二维与四维超声用于产前胎儿心脏筛查的价值比较
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摘要
目的比较二维与四维超声在产前胎儿心脏筛查中的应用价值。方法回顾性分析2014年8月—2016年10月在我院接受产前胎儿心脏筛查的孕妇的临床资料,所有孕妇均接受二维和四维超声检查。统计胎儿心脏畸形检出率,分析比较二维和四维超声对胎儿心脏畸形诊断的准确率、特异度和灵敏度。结果 4 500例接受产前筛查的高危孕妇中,确诊存在胎儿心脏畸形者66例,其中法洛四联症10例,永存动脉干7例,右心室双出口5例,下腔静脉离断3例,房室间隔缺损6例,大动脉转位2例,永存左上腔静脉12例,肺动脉瓣狭窄4例,室间隔缺损13例,单心室3例,三尖瓣下移畸形1例,胎儿心脏畸形检出率为1.47%。四维超声对胎儿心脏畸形诊断的准确率明显高于二维超声(χ~2=21.761,P<0.01);四维超声对胎儿心脏畸形诊断的灵敏度和特异度分别为93.28%、95.12%,高于二维超声。结论四维超声在产前胎儿心脏筛查中具有较高的应用价值,对胎儿心脏畸形筛查的正确率较二维超声高。
Objective To investigate the value of two-dimensional versus four-dimensional echocardiography in prenatal fetal heart screening. Methods A retrospective analysis was performed for the clinical data of pregnant women who underwent prenatal fetal heart screening in our hospital from August 2014 to October 2016,and all these pregnant women underwent two-dimensional and four-dimensional echocardiography.The detection rate of fetal heart malformation was determined,and two-dimensional and four-dimensional echocardiography were compared in terms of accuracy,specificity,and sensitivity. Results Of all4 500 high-risk pregnant women who underwent prenatal screening,66 were found to have fetal heart malformation,among whom10 had tetralogy of Fallot,7 had persistent truncus arteriosus,5 had double outlet of the right ventricle,3 had interruption of the inferior vena cava,6 had atrioventricular septal defect,2 had transposition of the great arteries,12 had persistent left superior vena cava,4 had pulmonary valve stenosis,13 had ventricular septal defect,3 had single ventricle,and 1 had Ebstein's anomaly,resulting in a detection rate of heart malformation of 1.47%.Four-dimensional echocardiography had a significantly higher accuracy in the diagnosis of fetal heart malformation than the two-dimensional echocardiography(χ~2=21.761,P<0.01).Four-dimensional echocardiography had a sensitivity of 93.28% and a specificity of 95.12%in the diagnosis of fetal heart malformation,which were significantly higher than those of two-dimensional echocardiography. Conclusion Four-dimensional echocardiography has a high value in prenatal fetal heart screening,with a higher accuracy than two-dimensional echocardiography.
Objective To investigate the value of two-dimensional versus four-dimensional echocardiography in prenatal fetal heart screening. Methods A retrospective analysis was performed for the clinical data of pregnant women who underwent prenatal fetal heart screening in our hospital from August 2014 to October 2016,and all these pregnant women underwent two-dimensional and four-dimensional echocardiography.The detection rate of fetal heart malformation was determined,and two-dimensional and four-dimensional echocardiography were compared in terms of accuracy,specificity,and sensitivity. Results Of all4 500 high-risk pregnant women who underwent prenatal screening,66 were found to have fetal heart malformation,among whom10 had tetralogy of Fallot,7 had persistent truncus arteriosus,5 had double outlet of the right ventricle,3 had interruption of the inferior vena cava,6 had atrioventricular septal defect,2 had transposition of the great arteries,12 had persistent left superior vena cava,4 had pulmonary valve stenosis,13 had ventricular septal defect,3 had single ventricle,and 1 had Ebstein's anomaly,resulting in a detection rate of heart malformation of 1.47%.Four-dimensional echocardiography had a significantly higher accuracy in the diagnosis of fetal heart malformation than the two-dimensional echocardiography(χ~2=21.761,P<0.01).Four-dimensional echocardiography had a sensitivity of 93.28% and a specificity of 95.12%in the diagnosis of fetal heart malformation,which were significantly higher than those of two-dimensional echocardiography. Conclusion Four-dimensional echocardiography has a high value in prenatal fetal heart screening,with a higher accuracy than two-dimensional echocardiography.
