产前超声对胎儿早期心脏畸形筛查的价值

目的探讨胎儿颈项透明层(NT)、三尖瓣频谱和心尖四腔观(FCV)三者联合应用在胎儿早期心脏畸形筛查中的临床意义。方法选取725例先天性心脏病高危孕妇,所有胎儿孕11¹4周检测NT、FCV;应用脉冲多普勒超声获取三尖瓣血流频谱,进行相应的血流频谱分析,同时对NT增厚、三尖瓣反流及四腔心异常的胎儿行超声心动图检查,对可疑CHD的胎儿于孕1814周检测NT、FCV;应用脉冲多普勒超声获取三尖瓣血流频谱,进行相应的血流频谱分析,同时对NT增厚、三尖瓣反流及四腔心异常的胎儿行超声心动图检查,对可疑CHD的胎儿于孕18²0周再次行超声心动图检查以确诊或除外CHD;其余胎儿于孕2020周再次行超声心动图检查以确诊或除外CHD;其余胎儿于孕20²4周行胎儿超声心动图检查。所有活产儿于生后1周内行超声心动图检查,引产的胎儿争取尸解。所得结果进行对比分析。结果 NT、三尖瓣频谱、FCV单独及NT+三尖瓣频谱+FCV联合筛选胎儿心脏病的敏感性分别为53%、47%、49%、93%。NT+三尖瓣频谱+FCV的敏感性明显高于其他方法(P<0.05)。结论 NT+三尖瓣频谱+FCV联合应用检测技术简单、易于普及推广,可明显提高筛选胎儿早期心脏畸形的敏感性。

Value of Prenatal Ultrasonography in Early Screening for Fetal Congenital Cardiac Defects

Objective To investigate the clinical signiifcance of nuchal translucency（NT）, the tricuspid waveform and the four–chamber view of heart（FCV）as well as combing the three methods to screen for fetal congenital heart disease in the ifrst-trimester pregnancy. Methods NT, FCV and the tricuspid waveform of 725 consecutive fetuses were conducted to high risk pregnancy within 11-14 gestational weeks. Fetuses with increased NT, tricuspid regurgitation and abnormal FCV were followed up with echocardiography. Those fetuses suspected with CHD were re-examined with echocardiography during 18-20 gestational weeks to obviate congenital heart disease. For the rest of study group, echocardiography detections were conducted during 20-24 weeks of gestation. All fetuses were followed up with echocardiography examination during 1 week after birth, and those abortions accepted autopsy. The results were analyzed. Results The sensitivity of NT, tricuspid waveform and FCV in screening the congenital cardiac defects alone was 53%, 47%, 49%. The sensitivity of combing NT＋tricuspid waveform＋FCV was higer（P〈0.05）. Conclusion The method of combining NT＋tricuspid waveform＋FCV will improve the overall sensitivity of the screening test in the ifrst-trimester pregnancy.