胎儿心脏超声和常规产前检查在胎儿心律失常诊断中的效果对比

探讨在胎儿心律失常诊断中采取胎儿心脏超声和常规产前检查的临床价值对比。选取2014年6月~2015年6月就诊并确诊为胎儿心律失常的孕妇48例作为研究对象,均行常规产前检查及超声心动图检查,对两组检查方法的诊断准确率进行统计对比。两种检查方法在诊断房性期前收缩、室性期前收缩、窦性心动过速方面比较差异无统计学意义(P>0.05);但超声心动图检查在诊断室上性心动过速、窦性心动过缓、心房扑动等方面的检出率高于常规产前检查,差异有统计学意义(P<0.05);超声心动图检查的准确率(100.00%)高于常规产前检查(79.17%),差异有统计学意义(P<0.05)。在胎儿心律失常诊断中,采取超声心动图检查具有无创、操作简便、诊断准确率高的优点,在临床中具有良好的诊断价值。     

胎儿心脏超声在胎儿心律失常中的临床价值分析

目的探究超声心动图在胎儿心律失常诊断中的临床运用价值。方法回顾性分析109例胎儿心律失常孕妇的临床资料,同一孕妇均采用常规产前检查和超声心动图检查,比较两种方法在胎儿心律失常检出率方面的差异。结果房性期前收缩和室性期前收缩的检出率两种方法比较差异无统计学意义（P〉0.05）;超声心动图对窦性心动过速和窦性心动过缓的检出率高于产前常规检查（P〈0.05）;超声心动图分别检出3例室上性心功过速和1例心房扑动,常规产前检查却未能检出;超声心动图对胎儿心律失常总检出率高于常规产前检查（100%vs 86.2%,P〈0.05）。结论超声心动图检查方法无创、简便、有效,对胎儿心律失常的有无及其类型的诊断能提供较为准确的诊断依据。     

频谱多普勒及M-型超声心动图检测胎儿心律失常的临床研究

目的：探讨频谱多普勒及M-型超声心动图对胎儿心律失常的诊断价值。方法：采用彩色多普勒超声心动图对孕龄16～41周的临床疑诊胎儿心律失常或存在其他异常的226例胎儿进行研究。结果：共检出胎儿心律失常53例(23．5％)，其中期前收缩40例(房性期前收缩35例，室性期前收缩5例包括室性早搏二联律、室性早搏三联律各1例)。心动过缓7例，心动过速4例，2：1房室传导阻滞、房扑各1例。53例心律失常胎儿中并发先天性心血管畸形4例(二尖瓣闭锁1例，共同房室通道1例，单心室伴肺动脉瓣狭窄1例，心脏肿瘤1例)。结论：胎儿频谱多普勒及M-型超声心动图是检出胎儿心律失常的可靠的无创性影像诊断技术，其应用有助于早期检出并指导心律失常胎儿的处置。     

胎儿心脏超声和常规产前检查在胎儿心律失常诊断中的效果对比

回顾性分析我院收治的46例胎儿心律失常孕妇临床资料,对同一孕妇进行超声心动图检查(观察组)与常规的产前检查(对照组),对两种方法检出胎儿心律失常的准确率进行比较。室性期前收缩与房性期前收缩对胎儿心律失常的检出率无显著差异,无统计学意义(P>0.05);超声心动图检出窦性心动过速、过缓的准确率明显高于常规产前检查(P<0.05);超声心动图检出胎儿心律失常的总准确率为78.26%(36/46),常规产前检查为100%(46/46),两组比较具有显著差异(P<0.05)。超声心动图在胎儿心律失常诊断中简便易行,有效率高,为胎儿心律失常及类型的诊断提供准确依据,值得临床推广与应用。     

彩色多普勒超声心动图在胎儿心律失常中临床应用探讨

目的:探究胎儿心律失常应用彩色多普勒超声心动图检查的临床价值。材料与方法:选取本院2015年1月-2016年1月收治的疑似胎儿心律失常孕妇180例临床资料予以回顾性地分析,所有孕妇均应用彩色多普勒超声心动图检查,并于胎儿出生后予以随访,观察和比较其诊断价值。结果:在本研究疑似胎儿心律失常孕妇180例中,通过彩色多普勒超声心动图检查后发现胎儿心律失常者出现36例(20.00%),其中先天心脏病2例(5.56%)、房扑1例(2.78%)、室性早搏4例(11.11%)、房性早搏17例(47.22%)、心动过缓2例(5.56%)、心动过速10例(27.78%),包括室上型心动过速7例(19.44%)、窦性心动过速3例(8.33%);在胎儿心律失常36例中,先天心血管畸形出现3例(8.33%),包括部分心内膜垫缺损1例(33.33%)、主动脉缩窄2例(66.67),且分别对应室上型心动过速、心动过缓;彩色多普勒超声心动图诊断误诊率、准确率和胎儿出生后实际情况对比未显示高度差异(P0.05)。结论:胎儿心律失常应用彩色多普勒超声心动图检查价值较高,能够降低误诊率,提高诊断准确率,于早期对胎儿的心脏结构状况与心律失常类型加以明确,为临床妊娠终止和采取有效干预措施提供参考,可应用于临床。     

