孕早期超声筛查胎儿结构畸形的循证病案讨论  

Evidence-Based Case Report on the Effect of Ultrasound Screening to Pregnant Women at 11-14 Gestational Weeks on Fetus of Fetal Malformations

作　　者：唐英[1] 刘关键[2] 杨太珠[1] 

机构地区：[1]四川大学华西第二医院超声科,成都610041 [2]四川大学华西医院循证医学与临床流行病学教研室,成都610041

出　　处：《中国循证医学杂志》2009年第6期705-708,共4页Chinese Journal of Evidence-based Medicine

摘　　要：目的循证探讨1例孕早期(孕11～14周)超声筛查胎儿结构畸形是否有效。方法针对孕早期是否可进行超声筛查胎儿结构畸形的问题,全面检索Cochrane图书馆(2008年第4期)、MEDLINE(1981～2008)、OVID ACP JournalClub(1991～2008)、BMJ Clinical Evidence(1999～2008),获取并评价相关系统评价、随机对照试验、临床对照试验证据,并将最佳证据用于临床实践。结果从Cochrane图书馆检索到系统评价3篇、随机对照试验5篇、队列研究9篇。结果显示:产前各孕期的超声检查能够发现不同类型的胎儿结构畸形,但不能发现所有胎儿结构畸形;在孕11～14周超声测量胎儿颈部透明层厚度,可显示胎儿主要的系统器官结构,从而探查部分胎儿结构畸形和筛查胎儿染色体畸形高危人群,尽早临床决策;孕早期超声筛查胎儿畸形不能取代孕中期筛查,两者联合可较好地筛查胎儿畸形。目前并无证据表明孕早期超声筛查会影响胎儿发育及出生后生长发育。结论对孕11～14周孕妇进行超声筛查胎儿结构畸形有效。Objective To formulate an evidence-based conclusion concerning ultrasound screening for fetal malformations for a pregnant woman after 12 gestational weeks. Methods Based on the clinical problem of whether pregnant women need ultrasound screening for＇ fetal malformations after 11-14 gestational weeks, we used ＂ultrasound or sonography and prenatal or fetal at first trimester or 11-14 weeks; ultrasound exposure; fetal development＂ as the keywords and searched The Cochrane Library （Issue 4, 2008）, MEDLINE （1981 to 2008）, ACP Journal Club （1991 to 2008）, and BMJ Clinical Evidence （1999 to 2008） for systematic reviews, randomized controlled trials （RCTs） and controlled clinical trials. The methodological quality of the included studies was assessed to identify the current best evidence. Results Three systematic reviews, two RCTs and ten cohort ,;tudies were retrieved. The results showed ultrasound screening detected different fetal malformations in the first, second and third trimester. Not all of the fetal malformations could be detected through prenatal ultrasound screening. Nuchal translucency （NT） measurement as a tool for screening chromosomally abnormal fetuses and detecting fetal malformations by ultrasound proved to be effective if performed within 11-14 gestational weeks. The routine second trimester screening, however, could not be replaced by a detailed ultrasound examination at 11-14 gestational weeks. Most of the trials concluded that the effect of ultrasound on a fetus was not harmful. Conclusion The findings of this study should reassure physicians and parents alike that ultrasound screening is an appropriate option for the pregnant women after 12 gestational weeks.

关 键 词：超声检查 胎儿畸形 孕早期(孕11~14周) 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]