对比分析不同孕周胎儿心脏畸形的超声诊断价值

发布时间：2018-01-13 16:42

本文关键词：对比分析不同孕周胎儿心脏畸形的超声诊断价值　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在运用二维及彩色多普勒超声,采用多切面连续扫查,探讨孕期不同阶段标准切面的显示率,探究超声诊断胎儿先天性心脏畸形的价值,对比分析孕期各阶段胎儿心脏结构异常检出率的差异,找出适合胎儿心脏超声检查的最佳孕周阶段,同时比较不同切面组合对胎儿心脏结构异常的诊断价值,寻找最好的切面组合方案,达到提高胎儿先天性心脏畸形诊断的准确性、早期发现、早期诊断的目的,同时给予临床精准信息,体现母胎医学发展中的超声的应用价值。方法:选择2015年1月—2016年12月就诊于皖南医学院附属弋矶山医院超声科单胎孕妇16204例根据各自孕周,随机自动入组,根据孕周分为18-22周、23-27周及28-32周,各组按照国际妇产超声学会(ISUOG)指南先行胎儿系统筛查,以免漏诊胎儿心外畸形,接着按照美国胎儿超声心动图指南获取胎儿心脏标准切面,主要包括四腔心切面(4CV)、左室流出道切面(LVOT)、右室流出道切面(LVOT)及三血管气管切面(3VT),在行胎儿超声心动图检查过程中,必要时拓展主动脉弓切面、动脉导管弓切面及上下腔切面以明确诊断。根据上述标准切面提出下面三组组合方案:(1)4CV(简称A方案);(2)4CV+3VT(简称B方案);(3)4CV+3VT+LVOT+RVOT(简称C方案)。观察胎儿心脏各切面的显示情况,明确有无心脏结构异常,对比不同方案切面的显示率及其对胎儿畸形诊断的敏感性及特异性,并对不同孕周阶段的各个标准切面的显示率及胎儿心脏畸形检出率进行对比分析。对筛查出心脏结构异常的胎儿,继续妊娠者,在胎儿出生后的半月内均进行新生儿的彩色多普勒超声心动图复查,终止妊娠者,在孕妇及家属知情同意前提下,对引产儿进行尸检。结果1.16204胎儿中,经产前超声筛查出先天性心脏病165例,检出率为10.2‰。2.16204胎儿中,2015年3763例,2016年12441例,筛查出畸形例数分别为25例、140例,检出率分别为6.6‰、11‰。3.16204例胎儿中,4CV在总体显示率最高,其次是3VT、LVOT、RVOT,显示率分别为99.21%、98.57%、97.96%、97.88%。拓展切面主动脉弓/动脉导管弓切面显示率为96.77%,上下腔静脉切面显示率为96.33%。4.比较三个不同孕周阶段中标准切面显示率,显示率最高的孕周阶段是孕23-27周,其中孕23-27周、孕18-22周与孕28-32周标准切面显示率对比分析,发现差别均具有统计学意义,孕18-22周与孕23-27周标准切面显示率比较无显著差异,无明显统计学意义。5.本课题研究中,使用A方案的敏感性为84.24%,特异性为99.90%;使用B方案的敏感性为89.69%,特异性为99.86%;使用方案C的敏感性为93.93%,特异性为99.83%。三种方案分别与临床随访结果进行一致性比较,kappa值分别为0.868、0.882、0.892,三种方案与临床结果一致性均较满意,其中方案C与临床随访结果一致性最好。结论1本研究发现,超声对胎儿先天性心脏畸形检出率高(10.2‰),超声对胎儿心脏畸形产前诊断具有重要价值。2本研究认为,孕18-22周及孕23-27周是胎儿心脏畸形筛查的最合适检查时间,尤以孕23-27周为最好,但是在妊娠晚期仍按照妊娠中期指南筛查胎儿心脏畸形,可更大程度上减少漏误诊,同时对胎儿先心病的检出也具有重要意义。3本研究认为4CV+3VT+LVOT+RVOT(简称C方案)作为临床常规胎儿心脏筛查切面,稍有疑问者,加用拓展切面(主动脉弓/动脉导管弓切面及上下腔静脉切面)进行补充检查,同时结合彩色多普勒血流及频谱的优势,全面动态观察,有益于进一步明确胎儿心脏结构畸形的诊断。将有助于先心病的诊断。
[Abstract]:Objective: the purpose of this study is to use the two-dimensional and color Doppler ultrasound. The multi section continuous scanning, explore the display rate of standard section in different stages of pregnancy, explore ultrasound diagnosis of fetal congenital heart malformation, comparative analysis of various stages of pregnancy fetal cardiac structural abnormalities detection rate differences, to find suitable for the best pregnancy fetal echocardiography week, and compare the different facets of combination for diagnosis of fetal cardiac structural abnormalities, find the best combination of view, to improve the accuracy of diagnosis of fetal congenital heart disease early detection, early diagnosis, and give precise clinical information, application value of ultrasound in the development of fetal medicine. Methods: January 2015 December 2016 in Wangnan Medical College Hospital Affiliated of Rocky Mountain hospital department of ultrasound in 16204 cases of singleton pregnant women according to their gestational age, random automatic According to the gestational age group, divided into 18-22 weeks, 23-27 weeks and 28-32 weeks, groups in accordance with the international society of Obstetrics and Gynecology ultrasound (ISUOG) guidelines for the first fetal screening system, in order to avoid misdiagnosis of fetal heart malformation, then according to the fetal echocardiography guide for fetal heart standard section, including four chamber view (4CV), left ventricular outflow tract (LVOT), right ventricular outflow tract (LVOT) and three vessel trachea view (3VT), in the process of fetal echocardiography, when necessary to expand the aortic arch section, ductal arch section and the lower section to confirm the diagnosis. Put forward the following three groups according to the standard section: combination