联合多切面法在产前超声诊断胎儿先天性心脏病中的应用价值  

Value of multi-section ultrasound in prenatal diagnosis of congenital heart disease

作　　者：于岚[1] 林光耀[2] 朱丽红[1] 王海英[1] 何惠丽[1] 苏陈艾[1] 王梅[1] 关娜[1] 

机构地区：[1]新疆维吾尔自治区人民医院超声科,乌鲁木齐830001 [2]新疆医科大学研究生院

出　　处：《中华围产医学杂志》2014年第2期99-103,共5页Chinese Journal of Perinatal Medicine

基　　金：新疆维吾尔自治区科技支撑计划（201033120）

摘　　要：目的 评价联合多切面法在产前超声诊断胎儿先天性心脏病中的应用价值. 方法 2008年1月17日至201 3年3月15日,在新疆维吾尔自治区人民医院进行产前超声筛查并分娩的孕妇共11 153例,在妊娠（26.6±5.8）周行产前超声检查.采用Yagel五切面（胎儿上腹部横切面、四腔心切面、左心室流出道切面、右心室流出道切面和三血管切面）检查方法进行常规检查;如发现胎儿心脏结构异常,联合其他切面进一步检查,包括主动脉弓长轴切面、动脉导管弓长轴切面、上下腔长轴切面、大动脉短轴切面以及心底流出道切面.以引产的先天性心脏病胎儿尸体解剖结果、新生儿心脏手术结果或超声检查结果为金标准,计算联合多切面法产前超声诊断胎儿先天性心脏病的敏感性、特异性、阳性预测值和阴性预测值. 结果 有完整随访资料者10 071例纳入分析,产前超声检出胎儿先天性心脏病105例,检出率为1.04％.105例中的3例胎儿产前超声诊断为室间隔缺损,新生儿超声显示正常;另有9例胎儿产前超声检出先天性心脏病类型与产后诊断不一致,分别为：3例产前诊断为大动脉异位型右心室双出口,产后诊断为大动脉转位;1例产前诊断为永存动脉干,产后诊断为法洛四联症并肺动脉狭窄;1例产前诊断为大动脉转位,产后诊断为大动脉异位型右心室双出口;1例产前诊断为永存动脉干,产后诊断为法洛四联症;1例产前诊断为主动脉缩窄,产后诊断为主动脉弓离断;1例产前诊断为左心发育不良,产后诊断为单心室;1例产前诊断为法洛四联症,产后诊断为右心室双出口.9 966例产前超声检查正常的胎儿生后检出13例先天性心脏病,包括6例室间隔缺损,3例主动脉缩窄,2例继发性房间隔缺损和2例部分性肺静脉畸形连接.联合多切面法产前超声诊断胎儿先天性心脏病的准确率为88.6％（93/105）,敏感性为88.7％（102/115�Objective To assess the value of multi-section ultrasound in prenatal diagnosis of congenital heart disease. Methods Totally, 11 153 pregnant women, who underwent fetal echocardiography from January 17, 2008 to March 15, 2013 in People＇s Hospital of Xinjiang Uygur Autonomous Region, were retrospectively reviewed. The ultrasound scan was performed at （ 26.6±5.8 ） weeks of gestation. Yagel Five- section ultrasound （ transverse view of the fetal upper abdomen, four-chamber view, left ventricular outflow- tract view, right ventricular outflow-tract view and three-vessel view ） was adopted as routine screening. If abnormal cardial structure was found, more sections would be associated, such as longitudinal view of the aortic arch, arterial arch axis section,upper and lower long axis view, great artery short axis view and heart outflow tract views. Autopsy results, neonatal surgical results or long-term follow-up echocardiography results were compared with antenatal screening results to calculate the sensitivity, specificity, positive predictive value and negative predictive value of ultrasound screeing in prenatal diagnosis of congenital heart disease. Results Totally 10 071 cases with followed-up results were enrolled and analyzed. The detection rate of fetal congenital heart disease by prenatal ultrasound screening was 1.04% （ 105/10 071 ） . Among these detected 105 cases, there were three cases confirmed to be normal after birth and nine cases finally confirmed to be other cardiac anomalies, including three cases of double outlet of right ventricle with transposition of the great arteries detected prenatally but diagnosed as transposition of the great arteries postnatally; one case of persistent truncus arteriosus detected prenatally but diagnosed as tetralogy of Fallot complicated with pulmonary artery stenosis postnatally; one case of transposition of the great arteries detected prenatally but diagnosed as double outlet of right ventricle with transposition of the great arteries postnatally; one ca

关 键 词：心脏缺损 先天性 超声检查 产前 

分 类 号：R714.5[医药卫生—妇产科学]