四维超声成像技术在胎儿唇腭裂畸形中的诊断价值分析

目的 分析四维超声成像技术在诊断胎儿唇腭裂畸形中的应用价值。方法 选择2019年1月-2022年 1月于我院进行常规超声检查的12 334例孕妇作为研究对象,发现胎儿疑似唇腭裂畸形者,运用四维超声 成像技术帮助诊断,重点观察胎儿上唇皮肤及上腭骨的连续性,以引产后或分娩后胎儿的颜面部实际情况 作为评价标准,分析四维超声成像技术在胎儿唇腭裂畸形诊断中的准确性。结果 共发现5例唇腭裂畸形胎 儿,与引产后或分娩后胎儿颜面部实际情况一致,四维超声成像技术诊断准确性为100.00%。结论 四维超 声成像技术在胎儿唇腭裂畸形中的诊断准确性较高,对于诊断胎儿唇腭裂畸形具有较好的临床应用价值。     

实时灰阶二维血流显像联合空间-时间相关成像技术在胎儿心脏超声检查中的应用进展

四维超声扩大了胎儿心脏扫描成像技术的能力,不再局限于二维超声成像,为深入分析先天性心脏病提供了广阔的可能。实时灰阶二维血流显像（B-flow）联合空间-时间相关成像技术（BF-STIC）是近年发展的四维新技术,本文就其在胎儿心血管系统中的应用进展进行综述。     

胎儿主动脉弓离断的产前超声诊断现状

主动脉弓离断是一种罕见的严重先天性心脏病,胎儿期死亡率极高,其胚胎学起源复杂,表现形式多样,且多合并其他畸形,产前超声诊断困难。超声心动图作为目前临床常用的胎儿心脏检查手段,在先天性心脏病的筛查中发挥重要作用。本文主要从二维超声、三维超声在诊断中的应用及超声鉴别诊断方面对胎儿主动脉弓离断的产前超声诊断现状进行综述。     

产前四维超声对先天性心脏畸形诊断效果观察

目的探讨产前四维超声在先天性心脏畸形诊断中的应用效果。方法抽取2013-04—2016-02间在漯河医专附院进行产前检查的478例孕妇,均于产前进行二维超声及四维超声检查,并随访至分娩后1个月。对两种检测方法在先天性心脏畸形检出率及诊断准确率进行比较。结果四维超声检出率(3.77%)显著优于二维超声(1.67%),差异有统计学意义(P0.05);引产后确诊先天性心脏畸形19例,其中四维超声18例、二维超声8例(42.11%),差异有统计学意义(P0.05)。结论对孕妇产前实施四维超声检查,有利于早期对先天性心脏畸形作出正确诊断。     

二维超声联合三维超声诊断胎儿半椎体

目的探讨二维超声联合三维超声诊断胎儿脊柱半椎体的价值。方法回顾性分析11胎经随访证实的胎儿脊柱半椎体的二维及三维超声图像,比较二维超声、二维超声联合三维超声诊断半椎体的准确率。结果 11胎半椎体中,单发9胎,其中6胎为胸椎、2胎为腰椎、1胎为骶尾椎病变,胸腰段多发畸形2胎,其中1胎合并椎体融合。二维超声诊断胎儿半椎体7胎(7/11,63.64%),二维超声联合三维超声诊断胎儿半椎体11胎(11/11,100%),差异有统计学意义(P0.05);二维超声准确定位半椎体9胎(9/11,81.82%),二维超声联合三维超声准确定位半椎体10胎(10/11,90.91%),差异无统计学意义(P0.05)。结论二维超声联合三维超声可提高诊断胎儿半椎体准确率,有助于早期发现胎儿半椎体。     

时间-空间相关成像技术的反转模式在胎儿心血管成像中的应用进展

随着三维及四维超声技术的迅速发展,时间-空间相关成像技术(STIC)已成为研究胎儿心脏的一种相对成熟的技术,其多种成像模式可提供更多结构及血流的相关信息,为临床诊断提供依据。STIC技术的反转模式可更清晰、准确地呈现心室腔和血管腔的立体结构。本文就其在胎儿心血管系统中的研究进展进行综述。     

