摘要
目的:探讨经腹部、经阴道及经腹部和经阴道联合彩色多普勒超声检测在11～17孕周胎儿先天性心脏畸形(CHD)诊断中的应用效果。方法:选择进行胎儿超声心动图筛查的胎儿先天性心脏畸形高危孕妇779例作为研究对象。入选孕妇孕龄为11～17周,均接受经腹部和经阴道彩色多普勒超声检测,随访记录孕妇引产后病理解剖结果及分娩后超声心动图检查结果。比较经腹部、经阴道、经腹部与经阴道联合诊断对胎儿CHD的检出率及诊断价值。结果:779例胎儿CHD高危因素孕妇经引产后病理解剖学检查及分娩后心脏B超检查证实为CHD者78例,发病率10.01%。其中经腹部诊断胎儿CHD检出率为78.21%;经阴道检出率为91.03%;经腹部与经阴道联合诊断97.44%,差异具有统计学意义(P<0.05)。经腹部和经阴道诊断检出率均显著低于病理/随访结果(P<0.05),而经腹部与经阴道联合诊断对胎儿CHD检出率与病理/随访结果间差异无统计学意义(P>0.05)。经阴道超声诊断对胎儿CHD诊断灵敏度、诊断符合率显著高于经腹部,漏诊率显著低于经腹部(P<0.05)。经腹部与经阴道联合诊断的灵敏度和诊断符合率均显著高于经腹部诊断,漏诊率显著低于经腹部诊断(P<0.05);高于经阴道超声诊断,但组间差异无统计学意义(P>0.05)。结论:经腹部与经阴道彩色多普勒超声联合诊断在11～17孕周胎儿先天性心脏畸形高危孕妇中胎儿CHD检出方面具有较高灵敏度,可显著提高胎儿CHD诊断符合率,为降低CHD胎儿出生率提供科学的诊断依据。
Objective:To investigate the effect of transabdominal,transvaginal and transabdominal combined with transvaginal color Doppler ultrasonography in the diagnosis of congenital heart disease(CHD)in 11 to 17 weeks of gestation.Methods:779 pregnant women with congenital heart high risk were enrolled.The gestational age of the pregnant women was 11 to 17 weeks.All patients underwent transabdominal and transvaginal color Doppler ultrasonography.The pathological anatomical results of pregnant women after induction of labor and the results of post-partum echocardiography were followed up.The detection rate and diagnostic value of fetal CHD were compared by transabdominal,transvaginal,transabdominal and transvaginal diagnosis.Results:779 cases of fetal CHD high risk factors were diagnosed as pathological anatomy after induction of labor and 78 cases of CHD confirmed by cardiac B-ultrasound after delivery,the incidence rate was 10.01% .The detection rate of fetal CHD by abdominal diagnosis was 78.21%;the rate of transvaginal detection was 91.03%;the diagnosis of abdominal and vaginal combined diagnosis was 97.44% ,the difference was statistically significant(P<0.05).The transabdominal and transvaginal diagnostic rates were significantly lower than the pathology/follow-up results(P<0.05),but there was no significant difference between the detection of fetal CHD and the pathology/follow-up results by transabdominal and transvaginal diagnosis(P>0.05).The sensitivity and diagnostic coincidence rate of fetal CHD diagnosis by transvaginal ultrasound diagnosis was significantly higher than that of transabdominal,and the rate of missed diagnosis was significantly lower than that of transabdominal(P<0.05).The sensitivity and diagnostic coincidence rate of transabdominal and transvaginal diagnosis were significantly higher than that of transabdominal diagnosis,the rate of missed diagnosis was significantly lower than that of transabdominal diagnosis(P<0.05),and the sensitivity and diagnostic coincidence rate of transabdominal and transvaginal diagnosis was higher than that of transvaginal ultrasound,but the difference between the groups was not statistically significant(P>0.05).Conclusion:Transabdominal and transvaginal color Doppler ultrasound combined diagnosis of fetal CHD detection in pregnant women with high risk of congenital heart disease at 11 to 17 weeks of gestation,can significantly improve the diagnostic rate of fetal CHD diagnosis,and provide a reduction in the birth rate of CHD.The scientific diagnosis basis is worthy of promotion by medical institutions.
作者
张展
张杰
张立新
ZHANG Zhan;ZHANG Jie;ZHANG Lixin(Ultrasonography Department of Xi’an Children’s Hospital(Xi’an 710003))
出处
《陕西医学杂志》
CAS
2019年第5期607-610,共4页
Shaanxi Medical Journal
基金
陕西省科学技术研究发展计划项目(2014K12-13)
关键词
先天性心脏畸形
胎儿
经腹部
经阴道
彩色多普勒超声
诊断
Congenital heart disease
Fetal
Transabdominal
Transvaginal
Color doppler ultrasound
Diagnosis
作者简介
通讯作者:张杰.