超声心动图诊断下腔静脉瓣冗长的临床价值

目的 探讨超声诊断下腔静脉瓣(EV)冗长的意义及其对心脏结构功能及心律失常的影响.方法 回顾性分析28例EV冗长患者(EV冗长组)的超声心动图和心电图资料,并与对照组比较.结果 EV冗长组中3例左心房增大,1例右心房增大,13例(13/28,46.43％)伴有心律失常,其中房性期前收缩(APC)7例(7/28,25.00％),窦性心动过速及窦性心动过缓各2例,心房颤动1例,室性期前收缩1例,10～20岁青年患者中有3例伴发APC;对照组窦性心动过速及窦性心动过缓各1例,左心房增大1例,两组左心室射血分数均在正常范围.EV冗长组较对照组发生心律失常的比例高(P＜0.05),心脏结构及左心室收缩功能的差异无统计学意义(P均＞0.05).结论 EV冗长可能为引起APC的原因之一,超声诊断EV冗长有助于临床确定心律失常病因.     

超声心动图检测胎儿心律失常的临床诊断价值分析

目的探讨超声心动图在胎儿心律失常中的诊断价值。方法使用彩色多普勒超声仪探查胎儿心律及心脏结构,对比心律失常胎儿(50例,观察组)与健康胎儿(256例,对照组)超声心动图指标。结果观察组胎儿降主动脉、脐动脉、大脑中动脉指标与对照组比较差异有统计学意义(P<0.05)。观察组50例中期前收缩30例,心动过速10例,心动过缓6例,房室传导阻滞4例;心脏结构异常者6例。随访44例,39例预后良好,5例停止妊娠。结论超声心动图有助于早期发现心律失常及心脏结构畸形,为预后提供重要参考。     

超声检测胎儿肝静脉频谱在胎儿期外收缩诊断中的价值

目的评价超声检测胎儿肝静脉频谱在胎儿期外收缩诊断及预后判断中的价值。方法 139例心律不齐胎儿,超声检查其肝静脉和行超声心动图检查,分别于2周后、分娩时和出生后3 d内复查。结果超声检查示124例(89.8%)胎儿室上性期外收缩,15例(10.2%)室性期外收缩;分娩时室上性期外收缩14例(11.3%),室性期外收缩3例(20.0%);出生后3d内16例心律恢复正常,1例室上性期外收缩发展为室上性心动过速。结论超声检测胎儿肝静脉频谱可鉴别室上性期外收缩与室性期外收缩,室性期外收缩更易在整个妊娠期持续存在,只有极少数期外收缩病例发展为心动过速或伴有先天性心脏畸形。     

胎儿超声心动图对胎儿心律失常的诊断价值47例分析

目的:探讨应用M型超声心动图(M-UCG)及频谱多普勒超声诊断胎儿心律失常的价值。方法:应用M型超声心动图及频谱多普勒超声对47例疑有胎儿心律失常的患者进行胎儿心脏超声检查。结果:通过心脏彩超共诊断出32例胎儿心律失常,其中房性早搏16例,室性早搏7例,心动过速6例,心动过缓3例。结论:超声心动图可以快速有效的检测出胎儿心律失常,而且可以较为准确的对胎儿心律失常进行分类,是胎儿心律失常的首选诊断措施。     

经腹部彩色多普勒超声对孕早期胎儿心律失常的初步研究

目的：探讨经腹部彩色多普勒超声诊断孕早期胎儿心律失常可行性及临床价值。材料和方法：采用经腹部彩色多普勒超声对11956例孕12~14周胎儿进行检查,应用M型和多普勒超声等多种方法诊断胎儿心律失常并分析其类型。观察是否存在胎儿心脏结构及其他异常,对存活病例均于孕22-24周行系统的胎儿超声心动图检查,超声结果与胎儿引产结果及出生后彩色多普勒超声对照。结果：11956例中发现胎儿心律失常12例(12/11956,0.1%)。其中窦性心动过速9例；心动过缓2例(房室传导阻滞)；房性早搏1例。合并胎儿畸形6例,包括胎儿先天性心脏病4例,肢体-体壁综合征1例;胎儿水肿1例,均中止妊娠,结果与产前诊断相符。结论：经腹部彩色多普勒超声能早期诊断胎儿心律失常及胎儿系统畸形,对临床早期干预和处理有重要的指导意义。     