引文
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[11]方友萍,金雪鸿,王晓红,等.产前系统胎儿超声筛查胎儿心脏的临床价值[J].医学影像学杂志,2016,26(5):932-934.
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[13]仇利,罗红.产前超声筛查中孕期胎儿心脏畸形对诊断染色体异常价值的Meta分析[J].中国介入影像与治疗学,2016,13(12):747-752.
[14]许怡韵,蔡艳,陈恩,等.胎儿心脏畸形诊断中产前超声筛查五步检查法的应用效果观察[J].中国实用医刊,2016,43(13):108-110.
[15]LIU L,HE Y,LI Z,et al.Application of two-dimensional echocardiography combined with enhanced flow in diagnosing fetal heart malformation[J].Clinical and Experimental Obstetrics&Gynecology,2014,41(2):195-201.
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[17]丁海耀,周文蓉.二维联合四维超声检查在先天性心脏畸形胎儿产前诊断中的应用[J].山东医药,2016,56(20):63-64.
[18]宋桂敏,曹芳蕾,高锦鹰,等.产前四维超声对先天性心脏畸形的诊断作用[J].中国妇幼保健,2016,31(14):2961-2964.
[19]谷小乐.二维超声联合四维超声在诊断产前胎儿心脏畸形中的应用价值[J].内蒙古医学杂志,2017,49(5):614-616.
[20]李红军,陈欣林,杨小红.二维、四维超声联合检查对胎儿畸形的诊断价值[J].中国妇幼保健,2016,31(14):2964-2966.
[21]陶珍,魏玲玲,王颖.中孕早期胎儿先天性心脏病筛查中四维超声时空关联成像技术的临床应用效果观察[J].中国产前诊断杂志(电子版),2016,8(1):7-10.
[22]曹伟雅.四维彩色多普勒超声在胎儿先天性心脏病筛查中应用研究[J].现代医用影像学,2017,26(4):1090-1091.
[23]王菊云,杨高娥,汤光贤.二维超声联合四维超声在不同孕期胎儿心脏检查中的应用[J].长江大学学报(自然科学版),2016,13(24):40-41.
[24]曹春峰.比较分析二维超声和四维超声在产科检查诊断中的应用效果[J].中国保健营养,2016,26(27):395-396.
[25]李勇.四维彩超在胎儿先天性心脏病筛查中的应用及高危因素分析[J].齐齐哈尔医学院学报,2017,38(12):1391-1392.
[26]樊友彬.探讨二维和四维超声在胎儿先天性心脏病超声诊断中的意义[J].医学信息,2016,29(3):288.
[27]练纯玉.四维超声产前诊断胎儿畸形的价值[J].现代医用影像学,2016,25(1):134-135.
[28]姚国林,区秀红,谢树浩,等.四维超声STIC技术在中孕早期胎儿心脏检查中的应用探讨[J].齐齐哈尔医学院学报,2017,38(16):1897-1898.
[29]毛利萍.四维超声在胎儿心脏畸形诊断中的应用研究[J].现代医用影像学,2016,25(4):779-780.
[2]遇晓娜.彩色多普勒超声在非高危胎儿产前心脏筛查中的临床意义[J].中国实用医药,2015,19(27):43-44.
[3]刘涛,熊奕,吴瑛.基层医院产前胎儿心脏超声筛查漏诊情况分析[J].临床误诊误治,2014,27(2):35-37.
[4] KORDJALIK P,RESPONDEKLIBERSKA M,SLODKI M,et al.Pulmonary valvar stenosis in Polish National registry for fetal cardiac malformations[J].Prenatal Cardiology,2015,4(1):13-16.
[5]孙东艳,徐力,李颖,等.超声在胎儿心脏畸形筛查中的临床应用[J].中国医药指南,2015,13(14):169-170.
[6]王刚,莫海云,陈深钢.三维超声技术对产前胎儿心脏筛查的调查分析[J].疾病监测与控制,2015,9(5):336-337.
