高危妊娠中孕11～16周应用超声筛查胎儿心脏畸形的价值

目的：探讨高危妊娠中孕11~16周应用超声筛查胎儿心脏畸形的意义。方法：回顾性分析天津市中心妇产科医院与美国费城儿童医院胎儿心脏中心就诊的高危妊娠孕妇668例，于孕11～16周胎儿心脏超声筛查，其中404例采用四腔心切面筛查法，264例采用心脏节段性扫查法。结果：在所有高危妊娠孕妇中，应用四腔心切面筛查法，严重复杂性先心病的检出率为5.7%（23/404），应用心脏节段性扫查法严重复杂性先心病检出率为9.5%（25/264），两者比较差异无统计学意义（P＞0.05）。胎儿颈部透明层（nuchal translucency，NT）增高与淋巴水囊瘤患者中，应用四腔心切面筛查法，严重复杂性先心病的检出率为2.5%（9/362），心脏节段性扫查法检出率为10.0%（7/70），两者比较差异有统计学意义（P＜0.05）。同一孕期（孕12~14周前）比较，四腔心切面筛查法与心脏节段性扫查法对于严重复杂性先心病的检出率分别为5.9%（21/358）、10.4%（8/77），两者比较差异无统计学意义（P＞0.05）。结论：随着心脏畸形的高危因素如NT值增高、淋巴水囊瘤、胎儿心外畸形等在早期得以越来越多地检出，在同一时间段内应用超声筛查胎儿心脏畸形尤为必要。四腔心切面作为胎儿超声心动图中最重要、最易获得的切面，尤其在早期胎儿心脏体积较小的情况下，对于严重复杂性先心病的检出具有较高的临床应用价值。先心病的早期检出能最大限度减轻对孕妇本身的损害。

Clinical Value of Fetal Echocardiography on High Risk Pregnancies between 11 and 16 Weeks′ Gestation

Objective：To evaluate the clinical value of fetal echocardiography on high risk pregnancies of congenital heart disease between 11 and 16 weeks′ gestation. Methods: 668 women with high risk pregnancies underwent fetal echocardiography between 11 and 16 weeks′ gestation in Tianjin central hospital of Gynecology and Obstetrics and Division of Cardiology, the Children′s Hospital of Philadelphia. Among them , 404 cases were screened with four-chamber view scanning methods and 264 cases with sequential segmental scanning methods. Results: Among all the high-risk pregnancies, the detection rate of complicated congenital heart diseases was 5.7%（23/404） by fetal echocardiography four-chamber view scanning methods and 9.5%（25/264） by sequential segmental scanning methods, there was no statistical difference （P＞0.05）. The detection rate of complicated congenital heart diseases in increased NT and cystic lymphangioma pregnancies was 2.5% （9/362） by fetal echocardiography four-chamber view scanning methods and 10.0%（7/70） by sequential segmental scanning methods, with was statistical difference（P＜0.05）. The detection rate of complicated congenital heart diseases between 12 weeks′ and 14 weeks′ by the two scanning methods were 5.9%（21/358） and 10.4%（8/77）, respectively, with no statistical difference （P＞0.05）。Conclusions: As more and more high risk factors, such as increased NT, cystic lymphangioma and fetal non-cardiac malformation, were found in early pregnancy, it was necessary to screen the fetal heart malformation at the same time. Four-chamber view was the most important and easily available section in fetal echocardiography, especially in the early stages. Four-chamber view scanning methods had a high practical and clinical application value for the detection of severe congenital heart disease. Early detection of severe congenital heart disease can reduce the damage to pregnant women themselves.