M型超声结合房室梯形图分析法诊断胎儿心律失常的临床应用价值

目的 探讨M型超声结合房室梯形图分析诊断胎儿心律失常的价值。方法 回顾性分析2016年1月至2020年10月期间重庆市妇幼保健院经胎儿超声心动图检查应用M 型超声取样线获取房室壁、房室瓣及半月瓣的活动曲线,结合房室梯形图法分析及诊断胎儿心律失常类型。结果 M型超声结合房室梯形图法共诊断165例胎儿心律失常,其中房性早搏76例(46.1%),室性早搏6例(3.6%),窦性心动过速43例(26.0%),室上性心动过速8例(4.8%),其中房性心动过速1例(0.6%),心房扑动1例(0.6%),窦性心律过缓22例(13.3%),房室传导阻滞9例(5.5%)。结论 M型超声结合房室梯形图诊断胎儿心律失常可行,此方法简单、直观,能明确胎儿心律失常类型。     

Recognition of fetal arrhythmias by echocardiography

Fetal arrhythmias were detected in 33/198 high risk pregnancies from 21 weeks to term. Using the two-dimensional echocardiographic image of the fetal heart as a guide, the M-mode beam was directed to define the motion of the ventricular and atrial walls and atrioventricular valve or semilunar valves. Atrial contraction was defined either by the atrial wall motion or from the A-point of the atrioventricular valve. Ventricular contraction was defined by closure of the atrioventricular valve (C-point), the onset of ventricular wall contraction, or from the semilunar valve opening. Ladder diagrams of the sequence of atrial and ventricular activation were constructed to define the temporal sequence of these events. Premature atrial contractions were present in 12. In one fetus this arrhythmia converted into supraventricular tachycardia while in the other 11 fetuses the course was benign. Two fetuses had premature ventricular contractions. Supraventricular tachycardia was noted in five fetuses. One with hydrops at 29 weeks returned to sinus rhythm following maternal administration of procainamide. A second hydropic fetus with paroxysmal atrial tachycardia and hydrops failed to respond to digitalis, propranolol, procainamide, verapamil, or amiodarone, and died shortly after cesarean section. Two mature fetuses had tachycardia close to term and were treated after cesarean section. One fetus with runs of atrial tachycardia died in utero. Three fetuses had complete heart block, two of whom were from mothers with connective tissue diseases. In four fetuses, there was bradycardia of less than 100/minute lasting more than 30 seconds, but these episodes disappeared in 2 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)     

胎儿阵发性室上性心动过速的超声诊断及治疗

目的探讨胎儿阵发性室上性心动过速（SVT）的产前超声诊断方法及常压氧疗法的疗效。方法应用胎儿多普勒超声心动图对从2250例心律失常胎儿中遴选的29例阵发性SVT进行心率、心律变化的分析,采用常压氧疗法治疗干预并对治疗前后胎儿心功能指标进行比较。结果29例阵发性sVT胎儿均于检查后行常压氧治疗干预,第1个疗程转律15例,第2个疗程转律12例（含3例转偶发早搏）;1例发生频发房性早搏;1例10d后发生持续性SVT。两个疗程常压氧治疗总有效率为93．1％。治疗前后心脏各指标对比明显改善。结论胎儿阵发性室SVT多由频发房性早搏导致,通常不出现心功能异常。常压氧疗法可有效抑制短阵房性心动过速,改善胎儿循环功能及提高血氧饱和度。     

Treatment of fetal supraventricular tachyarrhythmias

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm. The 14th patient underwent successful therapy after birth. All 14 fetuses survived despite severe fetal hydrops at the time of diagnosis in 13 of 14. The four remaining fetuses had either atrial flutter (3) or fibrillation. Two of the fetuses with atrial flutter died at birth, the 3rd survived after electrical cardioversion at birth. The fetus with atrial fibrillation converted to normal sinus rhythm and survived after maternal administration of digoxin. Using M-mode and pulsed Doppler echocardiography, the nature and electrophysiologic mechanism of the arrhythmia may be deduced. The latter information is reviewed along with the fetomaternal pharmacology of various antiarrhythmic agents to devise a rational antiarrhythmic treatment program.     

胎儿超声心动图检测胎儿房性期前收缩的临床研究

目的：探讨胎儿超声心动图对胎儿房性期前收缩观察价值及其临床意义。方法：采用彩色多普勒超声心动图对404例孕龄16～42周(平均32．5周)的胎儿进行研究．分析胎儿房性期前收缩的超声心动图特征及其检出率。结果：共检出胎儿房性期前收缩41例，检出率为10．1％。其中下传33例，不下传5例．部分下传3例。41例胎儿均不伴有先天性心血管畸形或其它畸形，出生后听诊均未闻及明显心脏杂音或心律不齐。结论：胎儿房性期前收缩为胎儿期最常见的心律失常，不伴有明显心血管畸形或其它胎儿畸形，绝大多数预后良好。     

First-trimester fetal heart block: a marker for cardiac anomaly.