超声诊断胎儿脐带绕颈的应用分析

目的探讨分析超声检查在诊断胎儿脐带绕颈的中的应用价值。方法对1082例在本院分娩的、妊娠晚期36-41周的孕妇进行二维和彩色多普勒超声检查,观察胎儿颈部压迹深度、脐带绕颈周数,检测脐动脉S/D比值,并将产前超声诊断为脐带绕颈与产后临床诊断为脐带绕颈的病例进行对比分析。结果本组病例产前经超声检查诊断为胎儿脐带绕颈307例,产后临床诊断为脐带绕颈者311例,诊断符合率为97.7%,误诊3例,漏诊7例。47例脐动脉S/D比值〉3,存在不同程度宫内窘迫现象。结论二维超声与彩色多普勒相结合检查胎儿脐带绕颈特异性强、准确率高,且能够实时观察胎动及胎心搏动情况,是目前产前诊断胎儿脐带绕颈的最佳方法,为临床选择正确的分娩方式提供了可靠的依据。     

二维、三维超声联合应用在胎儿唇腭裂畸形中的诊断价值

目的探讨二维、实时三维超声成像相结合对胎儿唇腭裂的诊断价值。方法采用全数字彩色多普勒超声诊断仪,对3752例21～27周的胎儿鼻唇部进行二维探测及实时三维重建。结果发现唇（腭）裂14例,漏诊2例。二维、实时三维超声成像相结合率达100%,诊断率达99.95%。结论二维、实时三维超声成像相结合可明显提高诊断率。     

胎儿主动脉弓离断的产前超声诊断

目的探讨胎儿主动脉弓离断的超声诊断特点。方法回顾性分析产前超声诊断为胎儿主动脉弓离断的35胎胎儿资料,同时纳入180胎正常胎儿。二维超声判断胎儿内脏及心脏位置,获取四腔心切面、左右心室流出道切面、三血管切面及三血管-气管切面等横断面,并扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状切面。测量主动脉弓离断胎儿左右心室内径比值及主动脉与肺动脉内径比值,并与相应孕周的正常胎儿进行比较。结果产前二维超声诊断A型、B型及C型主动脉弓离断分别为16、18及1胎,均伴室间隔缺损,共27胎经尸体检查或产后检查证实产前诊断,3胎诊断错误,余5例新生儿失访。四腔心切面及三血管切面发现主动脉弓离断胎儿左右心室内径比值和主动脉与肺动脉内径比值显著小于相应孕周正常胎儿,差异有统计学意义(P均0.01)。矢状切面对主动脉追踪连续扫查可确定主动脉的分支及走行,可明确诊断及分型。A型、B型及C型离断升主动脉走行及分支分别呈现典型的"W型"、"Y型"及"I型"。矢状面扫查及横断面扫查对胎儿主动脉弓离断的诊断率分别为90.00%(27/30)及56.67%(17/30),差异有统计学意义(P0.01)。结论产前二维超声可诊断胎儿主动脉弓离断,横断面扫查可发现某些线索,矢状面连续扫查对诊断胎儿主动脉弓离断具有重要意义。     

应用三维超声体积自动测量技术评价胎儿肺发育不良

目的探讨应用三维超声体积自动测量（VOCAL）技术测量胎儿肺体积的可行性及超声肺重比（UFLB）对胎儿肺发育不良（PH）的诊断价值。方法选取经产前超声检查诊断为先天性发育异常且孕妇选择引产并同意进行尸检的胎儿35胎,胎龄16～36周。应用VOCAL技术获得胎儿肺体积,采用二维超声测得的生物参数经Hadlock方程系统自动生成胎儿质量,进而获得UFLB。将应用VOCAL技术测得的胎儿肺体积与尸检后实测的肺体积进行比较,并评价UFLB对PH的诊断价值。结果应用VOCAL技术测得的胎儿肺体积与实测的肺体积之间的差值为（-0.81±1.77）cm3。应用UFLB诊断胎儿PH的敏感度为83.33%,特异度为95.65%,阳性预测值为90.91%,阴性预测值为91.67%,诊断准确率为91.43%。结论应用VOCAL技术可准确评估胎儿肺体积,UFLB对胎儿PH的产前诊断具有一定意义。     

Sonocubic fine: new three-dimensional ultrasound software to the screening of congenital heart diseases

Congenital heart disease is the most common fetal congenital malformations; however, the prenatal rate detection still is low. The two-dimensional echocardiography is the "gold standard" exam to screening and diagnosis of congenital heart disease during the prenatal; however, this exam is operator-depending and it is realized only in high risk pregnancies. Spatio-temporal image correlation is a three-dimensional ultrasound software that analyses the fetal heart and your connections in the multiplanar and rendering modes; however, spatio-temporal image correlation too is operator-depending and time-consuming. We presenting a new three-dimensional software named Sonocubic fine to the screening of congenital heart disease. This software applies intelligent navigation technology to spatio-temporal image correlation volume datasets to automatically generate nine fetal echocardiography standard views. Thus, this new software tends to be less operator-depending and time-consuming.     

