分阶段产前超声筛查对胎儿先天性心脏病检出的价值  

Value of phased prenatal ultrasound screening in detection of fetal congenital heart diseases

作　　者：吴晶晶[1] 周毓青 龚菁菁 何碧媛 陈田田 张会萍 唐龙英 WU Jingjing;ZHOU Yuqing;GONG Jingjing(Department of Ultrasound,Affiliated Shanghai Changning Maternal and Child Health Hospital,East China Normal University,Shanghai 200050,CHINA)

机构地区：[1]华东师范大学附属上海市长宁区妇幼保健院超声科,上海200050 [2]华东师范大学附属上海市长宁区妇幼保健院产科,上海200050

出　　处：《江苏医药》2022年第8期790-793,F0003,共5页Jiangsu Medical Journal

基　　金：上海市医学重点专科基金(ZK2019B02)。

摘　　要：目的 探讨分阶段产前超声筛查对胎儿先天性心脏病(先心病)检出的临床价值。方法 分别在早孕期(11~13周)、中孕早期(14~17周)、中孕中期(18~23周)和晚孕早期(28~33周)对2018—2021年上海市长宁区妇幼保健院产检孕妇进行胎儿先心病超声筛查,对筛查疑似病例进一步行胎儿超声心动图检查。胎儿先心病病例出生后随访6个月,分析分阶段产前超声筛查先心病的临床应用价值。结果 2018—2021年共筛查43 261例单胎胎儿,检出胎儿先心病718例(1.7%);其中,终止妊娠85例(11.8%),继续妊娠633例(88.2%)。718例先心病胎儿中,早孕期超声筛查发现27例(3.8%),中孕早期发现14例(1.9%),中孕中期发现656例(91.4%),晚孕早期发现21例(2.9%)。最早发现孕周为孕11周,最晚发现孕周为33周。按出生后循环特点分类,房室通道型先心病173例(4.00‰),动脉导管依赖型先心病43例(0.99‰),胎儿心律失常17例(0.39‰),胎儿心脏位置异常4例(0.09‰),其他类型先心病20例(0.46‰)。不同类型胎儿先心病发病率两两比较差异均有统计学意义(P<0.01)。结论 根据孕周分阶段产前超声筛查可有效发现胎儿先心病。及早发现凶险性动脉导管依赖型先心病有助于围产期和产后的正确处理。Objective To investigate the clinical value of phased prenatal ultrasound screening in the detection of fetal congenital heart disease(CHD).Methods Ultrasound screening of fetal CHD was carried out for pregnant women undergoing prenatal examination in Shanghai Changning Maternal and Child Health Hospital from 2018 to 2021 in stages during early pregnancy(11 weeks to 13 weeks plus 6 days), early second trimester(14 weeks to 17 weeks plus 6 days),middle trimester(18 weeks to 23 weeks plus 6 days) and early late trimester(28 weeks to 33 weeks plus 6 days),and further fetal echocardiography was performed in the suspected cases.The fetal CHD cases were followed up for 6 months after birth to analyze the clinical value of phased prenatal ultrasound screening for CHD.Results A total of 43 261 single fetuses were screened from 2018 to 2021,of whom 718 cases(1.7%) of fetal CHD were detected including 85 cases(11.8%) of terminated pregnancy and 633 cases(88.2%) of continued pregnancy.Among 718 fetuses with CHD,27 cases(3.8%) were found in early pregnancy, 14 cases(1.9%) in early second trimester, 656 cases(91.4%) in middle trimester and 21 cases(2.9%) in early late trimester.The earliest and latest detection of CHD was 11 weeks plus 6 days and 33 weeks plus 6 days of pregnancy, respectively.According to the characteristics of postnatal circulation, 173 cases(4.00‰) of atrioventricular channel CHD,43 cases(0.99‰) of ductus arteriosus-dependent CHD,17 cases(0.39‰) of fetal arrhythmia, 4 cases(0.09‰) of fetal heart position abnormality, and 20 cases(0.46‰) of other types of CHD were detected.There was significant difference in the incidence rate of various fetal CHD(P<0.01).Conclusion Prenatal ultrasound screening by stages according to gestational weeks can effectively detect fetal CHD.Early detection of dangerous ductus arteriosus-dependent CHD is helpful for the correct management during perinatal and postpartum period.

关 键 词：胎儿 先天性心脏病 超声 产前诊断 

分 类 号：R445[医药卫生—影像医学与核医学]