[7]周钰昆,王凤兰,张金辉,等.胎儿心脏超声检查在产前筛查中的应用[J].中国妇幼保健,2016,31(23):5178-5180.
[8]王金瑜,赵笔辉,李燕静.产前超声在胎儿先天性心脏病筛查中的临床应用价值[J].医学影像学杂志,2016,26(7):1321-1323.
[9] CHEN C P,CHANG T Y,GUO W Y,et al.Detection of maternal transmission of a splicing mutation in the TSC2gene following prenatal diagnosis of fetal cardiac rhabdomyomas mimicking congenital[J].Chemical Engineering Science,2015,133(22):6674-6687.
[10]夏礼锋,黄威.胎儿四维彩色多普勒超声和胎儿超声心动图用于诊断产前胎儿心脏畸形的随机对照研究[J].实用医技杂志,2016,23(10):1082-1084.
[11]方友萍,金雪鸿,王晓红,等.产前系统胎儿超声筛查胎儿心脏的临床价值[J].医学影像学杂志,2016,26(5):932-934.
[12]蔡石兰.产前超声筛查胎儿心脏异常的现状和研究进展[J].医学综述,2014,20(16):2963-2965.
[13]仇利,罗红.产前超声筛查中孕期胎儿心脏畸形对诊断染色体异常价值的Meta分析[J].中国介入影像与治疗学,2016,13(12):747-752.
[14]许怡韵,蔡艳,陈恩,等.胎儿心脏畸形诊断中产前超声筛查五步检查法的应用效果观察[J].中国实用医刊,2016,43(13):108-110.
[15]LIU L,HE Y,LI Z,et al.Application of two-dimensional echocardiography combined with enhanced flow in diagnosing fetal heart malformation[J].Clinical and Experimental Obstetrics&Gynecology,2014,41(2):195-201.
[16]杨静,刘霞,许川一,等.四维超声STIC技术在胎儿心脏畸形辅助诊断中的应用价值[J].中华全科医学,2016,14(3):452-454.
[17]丁海耀,周文蓉.二维联合四维超声检查在先天性心脏畸形胎儿产前诊断中的应用[J].山东医药,2016,56(20):63-64.
[18]宋桂敏,曹芳蕾,高锦鹰,等.产前四维超声对先天性心脏畸形的诊断作用[J].中国妇幼保健,2016,31(14):2961-2964.
[19]谷小乐.二维超声联合四维超声在诊断产前胎儿心脏畸形中的应用价值[J].内蒙古医学杂志,2017,49(5):614-616.
[20]李红军,陈欣林,杨小红.二维、四维超声联合检查对胎儿畸形的诊断价值[J].中国妇幼保健,2016,31(14):2964-2966.
[21]陶珍,魏玲玲,王颖.中孕早期胎儿先天性心脏病筛查中四维超声时空关联成像技术的临床应用效果观察[J].中国产前诊断杂志(电子版),2016,8(1):7-10.
[22]曹伟雅.四维彩色多普勒超声在胎儿先天性心脏病筛查中应用研究[J].现代医用影像学,2017,26(4):1090-1091.
[23]王菊云,杨高娥,汤光贤.二维超声联合四维超声在不同孕期胎儿心脏检查中的应用[J].长江大学学报(自然科学版),2016,13(24):40-41.
[24]曹春峰.比较分析二维超声和四维超声在产科检查诊断中的应用效果[J].中国保健营养,2016,26(27):395-396.
[25]李勇.四维彩超在胎儿先天性心脏病筛查中的应用及高危因素分析[J].齐齐哈尔医学院学报,2017,38(12):1391-1392.
[26]樊友彬.探讨二维和四维超声在胎儿先天性心脏病超声诊断中的意义[J].医学信息,2016,29(3):288.
[27]练纯玉.四维超声产前诊断胎儿畸形的价值[J].现代医用影像学,2016,25(1):134-135.
[28]姚国林,区秀红,谢树浩,等.四维超声STIC技术在中孕早期胎儿心脏检查中的应用探讨[J].齐齐哈尔医学院学报,2017,38(16):1897-1898.
[29]毛利萍.四维超声在胎儿心脏畸形诊断中的应用研究[J].现代医用影像学,2016,25(4):779-780.