四维超声联合经腹部超声心动图在胎儿先天性心脏病筛查中的应用研究

Application of four-dimensional ultrasound combined with transabdominal echocardiography in screening of fetal congenital heart disease

目的探讨四维超声联合经腹部超声心动图在胎儿先天性心脏病产前筛查中的临床价值。方法选取2020年4月至2023年4月该院行产前筛查的2013例孕妇,进行四维超声、经腹部超声心动图检查,以出生后超声心动图检查结果或引产后尸检结果为“金标准”,分析四维超声、经腹部超声心动图筛查胎儿先天性心脏病的效能。结果2013例孕妇中,56例经“金标准”证实胎儿存在先天性心脏病,而经腹部超声心动图检出46例,四维超声共检出48例,二者联合检出55例。四维超声、经腹部超声心动图筛查胎儿先天性心脏病的灵敏度、准确度、阴性预测值低于二者联合筛查时,差异有统计学意义(P<0.05)。四维超声联合经腹部超声心动图的筛查结果与“金标准”的检查结果具有极好一致性(kappa值=0.972,P<0.001)。四维超声、经腹部超声心动图筛查房间隔缺损的准确率低于二者联合筛查时,差异有统计学意义(P<0.05)。结论四维超声联合经腹部超声心动图具有较高的灵敏度、准确度,能够更有效地筛查胎儿先天性心脏病,特别是房间隔缺损。

Objective To explore the clinical value of four-dimensional ultrasound combined with transabdominal echocardiography in the screening of fetal congenital heart disease.Methods A total of 2013 pregnant women who underwent prenatal screening in the hospital from April 2020 to April 2023 were selected for four-dimensional ultrasound and transabdominal echocardiography.The results of postnatal echocardiography or autopsy after induction of labor were used as the“gold standard”to analyze the efficacy of four-dimensional ultrasound and transabdominal echocardiography in screening fetal congenital heart disease.Results Among the 2013 pregnant women,56 cases were confirmed to have congenital heart disease by the“gold standard”,while 46 cases were detected by transabdominal echocardiography,48 cases were detected by four-dimensional echocardiography,and 55 cases were detected by the combination of the two.The sensitivity,accuracy and negative predictive value of four-dimensional ultrasound and transabdominal echocardiography in screening fetal congenital heart disease were lower than those of the combined screening,and the differences were statistically significant(P<0.05).The screening results of four-dimensional ultrasound combined with transabdominal echocardiography were in excellent agreement with the results of the“gold standard”(kappa value=0.972,P<0.001).The accuracy of four-dimensional ultrasound and transabdominal echocardiography in screening atrial septal defect was lower than that of the combined screening,and the difference was statistically significant(P<0.05).Conclusion Four-dimensional ultrasound combined with transabdominal echocardiography has high sensitivity and accuracy,and can more effectively screen fetal congenital heart disease,especially atrial septal defect.