彩色多普勒超声心动图顺序分段法诊断胎儿先天性心脏病的研究  

Diagnosis of Fetal Congenital Heart Diseases with the Sequential Segmental Approach Using Color Doppler Echocardiography

作　　者：张红环[1] 黄泳华[2] 彭宇程[3] 杨海玉[3] 罗中明[2] 李伦明[4] 茹景顺[5] 

机构地区：[1]江门市中心医院超声心动图室,广东省江门市529070 [2]江门市中心医院产科,广东省江门市529070 [3]江门市中心医院心内科,广东省江门市529070 [4]江门市中心医院心外科,广东省江门市529070 [5]江门市中心医院病理科,广东省江门市529070

出　　处：《中国超声医学杂志》2004年第8期615-619,共5页Chinese Journal of Ultrasound in Medicine

基　　金：广东省江门市科技局课题资助项目 (No. 2 0 0 2 0 8)

摘　　要：目的　评价彩色多普勒超声心动图 (UCG)顺序分段法诊断胎儿先天性心脏病 (CHD)的准确性和临床价值。方法　 2 0 0 0年 2月至 2 0 0 2年 12月对 92 5例胎儿进行超声心动图检查 ,其中心脏病高危胎儿 2 4 7例 ,分别用顺序分段法和四腔心加两心室流出道切面法 UCG检查。以引产后尸解或生后 U CG作为对照标准。结果　终止妊娠胎儿尸解和生后 UCG检查证实 CHD36例 ,节段畸形 6 5个。 UCG顺序分段法发现 CHD35例 ,敏感性97.2 % ,特异性 10 0 % ,准确性 99.6 % ;节段畸形 6 4个 ,敏感性 98.5 % ,特异性 10 0 % ,准确性 99.9%。四腔心加两心室流出道切面法发现 CHD2 8例 ,敏感性 77.8% ,特异性 10 0 % ,准确性 96 .8% ;节段畸形 5 1个 ,敏感性 78.5 % ,特异性 10 0 % ,准确性98.5 %。两种方法诊断胎儿 CHD和显示节段畸形敏感性有显著的统计学差异 (P<0 .0 1)。结论　U CG胎儿顺序分段法是诊断胎儿 CHD较完善、可靠的方法 ,可明显提高胎儿 CHD诊断的敏感性 ,已成为产前筛选CHD和指导干预的重要方法。Objective This study was designed to evaluate the accuracy and the clinical value of the sequential segmental approach using color Doppler echocardiography for fetal congenital heart diseases(CHD).Methods The study included 247 high risk of CHD.All fetuses were examined using color Doppler echocardiography with sequential segmental approach and four-chamber plus two ventricular outflow tract views.Echocardiographic results were compared with necropsy specimens of the fetal heart after termination of pregnancy or postnatal echocardiography.Results Necropsy specimens or postnatal echocardiography verified CHD in 36 fetuses with 65 segment anomalies.The sequential segmental approach by color Doppler echocardiography demonstrated CHD in 35 cases with 64 segmental anomalies.The sensitivity,specificity and accuracy of sequential segmental approach for detecting CHD were 97.2%,100% and 99.6%,and for detecting segmental anomaly were 98.5%,100% and 99.9%,respectively.The four-chamber plus two ventricular outflow tract views demonstrated CHD in 28 cases with 51 segmental anomalies.The sensitivity,specificity and accuracy for detecting CHD were 77.8%,100% and 96.8%,and for detecting segmental anomaly were 78.5%,100% and 98.5%,respectively.The sensitivity differences of the two methods detecting CHD and segmental anomaly were significant(P<0.01).Conclusions The sequential segmental approach is a consummate and reliable method for diagnosing fetal CHD.It can improve sensitivity for detecting CHD and segmental anomaly.It has become an important method for prenatal screening CHD and guiding interventional treatment.

关 键 词：彩色多普勒 超声心动图 UCG 顺序分段法 胎儿 先天性心脏病 心房 

分 类 号：R445.1[医药卫生—影像医学与核医学]