超声心动图在妊娠中晚期胎儿复杂性先天性心脏畸形筛查中的作用
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摘要
目的分析妊娠中晚期胎儿复杂性先天性心脏畸形筛查中超声心动图的作用。方法选择2016年7月～2018年1月在江油市人民医院就诊的600例高危孕妇为研究对象,所有研究对象均行妊娠中晚期超声心动图检测,并将检测结果与产后病理结果进行对比,比较超声心动图检查的诊断准确性。结果 600名孕妇经彩色多普勒超声检查共检出复杂性先天性心脏畸形者23例,占3.83%;产后病理检查结果显示,研究对象中复杂性心脏畸形者共26例,占4.33%;两者检出率比较无统计学意义(P> 0.05),超声心动图筛查准确率为88.46%,且23例经超声检测出的畸形胎儿中,以法洛四联症为主,其次为右室双出口、完全性心内膜垫缺损等。经彩色多普勒超声检查显示为复杂性先天性心脏畸形23例患者中,胎儿内径增宽者9例,占39.1%,内径狭窄者7例,占30.4%,内径正常者7例,占30.4%。结论妊娠中晚期胎儿复杂性先天性心脏畸形筛查中应用超声心动图检查具有较高价值,可在临床上推广应用。
Objective To analyze the role of echocardiography in the screening of complex congenital heart malformations in middle and late pregnancy. Methods From July 2016 to January 2018, 600 high-risk pregnant women admitted to Jiangyou People's Hospital were selected as the study subjects. All the subjects underwent echocardiography in the middle and late pregnancy, and the test results were compared with the postpartum pathological results to compare the diagnostic accuracy of echocardiography. Results A total of 23 cases(3.83%) of 600 pregnant women with complex congenital heart malformation were detected by color doppler ultrasonography. Postpartum pathological examination showed that there were 26 cases of complicated cardiac malformation among the subjects, accounting for 4.33%.There was no significant difference in detection rate between the two group(P > 0.05). The accuracy of echocardiographic screening was 88.46%, and among 23 cases of abnormal fetuses detected by ultrasound, tetralogy of fallot was the main one, followed by right ventricular double outlet and complete endocardial cushion defect. Among the 23 patients with complex congenital heart malformation revealed by color doppler ultrasonography, 9 cases(39.1%) had wider fetal diameter, 7 cases(30.4%) had narrow diameter, and 7 cases(30.4%) had normal diameter. Conclusion The application of echocardiography in screening complicated congenital heart malformations of fetuses in middle and late pregnancy is of high value and can be popularized in clinical practice.
Objective To analyze the role of echocardiography in the screening of complex congenital heart malformations in middle and late pregnancy. Methods From July 2016 to January 2018, 600 high-risk pregnant women admitted to Jiangyou People's Hospital were selected as the study subjects. All the subjects underwent echocardiography in the middle and late pregnancy, and the test results were compared with the postpartum pathological results to compare the diagnostic accuracy of echocardiography. Results A total of 23 cases(3.83%) of 600 pregnant women with complex congenital heart malformation were detected by color doppler ultrasonography. Postpartum pathological examination showed that there were 26 cases of complicated cardiac malformation among the subjects, accounting for 4.33%.There was no significant difference in detection rate between the two group(P > 0.05). The accuracy of echocardiographic screening was 88.46%, and among 23 cases of abnormal fetuses detected by ultrasound, tetralogy of fallot was the main one, followed by right ventricular double outlet and complete endocardial cushion defect. Among the 23 patients with complex congenital heart malformation revealed by color doppler ultrasonography, 9 cases(39.1%) had wider fetal diameter, 7 cases(30.4%) had narrow diameter, and 7 cases(30.4%) had normal diameter. Conclusion The application of echocardiography in screening complicated congenital heart malformations of fetuses in middle and late pregnancy is of high value and can be popularized in clinical practice.
引文
[1]高兴,谢景来,陈海燕.四腔心联合三血管切面在孕中-晚期筛查胎儿先天性心脏病的应用价值[J].岭南心血管病杂志,2017,23(2):175-178.
[2]薛前海,王胜华.自动化容积成像技术在中晚孕期正常胎儿心脏超声检查中的应用[J].中国医学前沿杂志:电子版,2014,6(7):160-162.
[3] Traversi E,Cobelli F,Pozzoli M. Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure even when atrial fibrillation is present[J]. Eur J Heart Fail,2001,3(2):173-181.
[4] Araujo Júnior E,Rocha LA,Nardozza LM. Sonocubic fine:new three-dimensional ultrasound software to the screening of congenital heart diseases[J]. Rev Bras Cir Cardiovasc,2014,29(3):426-431.
[5]陈海燕,谢景来,高兴.四腔心联合三血管切面在孕中晚期胎儿心脏病超声筛查中的应用[J].现代医用影像学,2016,25(3):509-511.
[6]马建芳.产前超声检测肺静脉血流流速曲线在胎儿心脏结构异常中的诊断价值[D].苏州:苏州大学,2014.
[7]邢悦.二维超声结合增强型血流成像技术诊断胎儿心脏畸形的应用观察[J].医学信息,2017,30(5):269-270.
[8]杨巧,罗孝勇,邓萍,等.超声在胎儿心脏结构性异常中的诊断价值[J].临床超声医学杂志,2015,17(8):561-564.
[9]李彦,黄文起,林光耀.二维联合三维超声在产前早孕晚期胎儿心脏畸形诊断中的应用研究[J].医学影像学杂志,2017,27(9):1676-1678.
