产前胎儿超声心动图常规及系统筛查的临床应用研究

目的研究产前彩色多普勒胎儿超声心动图（FECG）在一般胎儿畸形常规筛查及心脏病高危胎儿和心脏畸形胎儿系统筛查中的临床应用。方法2004年1月至2006年12月对12900例胎儿进行常规胎儿超声心动图筛查（四腔心切面,左、右室流出道切面及主动脉弓、动脉导管弓切面）,其中对心脏病高危胎儿320例进行系统胎儿超声心动图检查（顺序分段法并适当配合彩色多普勒及脉冲多普勒超声检查）。以引产后尸解或生后ECG作为对照标准。结果终止妊娠胎儿尸解和生后ECG检查证实胎儿先天性心脏病（CHD）58例,占0.45%,漏诊5例;敏感性91.38%,准确性99.35%。结论胎儿超声心动图常规及系统诊断技术是诊断胎儿CHD较完善、可靠的方法,可明显提高胎儿CHD诊断的敏感性,已成为产前筛选CHD和指导干预的重要方法。

Clinical Application of Fetal Echocardiography in Prenatal Routine and Systemic Screening

Objective To investigate the clinical application of color Doppler fetal echocardiography(FECG)in prenatal routine and systemic screening to find out high risk anomaly and fetal congenital heart diseases(CHD).Methods The study included 12900 fetuses.All fetuses were examined using routine fetal echocardiography(FECG)with four-chamber,left and right ventricular out-flow plus aortic arch view and ductus artery view.In 12900 fetuses,320 high risk CHD were examined using systemic FECG with sequential segmental approach,and with color Doppler and pulsed wave Doppler(PW)and ECG.Echocardiographic results were compared with necropsy specimens of the fetal heart after termination of pregnancy or postnatal ECG.Results Necropsy specimens or postnatal ECG verified CHD in 58 fetuses(0.45 %),and 5 cases were not detected.The diagnostic sensitivity and accuracy of FECG were 91.38% and 99.35%,respectively.Conclusions The prenatal routine and systemic screening of FECG is a consummate and reliable method for diagnosing fetal CHD.It can improve the sensitivity for detecting CHD.It has become an important method for prenatal screening CHD and for guiding interventional treatment.