智能三维超声成像在胎儿领域的应用进展

胎儿产前超声检查对胎位和诊断医师的技术水平依赖性较强,尤其当胎儿存在复杂的心脏和颅脑结构异常时,超声检查难度更大。智能三维超声可对容积数据进行"自动"分析和测量,简化操作流程,获得诊断所必须的标准切面,减少对操作医师技术的依赖性,提高对疾病的诊断准确率。本文对智能三维超声成像技术在胎儿心脏切面、颅脑正中矢状面、颈项透明层切面的自动获取及参数自动测量等方面的应用特点和新进展进行综述。     

Should what we know about neurobehavioral development,complex congenital heart disease,and brain maturation affect the timing of corrective cardiac surgery?

Despite remarkable improvements in perioperative care, adverse neurobehavioral outcomes following neonatal and infant cardiac surgery are commonplace and are associated with substantial morbidity. It is becoming increasingly clear that complex congenital heart disease is associated with both abnormalities in neuroanatomic development and a delay in fetal brain maturation. Substantial cerebral ischemic/hypoxic injury has been detected in neonates with complex congenital heart disease both prior to and following corrective cardiac surgery. The brain of the neonate with complex congenital heart disease appears to be uniquely vulnerable to the types of ischemic/hypoxic injury associated with perioperative care. It remains to be determined whether delaying surgical correction to allow for brain maturation will be associated with improvements in neurobehavioral outcomes.     

非先天性心脏病患儿气道环状软骨平面横径预测模型能否适用于先天性心脏病患儿

目的 评价基于非先天性心脏病患儿(children without congenital heart disease,NCHD)气管环状软骨平面横径值(transverse diameter of cricoid cartilage,CD)与年龄或体型所建立的直线回归方程,比较回归方程预测先天性心脏病患儿(children with congenital heart disease,CHD)环状软骨平面的气管横径值(cricoid diameter predicted by formula,CDfomula)和超声实测值(cricoid diameter measured by ultrasound,CDultra)的一致性.方法 纳入64名NCHD,镇静后测量CDultra,记录患儿年龄、身高、体重、BMI、体表面积等数据,采用逐步向前法与CD建立线性回归模型.纳入CHD 30例和NCHD 25例,比较两组患儿CD超声测量值与线性回归模型预测值的一致性.结果 NCHD的CD值与年龄呈正相关(r=0.90,P＜0.05),回归方程为CD(cm)=0.048×年龄(岁)+0.525.两组人群CDfomulaCDultra之间存在相关性(P＜0.05),NCHD组患儿CDfomula和CDultra的相关性为0.94,而CHD组患儿CDfomula和CDultra的相关性为0.71.NCHD组和CHD组CDultm和CDfomula的偏移值分别为-0.00 cm、-0.01 cm,95％一致性界限分别为(-0.06 cm,0.05 cm)和(-0.17 cm,0.15 cm),虽然两组患儿CDultra和CDfomula的偏移相近,但是CHD组患儿的界限值宽于NCHD组患儿.结论 在建立NCHD超声测量的CD值与年龄间线性回归方程的基础上,认为CHD模型预测和超声实测的一致性不如NCHD.因此在CHD气管插管时,测量CDultra可能会使气管导管的选择更加准确和便捷.     

Pregnancy and cardiac interventions: What are the optimal management options?

Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.     

产前超声诊断胎儿尿道下裂进展

尿道下裂是胎儿常见泌尿系统先天畸形。产前二维及三维超声检查均可用于诊断胎儿尿道下裂,二者联合可提高诊断效能;在此基础上进行彩色多普勒超声检查可进一步明确尿道开口位置,提高诊断准确率,降低误诊率。本文对产前超声诊断胎儿尿道下裂进展进行综述。     

The pregnant cardiac woman

Cardiac diseases are present in 0.5-4% of pregnancies, and they remain a frequent cause of death during pregnancy. Pregnancy per se imposes significant hemodynamic changes, placing a major burden on the cardiovascular system. The early recognition and close follow-up of patients with cardiac diseases will improve maternal tolerance to the cardiovascular burden imposed by pregnancy, promote fetal growth and neonatal survival. Rheumatic heart disease remains the most frequent heart disease in the pregnant population with pulmonary edema as the most frequent complication. Atrial septal defect is the most frequent congenital heart disease in the adult population, whereas tetralogy of Fallot is the most common cyanotic congenital heart disease. An improvement in modern techniques of monitoring, a better understanding of the pathophysiology of cardiac disease, as well as multidisciplinary care has led to a substantial improvement in outcome of the pregnant cardiac patient. Management should be initiated before conception as it will provide optimal clinical conditions and sufficient information on the underlying pathophysiology.