在西藏自治区首次推广规范化产前超声筛查的效果评价

目的首次在西藏自治区推广规范化产前超声筛查，评价培训一年后西藏自治区出生缺陷病例筛查与诊断的临床应用价值。 方法2016年8月湖北省妇幼保健院联合西藏自治区卫生健康委员会及西藏自治区医学会超声专业委员会按照国际妇产超声指南对西藏自治区进行为期21 d的规范化产前超声筛查培训，理论授课86学时，实际上机操作培训总计560学时。与培训前2016年1月至7月30日对比，分析培训后西藏自治区产前超声筛查临床应用情况。 结果培训前调查问卷26家医院中仅2家开展产前超声筛查，培训后一年26家医院产前超声筛查覆盖率达81.82%（18/22）。培训后日喀则、山南、那曲、阿里、昌都5个区域结束了产前超声结构异常胎儿零检出，2017年完成了2~25例不等的结构异常胎儿的诊断。拉萨妇幼保健院培训前16个切面超声筛查，培训后按照国际指南做到34个切面；与培训前2016年1月至7月30日对比：（1）超声筛查出胎儿结构异常阳性率由0.34%（54/15，716）上升至0.56%（210/37，286）；（2）患者来源由西藏自治区4个区扩展至全区（7个）；（3）检出各系统结构异常顺位发生变化，心血管系统异常从无到有，水肿、泌尿系统等结构异常检出明显增多。检出结构畸形病种从21种上升至69种。 结论在西藏自治区推广规范化产前超声筛查培训，显著提高拉萨市妇幼保健院产前超声筛查水平，结束了日喀则、山南、那曲、阿里、昌都区域零检出，对逐渐普及推广产科超声规范化，更多藏族孕妇能在孕期接受规范的超声筛查，有效降低西藏出生缺陷发生率意义重大。

Effects of standardized training of prenatal ultrasound screening of birth defects in Tibet autonomous region

ObjectiveTo evaluate the effects of standardized training of prenatal ultrasound screening of birth defects in Tibet. MethodsDoctors from Hubei Province gave standardized training of prenatal ultrasound screening (86 hours of theoretical lectures and 560 hours of actual operation training) in Tibet according to the International Society of Ultrasound in Obstetrics & Gynecology guidelines, which lasted about 21 days in August 2016. The prenatal ultrasound diagnosis of birth defects by 30 ultrasound trainees who came from 26 hospitals in 7 areas of Tibet from September 2016 to September 2017 was analyzed. ResultsCompared to the pre-training value [7.7% (2/26)], the rate of prenatal ultrasonic screening increased to 81.82%% (18/22) in 2017. The situation that no prenatal ultrasound screening had been performed in Rigaze, Shannan, Naqu, Ali, and Changdu were altered, and about 2-25 structural abnormal fetuses were identified in those areas. Compared to the pre-training value [0.34% (54/15, 716)], the positive rate of fetal structural abnormalities screened by ultrasound in Lhasa Maternal and Child Health Hospital increased to 0.56% (210/37, 286). The number of detected abnormal structures of each body system was increased after training. ConclusionStandardized prenatal ultrasound training effectively improves the prenatal detection rate of birth defects in Tibet autonomous region. After training, the detection rate of birth defects by prenatal ultrasound, the detection time, and the number of malformations detected in each body system are obviously improved.