“胎儿心脏筛查指南”在产前超声筛查胎儿先天性心脏病中的应用价值  

Importance of ＂Guidelines for performing fetal cardiac scan＂ in prenatal screening for fetal congenital heart disease

作　　者：徐燕[1] 胡娅莉[1] 茹彤[1] 顾燕[1] 杨燕[1] 戴晨燕[1] 

机构地区：[1]南京大学医学院附属鼓楼医院母胎医学中心,210029

出　　处：《中华妇产科杂志》2009年第2期103-107,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：江苏省医学重点学科项目（XK200709）;2006年江苏省科技发展计划项目（BS2006012）;南京市卫生局重点项目（ZKX06018）

摘　　要：目的探讨2006年国际妇产科超声协会公布的“胎儿心脏筛查指南”在产前超声筛查胎儿先天性心脏病中的应用价值。方法2006年9月—之007年7月在南京大学医学院附属鼓楼医院母胎医学中心接受胎儿超声筛查的单胎孕妇5000例。平均年龄28岁（18～48岁），平均孕周27周（妊娠18～40周）。以“胎儿心脏筛查指南”为标准对胎儿四腔心和左、右心室流出道及三血管切面进行扫查，对疑有心脏异常者进一步行胎儿超声心动图检查，对确诊先天性心脏病胎儿建议羊水或脐血穿刺行染色体核型分析，终止妊娠者行胎儿尸体心脏解剖；继续妊娠者，于胎儿出生后2～6个月行超声心动图随访。结果（1）超声筛查各切面获取率：5000例单胎孕妇中，四腔心切面获取率为97．64％（4882／5000），其中左、右心室流出道及三血管切面的获取率分别为87．69％（4281／4882）、82．51％（4028／4882）和96．29％（4701／4882）。5000例孕妇中，孕中期筛查2750例，孕晚期筛查2250例，孕晚期各标准切面的获取率明显低于孕中期（P〈0．05）。（2）胎儿先天性心脏病发病率：4882例胎儿中最终诊断先天性心脏病73例，发病率为1．50％（73／4882），其中产前超声确诊50例（孕中期24例、孕晚期26例）。超声漏诊23例，误诊1例，合并其他器官畸形18例。（3）随访结局：产前诊断为先天性心脏病的胎儿中接受尸体心脏解剖19例，均与产前超声诊断结果一致；继续妊娠者胎儿出生后接受超声心动图检查12例，其中与产前诊断符合11例，另1例产前诊断三尖瓣关闭不全，产后超声检查正常。接受染色体检查23例，染色体核型异常7例。（4）产前超声筛查的敏感性与特异性：四腔心切面确诊先天性心脏病胎儿28例，同时加入左、右心室流出道及三血管切面共诊断先天性心脏病50例，诊断的敏感性为69�Objective To investigate the application of ＂Guidelines for performing fetal cardiac scan＂, issued by the International Society of Ultrasound in Obstetrics and Gynecology in 2006, in prenatal screening of fetal congenital heart disease （CHD）. Method Totally, 5000 singleton pregnancies presented at the Maternal-Fetal Medical Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School from September 2006 to July 2007, for prenatal screening were included in this study, with the median maternal age of 28 （range, 18 -48 ） and the median gestation of 27 （range, 18 ~ 40 ） weeks. Ultrasound screenings were performed on each fetal heart according to ＂ Guidelines for performing fetal cardiac scan＂ via the four-chamber and outflow tracts ＆ three-vessel views and fetal echocardiographies were further conducted for suspected cases. Once congenital heart disease was confirmed, amniocentesis or cordocentesis was suggested for fetal karyotyping for ongoing pregnancies and autopsy was performed when the pregnancy was terminated after formal consent. Born babies were followed up at 2 - 6 months of age using echocardiography. Result The four-chamber views were successfully obtained in 97.64% （4882/5000） of all the pregnancies , among which the left ventricular and right ventricular outflow tracts and three-vessel views were obtained in 87. 69% （4281/4882）, 82. 51% （ 4028/4882 ） and 96. 29% （ 4701/4882 ）, respectively. Higher successful rate was found in the second trimester than the third trimester in obtaining the standard views （ P 〈 0. 05）. Finally, 73 （ 1.50% ） among the 4882 cases were diagnosed as CHD. Fifty of them were diagnosed prenatally （24 eases in the second trimester and 26 eases in the third trimester） and 23 were missed and 1 misdiagnosed by prenatal ultrasound. Eighteen eases were found with extraeardiac malformations. Autopsy was performed in 19 CHD which diagnosed prenatally, and all autopsy reports were consistent with ultrasound founding

关 键 词：心脏缺损 先天性 超声检查 产前 超声心动描记术 

分 类 号：R686[医药卫生—骨科学]