超声在胎儿心脏畸形筛查中的应用及影响因素分析

目的明确超声在胎儿心脏畸形筛查中的应用价值，减少其影响因素，最大限度地降低畸形儿的出生。方法采用四腔心切面加声束平面头侧偏斜法，对3821例中晚期妊娠胎儿进行心脏超声筛查，并分析影响因素。筛查结果以引产后尸检或生后超声心动图对照。结果经引产和生后证实的心脏畸形23例，经产前超声检查诊断为心脏畸形21例，检出率为91．30％（21／23）。其中复杂性心脏畸形19例，占82．61％（19／23），一般畸形4例，占17．39％（4／23）。复杂性心脏畸形19例，产前初检诊断17例，复检诊断2例，检出率为100％（19／19）。结论超声是目前临床唯一能诊断胎儿心脏畸形而又无创性的检查方法，能使绝大部分心脏畸形，特别是复杂畸形在胎儿期获得明确诊断。但在筛查时要充分认识到胎儿心脏畸形存在一定局限性与时效性等影响因素，对早期初筛“正常”的胎儿要重视复查。

Application of ultrasound in fetal cardiac abnormalltis screening and analyzing of influencing factors

Objective To identify the application value of ultrasound in the screening of fetal cardiac abnormalities and to reduce its affecting factors, in order to maximally decrease the birth of oaf. Methods Adopting the method of four chamber hearts cross-section and sound beam plane head laterodeviation, 3821 fetal hearts were screened by ultrasonocardiography in middle and late fetal period. The influencing factors were also analyzed. Screening results were compared with the autopsy following induced labor and the ultrasonocardiogram after borne. Results Total 23 cases of the cardiac anomalies were confirmed by odinopoeia or after bomed, 21 cases were diagnosed by antepartum ultrasonocardiography, the detectable rate were 91.3%（21/23）. And the complex cardiac anomalies were 19 cases, accounted for 82.61%（19/23）, the general malformation were 4 cases, accounted for 17.39%（4/23）. In 19 cases of the complex anomalies, 17 cases were diagnosed by antepartum examination in the first time, 2 cases were diagnosed by reexamination, the total detectable rate were 100%（19/19）. Conclusion Ultrasonography is not only non-invasive but also unique method in detecting fetal heart defects. It will help to diagnose definitely the vast majority of congenital malformation in the fetal heart, especially complex malformation in the middle and later fetal period. There are some limitations and chronergy in ultrasonography for the screening of fetal heart defects, which should be followed-up when the fetal appeared ＂normal＂in the early screening.