产前超声诊断992例胎儿心脏畸形分析  

Analysis on 992 cases of fetal cardiac abnormalities diagnosed by prenatal echocardiography

作　　者：王凤兰[1] 王建华[2] 张云亭[1] 易建平[3] 寇世和[3] 张伟[3] 周钰昆 

机构地区：[1]天津医科大学总医院,300072 [2]北京军区总医院超声科 [3]河北省唐山市妇幼保健院

出　　处：《中国妇幼保健》2015年第16期2600-2603,共4页Maternal and Child Health Care of China

基　　金：河北省重点科研课题〔11276102D〕

摘　　要：目的:探讨产前超声诊断胎儿心脏畸形的疾病分布特点、价值及降低漏诊率。方法:对进行产前胎儿心脏检查、诊断并经引产或出生后确诊的992例胎儿心脏畸形患儿的资料进行回顾性分析,并对心外疾病和漏诊病例进行分析。结果:本组检查胎儿心脏共11 136例,检出心脏畸形992例(1644处畸形),检出率为8.91%;其中复杂心脏畸形368例,单发心脏畸形624例。按心脏发病种类及数量排序,前五位依次是室间隔缺损、房室间隔缺损、共同动脉干、肺动脉狭窄、法乐氏四联症;伴随疾病按数量排序前五位依次为单脐动脉、羊水多、唇腭裂、脉络丛囊肿、颈背皮肤增厚。超声漏诊67例,前五位为室间隔缺损、轻型法洛氏四联症、肺动脉瓣轻度狭窄、肺静脉异位引流、主动脉弓缩窄。结论:产前超声对心脏复杂畸形和单发畸形都有较高的诊断率,是诊断胎儿心脏畸形不可缺少的手段,能为孕妇合理选择提供帮助。当合并单脐动脉、羊水多等疾病时应对胎儿心脏做针对性检查,当诊断主动脉弓病变时应谨慎、应多切面多次检查,以防漏诊或误诊。Objective： To explore the characteristics of distribution of fetal cardiac abnormalities diagnosed by prenatal echocardiography and the value of prenatal echocardiography to reduce the rate of missed diagnosis. Methods： The clinical data of 992 cases of fetal cardiac abnormalities diagnosed by prenatal echocardiography and confirmed by induced abortion and after birth was analyzed retrospectively,the extracardiac diseases and cases of missed diagnosis were analyzed. Results： A total of 992 cases（ 1 644 malformations） were diagnosed as cardiac malformations by prenatal echocardiography among 11 136 cases,the detection rate was 8. 91%; 368 cases of complex cardiac malformations and 624 cases of single cardiac malformations were included. According to the types and quantities of cardiac malformations,the top five cardiac malformations were ventricular septal defect,atrioventricular septal defect,common truncus arteriosus,pulmonary artery stenosis,and tetralogy of Fallot; according to the number of accompanying diseases,the top five cardiac malformations were single umbilical artery,polyhydramnios,cleft lip and palate,choroid plexus cyst,and increased nuchal fold. Sixty- seven cases were missed diagnosed,the top five cardiac malformations were ventricular septal defect,mild tetralogy of Fallot,mild pulmonary artery stenosis,ectopic drainage of pulmonary vein,and aortic arch stenosis. Conclusion： The diagnostic rates of complex cardiac malformations and single cardiac malformations are relatively high by prenatal echocardiography,prenatal echocardiography is an indispensable method in diagnosis of fetal cardiac malformations,which can offer help for reasonable selection of pregnant women. When the fetuses are found with single umbilical artery and polyhydramnios,and so on,fetal echocardiography should be performed correspondingly,it should be cautious when diagnosing aortic arch lesions,many views and multiple examination should be conducted to prevent missed diagnosis and misdiagnosis.

关 键 词：胎儿心脏畸形 流行病特点 产前超声诊断 

分 类 号：R714.5[医药卫生—妇产科学]