产前超声诊断先天性心脏病的误漏诊情况及影响因素分析  

Analysis of Misdiagnosis and Missed Diagnosis of Congenital Heart Disease by Prenatal Ultrasonography and Its Influencing Factors

作　　者：时明芳 张聪祎 SHI Mingfang;ZHANG Congyi(Department of Ultrasound,the Second People's Hospital of Hengshui City,Hengshui,Hebei 053000,China)

机构地区：[1]衡水市第二人民医院超声科,河北衡水053000

出　　处：《临床误诊误治》2024年第11期10-14,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探究产前超声诊断先天性心脏病(CHD)误漏诊的发生情况,并分析其影响因素。方法选取2019年5月至2023年2月行胎儿CHD筛查136例孕妇为研究对象,均进行产前超声检查,对比产前超声心动图检查异常结果与产后诊断或引产解剖结果,统计误诊及漏诊情况,利用单因素及多因素Logistic回归分析CHD产前超声误漏诊的影响因素。结果27例经引产或者产后确诊CHD患儿中,18例与产前超声检查完全符合,诊断符合率为66.67%。漏诊5例(室间隔缺损3例、右心室双出口2例),误诊4例(右心室双出口2例、法洛四联症2例),漏诊率为3.68%,误诊率为2.94%。年龄、吸烟史或被动吸烟、体质量增重过重、羊水不足、腹壁瘢痕、医生临床经验少是CHD产前超声误漏诊的独立危险因素(P<0.05,P<0.01)。结论产前超声对CHD具有良好的诊断价值,但存在一定的误漏诊情况。年龄、吸烟史或被动吸烟、体质量增重过重、羊水不足、腹壁瘢痕、医生临床经验少是产前超声误漏诊发生的危险因素,应针对以上因素采取相应措施以减少误漏诊。Objective To investigate the occurrence of misdiagnosis and missed diagnosis of congenital heart disease(CHD)by prenatal ultrasonography and to analyze its influencing factors.Methods A total of 136 pregnant women who un-derwent fetal CHD screening from May 2019 to February 2023 were selected as the research subjects.All of them underwent prenatal ultrasonography,the abnormal results of prenatal echocardiography were compared with the results of postpartum diagnosis or induction of labor,and the misdiagnosis and missed diagnosis were calculated.Univariate and multivariate lo-gistic regression analyses were used to analyze the factors affecting the misdiagnosis and missed diagnosis of prenatal ultraso-nography in CHD.ResultsAmong 27 patients diagnosed with CHD afer labor induction or postpartum,18 cases were com-pletely consistent with prenatal ultrasonography,and the diagnosis coincidence rate was 66.67%.There were 5 cases of missed diagnosis(3 cases of ventricular septal defect,2 cases of right ventricular double outlet)and 4 cases of misdiagnosis(2 cases of right ventricular double outlet and 2 cases of tetralogy of Fallot);the missed diagnosis rate was 3.68%,and the misdiagnosis rate was 2.94%.Age,smoking history or passive smoking,excess body mass gain,insufficient amniotic fluid,scarring of the ab-dominal wall,and little clinical experience of doctors were independent risk factors for misdiagnosis and missed diagnosis of prenatal ultrasonography of CHD(P<0.05,P<0.01).Conclusion Prenatal ultrasonography has good diagnostic value for CHD,but there is misdiagnosis and missed diagnosis.Age,smoking history or passive smoking,excess body weight gain,insuf-ficient amniotic fluid,scarring of the abdominal wall,and little clinical experience of doctors are risk factors for misdiagnosis.Targeted measures should be taken to reduce misdiagnosis and missed diagnosis.

关 键 词：先天性心脏病 产前超声 误诊 漏诊 年龄 羊水不足 腹壁瘢痕 影响因素分析 

分 类 号：R714.5[医药卫生—妇产科学]