[10]弓瑜.彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的临床价值[J].陕西医学杂志,2017,46(10):1449-1450.
[11]董华.胎儿超声心动图在中晚孕期胎儿复杂先天性心脏畸形诊断中的效果[J].中国妇幼保健,2017,32(23):6051-6053.
[12]张昌余,赵静,邹旷妮.中孕期胎儿先天性心脏病的产前超声筛查[J].成都医学院学报,2016,11(4):478-480.
[13]谢燕华,孙露.产前超声筛查胎儿先天性心脏病的临床意义及高危因素分析[J].中国现代医生,2016,54(16):72-74.
[14]谢素瑛.彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的应用[J].现代诊断与治疗,2015,26(13):2895-2896.
[15] Schiessl B,Fakler U,Vogt M,et al. 3-Dimensional Sonographic Volumetry of Fetal Brain,Liver and Myocardial Mass-Interdisciplinary Clinical Validation of the Method and Application in Fetuses With and Without Structural Heart Disease[J]. Z Geburtshilfe Neonatol,2011,215(2):60-68.
[16]周寿礼.超声心动图胎儿序列切面、系统扫查方法诊断胎儿复杂先天性心脏畸形的临床应用价值分析[J].临床医学研究与实践,2016,1(23):135-135.
[17]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.
[18]王荷芬,张鲁康,张丽.超声心动图对唐氏筛查胎儿先心病的诊断[J].中国妇幼健康研究,2015,26(4):818-820.
[19]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.
[20]战鸿雁.中晚期妊娠胎儿肺动脉射血加速时间测定及其临床意义[D].济南:山东大学,2015.
[21]向静文,李玮璟,闫瑞玲,等.妊娠早期超声筛查胎儿先天性心脏病的临床价值[J].中华围产医学杂志,2015,18(8):632-637.
[22]许晨琛.超声三血管气管切面用于胎儿先天性心脏畸形筛查的临床效果[J].中国卫生标准管理,2016,7(36):155-156.
[2]薛前海,王胜华.自动化容积成像技术在中晚孕期正常胎儿心脏超声检查中的应用[J].中国医学前沿杂志:电子版,2014,6(7):160-162.
[3] Traversi E,Cobelli F,Pozzoli M. Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure even when atrial fibrillation is present[J]. Eur J Heart Fail,2001,3(2):173-181.
[4] Araujo Júnior E,Rocha LA,Nardozza LM. Sonocubic fine:new three-dimensional ultrasound software to the screening of congenital heart diseases[J]. Rev Bras Cir Cardiovasc,2014,29(3):426-431.
[5]陈海燕,谢景来,高兴.四腔心联合三血管切面在孕中晚期胎儿心脏病超声筛查中的应用[J].现代医用影像学,2016,25(3):509-511.
[6]马建芳.产前超声检测肺静脉血流流速曲线在胎儿心脏结构异常中的诊断价值[D].苏州:苏州大学,2014.
[7]邢悦.二维超声结合增强型血流成像技术诊断胎儿心脏畸形的应用观察[J].医学信息,2017,30(5):269-270.
[8]杨巧,罗孝勇,邓萍,等.超声在胎儿心脏结构性异常中的诊断价值[J].临床超声医学杂志,2015,17(8):561-564.
[9]李彦,黄文起,林光耀.二维联合三维超声在产前早孕晚期胎儿心脏畸形诊断中的应用研究[J].医学影像学杂志,2017,27(9):1676-1678.
[10]弓瑜.彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的临床价值[J].陕西医学杂志,2017,46(10):1449-1450.
[11]董华.胎儿超声心动图在中晚孕期胎儿复杂先天性心脏畸形诊断中的效果[J].中国妇幼保健,2017,32(23):6051-6053.
[12]张昌余,赵静,邹旷妮.中孕期胎儿先天性心脏病的产前超声筛查[J].成都医学院学报,2016,11(4):478-480.
[13]谢燕华,孙露.产前超声筛查胎儿先天性心脏病的临床意义及高危因素分析[J].中国现代医生,2016,54(16):72-74.
[14]谢素瑛.彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的应用[J].现代诊断与治疗,2015,26(13):2895-2896.
[15] Schiessl B,Fakler U,Vogt M,et al. 3-Dimensional Sonographic Volumetry of Fetal Brain,Liver and Myocardial Mass-Interdisciplinary Clinical Validation of the Method and Application in Fetuses With and Without Structural Heart Disease[J]. Z Geburtshilfe Neonatol,2011,215(2):60-68.
[16]周寿礼.超声心动图胎儿序列切面、系统扫查方法诊断胎儿复杂先天性心脏畸形的临床应用价值分析[J].临床医学研究与实践,2016,1(23):135-135.
[17]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.
[18]王荷芬,张鲁康,张丽.超声心动图对唐氏筛查胎儿先心病的诊断[J].中国妇幼健康研究,2015,26(4):818-820.
[19]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.
[20]战鸿雁.中晚期妊娠胎儿肺动脉射血加速时间测定及其临床意义[D].济南:山东大学,2015.
[21]向静文,李玮璟,闫瑞玲,等.妊娠早期超声筛查胎儿先天性心脏病的临床价值[J].中华围产医学杂志,2015,18(8):632-637.
[22]许晨琛.超声三血管气管切面用于胎儿先天性心脏畸形筛查的临床效果[J].中国卫生标准管理,2016,7(36):155-156.