scheme (1) 4CV (A scheme); (2) 4CV+3VT (B scheme); (3) 4CV+3VT+LVOT+RVOT (C scheme). Show the observation of fetal heart sections, clear the display rate of cardiac structural abnormalities, comparing the different programs and section of fetal deformity The sensitivity and specificity of diagnostic, and display section each standard in different gestational period and the rate of abnormal fetal heart rate were analyzed. The screening of fetal cardiac abnormalities, pregnancy, were newborns after birth within the first half of the color Doppler echocardiography review, termination of pregnancy who, in pregnant women and their family members informed consent, an autopsy of aborted fetuses. Results 1.16204 fetus, prenatal ultrasound screening of 165 cases of congenital heart disease, the detection rate was 10.2 per thousand in 2015 3763 cases of fetal.2.16204, 2016, 12441 cases of malformation screening were 25 cases, 140 cases. The detection rate was 6.6 per thousand, 11 per thousand.3.16204 fetuses, 4CV showed the highest rate in general, followed by 3VT, LVOT, RVOT, the display rate were 99.21%, 98.57%, 97.96%, 97.88%. expansion section of the aortic arch / arterial arch section display The rate is 96.77%, inferior vena cava views display rate was compared with the standard 96.33%.4. three different gestational age stage display rate and the display rate is the highest stage of gestational age 23-27 weeks of gestation, the pregnant 23-27 weeks, 18-22 weeks pregnant and pregnant 28-32 week standard section display rate of contrast analysis, found that the difference was statistically significant, pregnant 18-22 weeks and 23-27 weeks pregnant standard section display rate is no significant difference of no statistical significance of.5. in this project, using the A scheme sensitivity was 84.24%, specificity was 99.90%; the sensitivity of using B method was 89.69%, the specificity was 99.86%; the sensitivity using the scheme of C is 93.93%, the specificity was three 99.83%. methods and clinical follow-up results for consistency, the kappa values were 0.868,0.882,0.892, three kinds of schemes and clinical results were satisfactory consistency, the scheme of C and clinical follow-up results from the best conclusion 1. The study found that ultrasound in diagnosis of fetal congenital heart malformation with high detection rate (10.2 per thousand), ultrasound has important value in.2 this study suggests that prenatal diagnosis for fetal heart malformation, pregnancy 18-22 weeks and 23-27 weeks of gestation fetal heart malformation screening is the most appropriate time of examination, especially in the 23-27 weeks of gestation for the best, but in late pregnancy mid pregnancy is still in accordance with the guidelines for screening of fetal cardiac malformation, can largely reduce misdiagnosis, while the detection of fetal congenital heart disease also has the important significance of.3 this study shows that the 4CV+3VT+LVOT+RVOT (C scheme) as the routine fetal heart screening section, there is little doubt that, with the expansion section (aortic arch / arterial arch section and the inferior vena cava section) supplementary examination, combined with color Doppler flow spectrum and the advantages of comprehensive dynamic observation, is beneficial to the further diagnosis of fetal cardiac malformations. It will be helpful to the diagnosis of congenital heart disease.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R714.5

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