彩色多普勒超声心动图在胎儿先天性心血管畸形的筛查与临床诊断价值观察

彩色多普勒超声心动图在胎儿先天性心血管畸形的筛查与临床诊断

价值观察

摘要目的探索彩色多普勒超聲心动图在胎儿先天性心血管畸形（先心病）的产前筛查和诊断中的价值。方法1600例产检的孕妇，其中800例高危孕妇作为高危组，800例无明显高危因素的健康孕妇作为对照组，两组孕妇进行产前彩色多普勒超声心动图检查，将检测出的胎儿先心病结果与引产后病理结果或出生后结果进行对比。结果高危组产前先心病检出率为6.63%，明显高于对照组的 1.88%，差异有统计学意义（P＜0.05）。与病理诊断或出生后检查结果对比，高危组产前超声检出正确率为98.15%，对照组的产前超声检出正确率为88.24%，比较差异无统计学意义（P>0.05）。在先心病类型上，房间隔缺损、室间隔缺损、大血管异常发生率较高，肺动脉闭锁的发生率最低，心脏增大并腹水、三尖瓣下移、法洛氏四联症的发生率均较低。漏诊病例中心脏增大并腹水1例，法洛氏四联症2例。结论在胎儿先心病的产前筛查和诊断中，应用彩色多普勒超声心动图检查效果确切，检出正确率高，有助于临床医师早期发现胎儿心血管发育畸形，从而及时采取必要的措施进行早期干预，提高人口出生质量。

关键词彩色多普勒超声；超声心动图；胎儿先天性心血管畸形；产前筛查；检出率；正确率

Observation of value by color Doppler ultrasonic cardiogram for screening and clinical diagnosis of fetal congenital cardiovascular malformation XIE Dan-hong，CHEN Ting-cai，SHENG Fan. Puning City People’s Hospital，Puning 515300，China

【Abstract】Objective To investigate value by color Doppler ultrasonic cardiogram for screening and clinical diagnosis of fetal congenital cardiovascular malformation （congenital heart disease）. Methods Among 1600 pregnant women with production inspection，there were 800 high risk pregnant women as high risk group and 800 healthy pregnant women without obviously high risk as control group. Both groups received prenatal color Doppler ultrasonic cardiogram for examination，and their detection outcomes were compared with pathological outcomes after induced labor or delivery. Results The high risk group had obviously higher detection rate of congenital heart disease as 6.63% than 1.88% in the control group，and the difference had statistical significance （P＜0.05）. Comparison with pathological diagnosis of postnatal examination showed accuracy rate of prenatal ultrasound as 98.15% in the high risk group and 88.24% in the control group，and their difference had no statistical significance （P>0.05）. Congenital heart disease types included atrial septal defect and ventricular septal defect. Incidence of aorta abnormality was high，while incidence of pulmonary artery atresia was the lowest. Incidences of cardiac enlargement complicated with ascites，tricuspid valve displacement and

tetralogy of Fallot were all comparatively low. There were 1 case with cardiac enlargement complicated with ascites and 2 cases with tetralogy of Fallot among cases with missed diagnosis. Conclusion Implement of color Doppler ultrasonic cardiogram in prenatal screening and diagnosis of fetal congenital cardiovascular malformation provides precise effect and high accuracy rate. This method is helpful for early discovery of fetal congenital cardiovascular malformation，along with application of timely and essential measures for early intervention and birth quality enhancement.【Key words】Color Doppler ultrasound；Ultrasonic cardiogram；Fetal congenital cardiovascular malformation；Prenatal screening；Detection rate；Accuracy rate

先心病是指胎儿在胎儿期出现的心血管发育畸形结果，其发生率约为4%～8%[1]。随着产前筛查方法的增多和完善，不少产前检查方法在产前筛查中能筛查出大部分的先心病胎儿，从而利于临床上进行早期干預，提高人口出生质量[2]。超声心动图是目前临床上用于胎儿先天性心血管畸形产前筛查和诊断的最为简单、安全的方法[3]，为探索其在产前筛查中的价值，特进行本次研究，现报告如下。

1 资料与方法

1. 1 一般资料选取2014年5月～2016年2月间来本院产检的孕妇1600例，800例高危孕妇作为高危组，800例无明显高危因素的孕妇作为对照组。高危组中孕妇年龄25～38岁，平均年龄（34.3±3.6）岁，孕周18～32周，平均孕周（24.5±4.7）周，其中有糖尿病史380例，有结缔组织病史116例，孕早期服用过影响胎儿药物145例，高龄孕妇159例。对照组中孕妇年龄24～34岁，平均年龄（28.5±6.3）岁，孕龄16～34周，平均孕周（25.3±5.2）周。两组一般资料比较差异无统计学意义（P>0.05），具有可比性。

1. 2 方法采用彩色多普勒超声诊断仪，使用腹部和成人心脏探头，腹部探头频率为2～6 MHz，心脏探头频率为3～10 MHz，孕妇取仰卧位，检查仪器的各项参数正常后，在孕妇腹部的胎儿上方进行扫查，进行常规的产前胎儿检查，先行胎儿四腔心切面扫查，然后进行五腔心平面、三血管平面、左右心室流出道平面、主动脉弓平面的扫查，观察心脏在胸腔的位置、大小、心尖朝向、左右心室大小等。最后使用彩色多普勒超声检查胎儿的卵圆孔、肺静脉、房室瓣口、主肺动脉、主动脉弓等的血流情况、频谱等。

1. 3 追踪随访对于诊断出有心血管畸形的胎儿，如实给孕妇及其家属阐述胎儿的宫内发育情况、可能出现的问题、产后存活情况等，遵从孕妇及家属的意见选择引产或继续妊娠。对于引产的胎儿，在获得孕妇及家属的同意后进行尸检，观察心血管结构、形态等。对于继续妊娠的则进行追踪随访直到胎儿分娩后1个月，观察胎儿的心脏超声检查结果。

1. 4 统计学方法采用SPSS19.0统计学软件处理数据。计量资料以均数±标准差（x-±s）表示，采用t检验；计数资料以率（%）表示，采用χ2 检验。