心脏超声在胎儿及新生儿先天性心脏病检查中的应用

发布时间：2018-03-16 20:42

本文选题：心脏超声　切入点：胎儿　出处：《华北理工大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的探讨心脏超声在胎儿心脏的检查以及胎儿、新生儿的先天性心脏病检查和诊治中的应用价值。方法时间上从2014年11月起直到2016年2月为止,在此期间在煤炭总医院,选取在妇产科建立档案并规律在本科进行产前检查的身体健康的孕妇,并且胎儿行产前检查无明显异常,胎儿心脏行心脏超声显示大致正常者共176例,作为研究对象纳入本研究。以孕周数作为分组依据,共分为5组,分别为孕22周(n=50)、孕23周(n=50)、孕24周(n=50)、孕32周(n=17)、孕34周(n=9)。应用专业超声心动图仪器对胎儿心脏进行检查,并对心脏结构及功能正常的胎儿心脏进行常规指标的测量及记录,随后对孕龄分别是22、23、24孕周数的正常胎儿的心脏各项测量指标进行专业的统计学分析,进而得到各测量指标的医学参考值范围。利用各个孕周数胎儿心脏各项指标的测量数值进行统计分析,从而比较相关指标间的差异,寻找内在医学规律。对研究期间煤炭总医院胎儿(n=185)及新生儿(n=70)研究对象,经心脏超声确定存在先天性心脏病的病例进行收集整理,从而探讨煤炭总医院胎儿及新生儿的先天性心脏病的发病率及疾病特征、临床应用价值等。对出生后24小时内的新生儿行心脏超声检查,发现卵圆孔未闭的新生儿(n=13)进行定期随访,之后对闭合规律进行探讨。结果1在课题研究期间,通过对符合条件的入组对象心脏超声各常规指标进行测量及统计,得出了煤炭总医院正常胎儿22、23、24孕周心脏超声各指标的医学参考值范围。2胎儿的心脏在解剖学和功能学上显示为右心占有优势,即与成人心脏的左心优势呈现相反的情况。在胎儿时期,人类心脏及大血管的各部位的内径测量值均随着孕龄的增加而加大,在统计学上呈现线性相关。各孕周胎儿心脏超声的Tei指数均在较恒定的范围内波动,不随孕龄的变化而大幅度的改变,所以该指标是评价胎儿心脏功能的一个良好指标。3在病例收集期间,发现并确定了多例胎儿及新生儿先天性心脏病,这些典型病例包括了胎儿的完全型心内膜垫缺损、完全型大动脉转位合并房室间隔缺损及肺动脉瓣狭窄、法洛四联征和新生儿的房、室间隔缺损等,并统计出了煤炭总医院胎儿和新生儿先天性心脏病发病率约为0.4%,与目前国内外统计出的公认的发病率相符。根据上述先心病病例分析并总结出本院先心病疾病谱有着自己的特征。还通过一个典型病例的诊疗经过分析并确定了心脏超声联合婴儿尸检、基因检测有着重要的应用价值。4出生后24小时内存在卵圆孔未闭的新生儿在之后的1年内是有闭合机会的,其中出生后7日内闭合概率更大。即使1年内未闭合也应继续随访,不宜认定为房间隔缺损。结论1通过课题研究所得的正常胎儿心脏超声心动图指标的参考范围可为煤炭总医院胎儿心脏超声检查提供一定的参考依据,尤其是在胎儿先天性心脏病的筛查过程中。2胎儿心脏有其自身的特殊性,其内在的规律对检查及临床诊治具有较高的指导意义。3目前,根据发病率的统计结果约为0.4%,认为煤炭总医院胎儿及新生儿的先天性心脏病的发病率与国内总体水平相似,也处于较高水平,并且疾病谱有其自身的特点。4出生后卵圆孔未闭应加强随访,以减少家庭及社会负担。
[Abstract]:Objective to investigate cardiac ultrasound in fetal heart examination and fetal, application value of neonatal congenital heart disease examination and diagnosis. Methods the time from November 2014 until February 2016, during this period in China Meitan General Hospital, select the establishment of files and rules for prenatal examination in the undergraduate physical health of pregnant women in obstetrics and Gynecology, and fetus prenatal examination showed no abnormalities, fetal heart echocardiography showed normal in 176 cases, as the research object were included in this study. The gestational age grouping number as the basis, divided into 5 groups, respectively, for 22 weeks of pregnancy (n=50), 23 weeks of pregnancy (n=50), at 24 weeks of pregnancy (n=50). 32 weeks (n=17), 34 weeks of pregnancy (n=9). The application of professional echocardiographic examination of the fetal heart instrument, and on the cardiac structure and function of normal fetal heart were measured and recorded conventional indicators, as well as the gestational age were pregnant 22,23,24 The measure of normal fetal heart weeks of professional statistics, then obtains the measurement index of medical reference range. Statistical analysis was performed by measuring the value of each gestational age of fetal cardiac indexes, thus the difference between the relevant indicators, to find the intrinsic rules of medical. During the study of fetal China Meitan General Hospital (n=185) and the newborn (n=70) study, the cardiac ultrasound confirms the presence of congenital heart disease were collected, so as to investigate the incidence of congenital heart disease and disease characteristics of China Meitan General Hospital fetus and newborn, clinical application value. In 24 hours after birth neonatal cardiac ultrasound examination, found patent foramen ovale the newborn (n=13) were followed up regularly, after the closure rules were discussed. The results of 1 during the research, through to meet the conditions of the subjects The conventional cardiac ultrasound measurement and statistics, the China Meitan General Hospital of normal fetal cardiac ultrasound at 22,23,24 weeks the indexes of the medical reference range of.2 in the fetal heart anatomy and function is displayed on the right heart have the advantage that the adult heart and left heart advantage is opposite. In the fetal period, the inner diameter measurement parts of the human heart and great vessels were increased with the increase of gestational age, in a statistically linear correlation. The fetal echocardiography Tei index fluctuations in the range is constant, does not change with gestational age and greatly changed, so the index is a good indicator of the period.3 evaluation of fetal cardiac function in patients were collected, identified cases of fetal and neonatal congenital heart disease, these typical cases include ctecd fetus, complete type Arteries with atrioventricular septal defect and pulmonary stenosis, tetralogy of Fallot and neonatal atrial, ventricular septal defect, and the statistics of the China Meitan General Hospital of fetal and neonatal congenital heart disease incidence rate is about 0.4%, consistent with the present statistics of the recognized incidence. According to the analysis of cases of congenital heart disease and summary the Institute of congenital heart disease spectrum has its own characteristics. The diagnosis and treatment of a typical case through analysis and determine the cardiac ultrasound combined with infant autopsy, genetic testing has important application value of.4 24 hours after birth in the memory of patent foramen ovale in neonates after 1 years there is a chance of closure among them, born within 7 days after the closure of a greater probability. Even if not closed within 1 years should also continue to follow up, should not be identified as ASD. Conclusion: 1 through the research of the normal fetal heart echocardiography The reference range of indicators can provide some reference for the China Meitan General Hospital fetal echocardiography, especially in the process of screening for fetal congenital heart disease in.2 fetal heart has its own particularity, its inherent law has higher examination and clinical significance of.3 at present, according to the statistical results about the incidence of 0.4%, that the incidence of congenital heart disease in China Meitan General Hospital of fetal and neonatal and the overall level of domestic similar, is also at a high level, and the.4 disease spectrum has its own characteristics after the birth of patent foramen ovale and follow-up, in order to reduce the burden on the family and society.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.5;R722.1

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