彩色多普勒超声心动图在胎儿先天性心血管畸形的筛查与临床诊断价值观察

摘要

目的：探索彩色多普勒超声心动图在胎儿先天性心血管畸形(先心病)的产前筛查和诊断中的价值。方法1600例产检的孕妇,其中800例高危孕妇作为高危组,800例无明显高危因素的健康孕妇作为对照组,两组孕妇进行产前彩色多普勒超声心动图检查,将检测出的胎儿先心病结果与引产后病理结果或出生后结果进行对比。结果高危组产前先心病检出率为6.63%,明显高于对照组的1.88%,差异有统计学意义(P<0.05)。与病理诊断或出生后检查结果对比,高危组产前超声检出正确率为98.15%,对照组的产前超声检出正确率为88.24%,比较差异无统计学意义(P>0.05)。在先心病类型上,房间隔缺损、室间隔缺损、大血管异常发生率较高,肺动脉闭锁的发生率最低,心脏增大并腹水、三尖瓣下移、法洛氏四联症的发生率均较低。漏诊病例中心脏增大并腹水1例,法洛氏四联症2例。结论在胎儿先心病的产前筛查和诊断中,应用彩色多普勒超声心动图检查效果确切,检出正确率高,有助于临床医师早期发现胎儿心血管发育畸形,从而及时采取必要的措施进行早期干预,提高人口出生质量。%Objective To investigate value by color Doppler ultrasonic cardiogram for screening and clinical diagnosis of fetal congenital cardiovascular malformation (congenital heart disease). Methods Among 1600 pregnant women with production inspection, there were 800 high risk pregnant women as high risk group and 800 healthy pregnant women without obviously high risk as control group. Both groups received prenatal color Doppler ultrasonic cardiogram for examination, and their detection outcomes were compared with pathological outcomes after induced labor or delivery. Results The high risk group had obviously higher detection rate of congenital heart disease as 6.63% than 1.88% in the control group, and the difference had statistical significance (P<0.05). Comparison with pathological diagnosis of postnatal examination showed accuracy rate of prenatal ultrasound as 98.15% in the high risk group and 88.24% in the control group, and their difference had no statistical significance (P>0.05). Congenital heart disease types included atrial septal defect and ventricular septal defect. Incidence of aorta abnormality was high, while incidence of pulmonary artery atresia was the lowest. Incidences of cardiac enlargement complicated with ascites, tricuspid valve displacement and tetralogy of Fallot were all comparatively low. There were 1 case with cardiac enlargement complicated with ascites and 2 cases with tetralogy of Fallot among cases with missed diagnosis. Conclusion Implement of color Doppler ultrasonic cardiogram in prenatal screening and diagnosis of fetal congenital cardiovascular malformation provides precise effect and high accuracy rate. This method is helpful for early discovery of fetal congenital cardiovascular malformation, along with application of timely and essential measures for early intervention and birth quality enhancement.