BACKGROUND: Fetal heart block in the second and third trimesters may be caused by transplacental passage of auto-antibodies or cardiac defects. Little is known about the etiology of first-trimester fetal heart block. MATERIALS AND METHODS: Fetal heart block was diagnosed in four patients (negative antibody serology) referred for first-trimester sonographic evaluation of increased fetal nuchal fold thickness with bradycardia. Two-dimensional echocardiography was complemented by color Doppler flow imaging of the fetal heart. Fetal arrhythmia was verified by M-mode, pulsed wave Doppler and/or color M-mode echocardiography. RESULTS: All fetuses had congenital heart disease, atrioventricular valve regurgitation, heart block and edema. Autopsy confirmed heterotaxy in three cases (left atrial isomerism with atrial septal defect; left isomerism with double-outlet right ventricle, great artery malposition and ventricular septal defect. The third case had dextrocardia with atrioventricular canal defect and the fourth case dextrocardia with great artery transposition. CONCLUSION: First-trimester fetal bradycardia may result from heart block of the type associated with complex congenital heart disease. Accelerated edema formation in this setting may be the basis of nuchal edema formation. First-trimester fetal echocardiography offers the potential for early diagnosis and intervention in these cases with poor prognosis.     

胎儿超声心动图评价胎儿心动过速的诊断及治疗干预

目的应用胎儿超声心动图诊断胎儿快速心律失常并对宫内干预治疗室上性心动过速（SVT）进行跟踪评价。 方法对已检出的1910例心律失常胎儿中的125例快速心律失常者，分为窦性心动过速、SVT、SVT合并心力衰竭（心衰）3组，对后两组胎儿进行宫内地高辛转律治疗。 结果胎儿心动过速125例（心率≥180O次／min），其中SVT29例（含房颤、房扑7例）；余为窦性心动过速96例。SVT组中合并复杂先天性心脏病者7例，胎儿水肿7例。合并先心病均于检查后中止妊娠，其余22例行常压氧治疗或经胎盘给药，首选药物为地高辛。新生儿随访期最长16个月，头颅CT、超声心动图等各项生理指标均正常。 结论胎儿超声心动图是目前唯一可迅速检出胎儿心律失常并明确性质的诊断手段，且重复性好。地高辛经胎盘给药治疗可有效转律并同时控制胎儿心衰减轻水肿且无致畸作用。     

肺源性心脏病心律失常的临床特点

目的探讨肺源性心脏病(肺心病)心律失常的临床特征及治疗原则。方法本组病例共136例,全部于入院后48 h内通过24 h心电监护或反复常规12导联心电图检查,及时发现心律失常类型并加以分析。结果本组肺心病患者合并心律失常率达67.64%(92例),其心律失常类型以房性心律失常最多,占42.08%,其次为窦性心动过速及室性心律失常。严重心律失常如室上性心动过速、多源室早、房室传导阻滞、心房扑动等也常出现。心律失常的出现及严重程度与患者病情的严重程度相关性明显。如心衰程度、肺部感染、低氧血症、水电解质紊乱等密切相关。结论肺心病心律失常发生率较高,且与肺心病患者病情严重程度密切相关,而心律失常治疗应通过积极的病因及合并症治疗,使用抗心律失常药物不是最佳办法。     

Clinical implications of fetal magnetocardiography.

OBJECTIVES: To test the usefulness and reliability of fetal magnetocardiography as a diagnostic or screening tool, both for fetuses with arrhythmias as well as for fetuses with a congenital heart defect. METHODS: We describe 21 women with either a fetal arrhythmia or a congenital heart defect discovered during prenatal evaluation by sonography. Four fetuses showed a complete atrioventricular block, two an atrial flutter, nine ventricular extrasystole, and one a complete irregular heart rate. Five fetuses were suspected to have a congenital heart defect. In all cases magnetocardiograms were recorded. RESULTS: Nine fetuses with extrasystole showed a range of premature atrial contractions, premature junctional beats or premature ventricular contractions. Two fetuses with atrial flutter showed typical flutter waves and four fetuses with complete atrioventricular block showed an uncoupling of P-wave and QRS complex. One fetus showed a pattern suggestive of a bundle branch block. In three of four fetuses with confirmed congenital heart defects the magnetocardiogram showed abnormalities. CONCLUSION: Fetal magnetocardiography allows an insight into the electrophysiological aspects of the fetal heart, is accurate in the classification of fetal arrhythmias, and shows potential as a tool in defining a population at risk for congenital heart defects.