产前超声诊断胎儿心血管畸形与产后诊断结果对比分析  

Comparative analysis of prenatal ultrasound diagnosis and postnatal diagnosis for fetal cardiovascular malformations

作　　者：林李梅[1] 郑洪平[1] 李晓云[1] 陈香洁 LIN Li-Mei;ZHENG Hong-Ping;LI Xiao-Yun(Maternal and Child Health Care Hospital of Longgang District,Shenzhen,Guangdong 518172,China)

机构地区：[1]深圳市龙岗区妇幼保健院,广东深圳518172

出　　处：《中国妇幼保健》2018年第16期3829-3831,共3页Maternal and Child Health Care of China

摘　　要：目的对比产前二维超声诊断胎儿心血管畸形与产后诊断结果的差异,探讨产前超声在筛查胎儿心血管畸形中的临床价值,为胎儿后续诊治处理方案提供参考。方法选择2013年2月-2016年2月在该院妇产科建档行孕期保健的孕18~24周孕妇2 127例行超声检查,其中186例胎儿经超声检查疑似为心血管畸形,跟踪186例胎儿的后续处理措施,对于实施流产者或胎死腹中的行病理检查,正常生产的胎儿行超声心动图、心导管或心血管造影检查进行确诊,产前超声未检出心血管畸形生产的新生儿于3个月内行超声检查。对疑似心血管畸形者采用超声心动图或心导管或心血管造影检查进行确诊,收集上述4种情况的诊断结果,与产前超声诊断结果进行比较。以病理检查、心导管及心血管造影检查结果为金标准,计算产前超声诊断结果的特异度、敏感度及准确度,分析产前超声诊断在胎儿心血管畸形筛查中的临床价值。结果经流产、死胎、心导管及心血管造影检查,186例受试者中的164例胎儿确诊为心血管畸形,1 941例产前未检出心血管畸形的新生儿出生后金标准诊断出2例心血管畸形。产前超声诊断胎儿心血管畸形的特异度为:98.06%,灵敏度为:89.15%,准确度为97.37%。166例心血管畸形患儿的类型为:室间隔缺损34例,房室隔缺损29例,房间隔缺损25例,肺动脉瓣狭窄25例,血管环18例,法洛四联症16例,肺静脉异位连接13例,右心室双出口10例。漏诊的2例心血管畸形患儿为法洛四联症,1例为产前检查时间为孕18周,1例为孕19周。结论产前超声诊断胎儿心血管畸形具有较高的特异度和灵敏度,但对于在孕19周前检查疑似心血管畸形胎儿应于24周左右再行超声检查,以期避免漏检的发生。Objective To compare the differences of prenatal ultrasound diagnosis and postnatal diagnosis for fetal cardiovascular malformations,explore the clinical value of prenatal ultrasound screening for fetal cardiovascular malformations,provide reference for diagnosis and treatment. Methods From February 2013 to February 2016,2 127 pregnant women of 18-24 gestational weeks establishing medical records and receiving antenatal care in Department of Gynecology and Obstetrics of Maternal and Child Health Care Hospital of Longgang District were selected,ultrasonography was performed,then 186 fetuses were suspected of cardiovascular malformations after ultrasonography,the subsequent treatment was followed up,abortion or stillbirth cases underwent pathological examination. The neonates born normally underwent ultrasonic cardiogram,cardiac catheterization or cardioangiography for definite diagnosis. The neonates without cardiovascular malformations after prenatal ultrasonography underwent ultrasonography within three months. The suspected cases underwent ultrasonic cardiogram,cardiac catheterization or cardioangiography for definite diagnosis. The diagnostic results of the above-mentioned situations were collected,then the results were compared with diagnostic result of prenatal ultrasonography. The results of pathological examination,cardiac catheterization or cardioangiography were collected as gold standard,specificity,sensitivity,and accuracy of prenatal ultrasonography were calculated.The clinical value of prenatal ultrasonography in screening of fetal cardiovascular malformations was analyzed. Results After abortion,stillbirth,cardiac catheterization,and cardioangiography,164 fetuses were diagnosed as cardiovascular malformations. Among 1 941 neonates without cardiovascular malformations after prenatal ultrasonography,2 neonates were diagnosed as cardiovascular malformations. The specificity,sensitivity,and accuracy of prenatal ultrasound in diagnosis of fetal cardiovascular malformations were 98. 06%,89. 15%,and97. 37%

关 键 词：胎儿心血管畸形 产前超声检查 产后诊断 对比分析 筛查价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]