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目的探讨超声心动图测定心脏轴变化在胎儿先天性心脏病(先心病)产前诊断中的临床意义。方法应用Acuson128×P/10彩色多普勒超声诊断仪检查518例胎龄18~40周的先心病高危胎儿和90例正常胎儿,在心脏超声四腔观基础上测定胎儿心脏轴,并从多切面观察胎儿心内结构,以确定胎儿有无先心病。结果正常胎儿心脏轴为(44.8±10.3)度,先心病胎儿心脏轴为(58.1±15.7)度,两者比较,差异有显著性(P<0.01)。单纯四腔观检测胎儿先心病的敏感性为68.5%,应用心脏超声四腔观加心脏轴测定检测胎儿先心病的敏感性为91.4%,两者比较,差异有显著性(P<0.05);518例先心病高危胎儿中,产前超声正确诊断先心病34例,假阳性1例,假阴性1例。结论正常胎儿心脏轴范围20~75度,如心脏轴>75度,应高度怀疑胎儿先心病;心脏轴测定在胎儿先心病筛查中具有重要作用,可作为一种常规测量指标。
Objective To investigate the clinical significance of echocardiography in the prenatal diagnosis of fetal congenital heart disease (CHD). Methods A total of 518 high-risk fetuses with gestational age 18 to 40 weeks and 90 normal fetuses were examined by Acuson128 × P / 10 color Doppler sonography. The fetal heart axis was measured on the basis of four-chamber echocardiography. Fetal observation of the fetal heart structure, in order to determine whether the fetus congenital heart disease. Results The normal fetal heart axis was (44.8 ± 10.3) degrees and the concentric heart axis was (58.1 ± 15.7) degrees. There was a significant difference between the two groups (P <0.01). The sensitivity of simple four-chamber examination of fetal congenital heart disease was 68.5%. The sensitivity of four-chamber echocardiography plus cardiac axis detection for detecting fetal congenital heart disease was 91.4%. The difference was significant (P <0.05). Among 518 high-risk fetuses with CHD, 34 cases of CHD were correctly diagnosed by prenatal ultrasound, 1 was false-positive and 1 was false-negative. Conclusion Normal fetal cardiac axis range from 20 to 75 degrees, such as cardiac axis> 75 degrees, should be highly suspected fetal congenital heart disease; determination of cardiac axis plays an important role in fetal congenital heart disease screening, can be used as a routine measurement.