital heart defect based on multimodal ultrasound,and to study its application value.Methods:A total of 300 pregnant women who received prenatal ultrasound diagnosis in hospital during the second trimester of pregnancy from April 2021 to July 2023 were randomly selected as the study objects.The routine obstetric ultrasound examination was used to determine the situation of the fetal growth and to verify the fetal weeks of these women.Then the multimodal ultrasound was used to examine the fetal heart,including the section of four-chamber cardiac,the three-vessel section,the aortic arch section,the left ventricular outflow tract section,and the right ventricular outflow tract section.Multisectional ultrasonography of the heart was performed in the neonates with normal delivery.300 fetuses were examined by multi-sectional ultrasonography to analyze whether the fetuses were accompanied with the congenital heart malformations or not.The results of the ultrasound examination and the follow-up results of the fetuses were compared.Results:21 fetuses with congenital heart defects were detected by ultrasound,including 8 cases with delivery by induced labor and the remaining 13 cases with normal delivery.The coincidence rate between the ultrasound diagnosis and the follow-up result was 100%,including enlarged foramen ovale diameter,tetralogy of Fallot,complete endocardial pad defect,mitral atresia,hypoplastic right ventricle syndrome,hypoplastic left ventricle syndrome,transposition of the great arteries,persistent truncus arteriosus,single ventricle and ebstein's anomaly.7fetuses were diagnosed as ventricular septal defect by ultrasound,and 5fetuses were diagnosed as ventricular septum by the follow-up results,with the diagnostic coincidence rate of 71.4%.Among 279fetuses without congenital heart defects diagnosed by ultrasound,1case with patent foramen ovale and 3cases with ventricular septal defect diagnosed by ultrasound were confirmed after birth,and 4cases were missed,with the missed diagnosis rate of 0.54%.The diagnostic rate of the fetal malformation with four-chamber heart section,three-vessel section,aortic arch section,left ventricular outflow tract section or right ventricular outflow tract section was 3.95%,0.63%,2.76%,3.27% or 3.25%,respectively.According to the decision-tree model,the suspicious fetal cardiac abnormalities detected by prenatal ultrasound,the advanced maternal age,the maternal drug treatment or radiation exposure,and the maternal family history of congenital heart disease were the independent risk factors of the fetal congenital heart disease,among which,the suspicious fetal cardiac abnormalities detected by prenatal ultrasound had the most significant effect.Conclusion:During the second trimester of pregnancy,the prenatal ultrasound multi section mode used to screen the fetal congenital heart defect can diagnose most of the fetal congenital heart defect.