二维超声联合四维彩超HD-flow彩色血流显像在产前诊断先天性心脏发育异常中的应用  

Application of two-dimensional ultrasonography combined with four-dimensional echocardiography with high-definition flow imaging in prenatal diagnosis of congenital heart dysplasia

作　　者：谢许萍[1] 马小燕[2] 胡燕芳[1] 张富[1] 桑颖[1] 杨晓君[1] 张胜林[3] XIE Xu-ping;MA Xiao-yan;HU Yan-fang;ZHANG Fu;SANG Ying;YANG Xiao-jun;ZHANG Sheng-lin(Department of Ultrasonography,Xiaolan People's Hospital of Zhongshan Affiliated to Southern Medical University,Zhongshan 528415,Guangdong,CHINA;Department of Ultrasonography,Maternity and Child Healthcare Hospital of Guangdong,Guangzhou 510000,Guangdong,CHINA;Department of Ultrasonography,Chenxinhai Hospital of Zhongshan,Zhongshan 528415,Guangdong,CHINA)

机构地区：[1]南方医科大学附属小榄人民医院超声科,广东中山528415 [2]广东省妇幼保健院超声科,广东广州510000 [3]中山市陈星海医院超声科,广东中山528415

出　　处：《海南医学》2019年第19期2531-2535,共5页Hainan Medical Journal

摘　　要：目的探讨二维超声联合四维彩超超高细微分辨血流技术(HD-flow)彩色血流显像在产前诊断先天性心脏发育异常中的临床应用价值。方法选取2016年7月至2018年2月在小榄人民医院行产前超声检查并分娩的单胎妊娠孕妇2 200例,先对所有入组的孕妇进行二维超声检查,二维超声检查提示胎儿疑似宫内心脏发育异常的孕妇再联合应用四维彩超HD-flow彩色血流显像进行检查。将进行二维超声的检查结果作为对照组,将二维超声+四维彩超HD-flow彩色血流显像的检查结果作为研究组,将出生后新生儿的心脏超声诊断结果或引产后胎儿心脏病理诊断结果作为金标准。观察所有入组孕妇中胎儿先天性心脏发育异常(FCHD)的检出情况,比较不同检查方式诊断FCHD胎儿的准确率。结果2 200例胎儿经随访诊断证实有56例胎儿存在先天性心脏发育异常,占所有入组胎儿总数的2.5%(56/2 200),其中,动脉弓畸形6例,三尖瓣畸形3例,完全性大动脉转位4例,右室双出口4例,单心室(房)4例,法洛四联症(TOF)8例,心内膜垫缺损4例,单纯性室间隔缺损9例、左心发育不良4例,肺动脉瓣闭锁5例,肺动脉瓣狭窄2例,永存动脉干3例;二维超声共检查出42例FCHD,有14例误诊或漏诊,准确率为75.0%,二维超声+四维彩超HD-flow彩色血流显像检查共查出52例FCHD,误诊或漏诊4例,准确率为92.8%,研究组的准确率高于对照组,差异具有统计学意义(P<0.05);研究组的灵敏度为92.1%、特异度为94.5%,对照组的灵敏度为60.7%、特异度为90.3%,研究组的灵敏度及特异度明显高于对照组,差异均有统计学意义(P<0.05)。结论二维超声联合四维彩超HD-flow彩色血流显像检查能显著提高FCHD的产前诊断准确率,具有较高的灵敏度及特异度,值得临床推广应用。Objective To explore study the application of two-dimensional ultrasonography combined with four-dimensional echocardiography with high-definition(HD)flow imaging in prenatal diagnosis of congenital heart dysplasia.Methods A total of 2 200 pregnant women of monocyesis,who underwent ultrasonography examination in Xiaolan People's Hospital of Zhongshan Affiliated to Southern Medical University from July 2016 to February 2018,were selected as the research subjects.All the enrolled pregnant women underwent two-dimensional ultrasonography first,those pregnant women whose two-dimensional ultrasonography showed suspected intrauterine cardiac dysplasia underwent four-dimensional echocardiography with HD flow imaging subsequently.The inspection result of two-dimensional ultrasound was chosen as the control group,the combination results of two-dimensional ultrasonography combined with four-dimensional echocardiography with high-definition(HD)flow imaging was selected as the research group,the results of echocardiographic diagnosis of postnatal neonates or fetal heart disease after induced labor were regarded as the gold standard.The detection of fetal congenital heart disease(FCHD)in all pregnant women was observed,and the accuracy of different examinations in the diagnosis of FCHD fetus was compared.Results Among the 2 200 cases of fetus,56 cases of FCHD were confirmed through follow-up diagnosis with 2.5%(56/2 200),including of 6 cases of arch deformity,3 cases of tricuspid anomaly,4 cases of completeness arteries transposition,4 cases of right ventricular double exports,4 cases of single ventricle(room),8 cases of TOF(tetralogy of fallot),4 cases of endocardial cushion defect,9 cases of simple ventricular septal defect,4 cases of left heart dysplasia,5 cases of pulmonary valve atresia,2 cases of pulmonary stenosis,and 3 cases of forever truncus arteriosus.Two-dimensional ultrasonic inspection confirmed 42 cases of FCHD,and 14 cases were misdiagnosed or missed,with the accuracy rate of 75.0%;two-dimensional ultrasonograp

关 键 词：二维超声 四维彩超 超高细微分辨血流技术 产前诊断 先天性心脏发育异常 灵敏度 特异度 准确率 

分 类 号：R714.43[医药卫生—妇产科学]