应用Yagel式快速心脏检查法产前筛查先心病的价值研究  

Prenatal diagnosis of congenital fetal heart abnormalities with Yagel method

作　　者：孙美玉[1] 李辉[1] 关云萍 周卫卫[2] 杨光 毕丽华 邵雪竹 王丹 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004 [2]沈阳市妇婴医院,沈阳110014 [3]大连妇产医院,大连116033 [4]锦州妇产医院,锦州121000

出　　处：《中国优生与遗传杂志》2010年第7期98-99,144,共3页Chinese Journal of Birth Health & Heredity

基　　金：国家"十一.五"科技支撑计划;项目号:2006BAI05A04;辽宁省科技攻关项目资助;项目号2005225008

摘　　要：目的探讨Yagel式胎儿心脏快速扫描法在胎儿心脏产前诊断中的价值。方法病例选自2002年以来在中国医科大学附属盛京医院、沈阳市妇婴医院、大连妇产医院和锦州市妇婴医院就诊的孕妇7394例,均为单胎妊娠,其中先天性心脏畸形(CHD)高危患者1276例。应用Yagel5个心脏横面检查方法进行胎儿心脏快速检查,并对引产胎儿进行尸体解剖核对产前诊断的正确性;对产前诊断未发现明显异常胎儿进行临床随访,胎儿出生后进行新生儿或婴儿心脏超声检查,判定产前诊断的正确性。结果 1.7394例孕妇中,检查发现胎儿心脏结构异常为79例(1.07%),其中31例(39.2%)患者来自于CHD高危人群。2.79例产前诊断为CHD患者中,72例选择了终止妊娠放弃胎儿,其中56例进行尸体解剖,其中1例患者病理诊断为永存动脉干畸形,产前诊断为法洛四联症;1例右心室双流出道,产前诊断为大动脉转位;1例为部分型肺静脉异位引流,产前诊断为左心发育不良;1例为主动脉缩窄,产前诊断为左心发育不良。3.79例产前诊断为CHD患者中,7例选择继续妊娠,其中室间隔缺损(VSD)3例,法洛四联症1例,永存动脉干1例,右心室占位病变(0.8cmX0.8cm)1例,轻度肺动脉狭窄伴三尖瓣返流1例。4.6118例产前诊断为正常胎儿心脏患者,新生儿或婴儿心脏超声检查发现室间隔缺损2例(0.03%);动脉导管未闭2例;房间隔缺损1例;部分肺静脉异位引流1例,主动脉轻度狭窄1例,肺动脉轻度狭窄1例。5.应用Yagel胎儿心脏检查方法诊断胎儿心脏异常的敏感性为90.8%,特异性为100%。结论 1.Yagel式胎儿心脏快速扫描法是产前诊断胎儿心脏畸形的安全、简单和有效方法。2.对所有人群进行胎儿心脏结构产前检查,减少严重心脏病患儿的出生,具有重大的社会和经济意义。Objective：To study the value of diagnosing congenital heart abnormalities prenatally with Yagel method. Methods：7394 singleton pregnancies were included in this study,1276 of them were at high-risk of congenital heart disease （CHD）. the fetal heart was scanned with Yagel＇s heart examination method using ultrasound,autopsy was performed for CHD fetuses when the pregnancy was terminated. A close following-up was given for normal fetal heart pregnancies and a neonatal echocardiography was performed to check the accuracy of prenatal diagnosis. Results：1. Seventy-nine cases （1.07%） were found fetal heart abnormalities in this study,39.2% of them were from high risk group. 2. Among 79 cases with CHD,72 chose to terminate pregnancy,56 of them were conducted autopsy,92.9% of them achieved unanimous conclusion between prenatal fetal echocardiography and autopsy. 3. Seven cases chose to continue pregnancy,three of them were VSD,one case was Tetralogy of Fallot,one case was truncus arteriosus,one case was a mass in the right ventricle and one case was pulmonary stenosis. 4. The sensitivity was 90.8% and the specificity was 100% with Yagel method. Conclusions：1. Yagel＇s fetal echo method is effective and simple way to diagnose CHD prenatlly. 2. It is worth while to scan fetal heart for all pregnancies

关 键 词：胎儿 心脏 畸形 产前 筛查 

分 类 号：R445.12[医药卫生—影像医学与核医学]