本文關(guān)鍵詞：對(duì)比分析不同孕周胎兒心臟畸形的超聲診斷價(jià)值　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 超聲 胎兒先天性心臟病 診斷 對(duì)比分析

【摘要】：目的:本研究旨在運(yùn)用二維及彩色多普勒超聲,采用多切面連續(xù)掃查,探討孕期不同階段標(biāo)準(zhǔn)切面的顯示率,探究超聲診斷胎兒先天性心臟畸形的價(jià)值,對(duì)比分析孕期各階段胎兒心臟結(jié)構(gòu)異常檢出率的差異,找出適合胎兒心臟超聲檢查的最佳孕周階段,同時(shí)比較不同切面組合對(duì)胎兒心臟結(jié)構(gòu)異常的診斷價(jià)值,尋找最好的切面組合方案,達(dá)到提高胎兒先天性心臟畸形診斷的準(zhǔn)確性、早期發(fā)現(xiàn)、早期診斷的目的,同時(shí)給予臨床精準(zhǔn)信息,體現(xiàn)母胎醫(yī)學(xué)發(fā)展中的超聲的應(yīng)用價(jià)值。方法:選擇2015年1月—2016年12月就診于皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院超聲科單胎孕婦16204例根據(jù)各自孕周,隨機(jī)自動(dòng)入組,根據(jù)孕周分為18-22周、23-27周及28-32周,各組按照國(guó)際婦產(chǎn)超聲學(xué)會(huì)(ISUOG)指南先行胎兒系統(tǒng)篩查,以免漏診胎兒心外畸形,接著按照美國(guó)胎兒超聲心動(dòng)圖指南獲取胎兒心臟標(biāo)準(zhǔn)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)及三血管氣管切面(3VT),在行胎兒超聲心動(dòng)圖檢查過(guò)程中,必要時(shí)拓展主動(dòng)脈弓切面、動(dòng)脈導(dǎo)管弓切面及上下腔切面以明確診斷。根據(jù)上述標(biāo)準(zhǔn)切面提出下面三組組合方案:(1)4CV(簡(jiǎn)稱A方案);(2)4CV+3VT(簡(jiǎn)稱B方案);(3)4CV+3VT+LVOT+RVOT(簡(jiǎn)稱C方案)。觀察胎兒心臟各切面的顯示情況,明確有無(wú)心臟結(jié)構(gòu)異常,對(duì)比不同方案切面的顯示率及其對(duì)胎兒畸形診斷的敏感性及特異性,并對(duì)不同孕周階段的各個(gè)標(biāo)準(zhǔn)切面的顯示率及胎兒心臟畸形檢出率進(jìn)行對(duì)比分析。對(duì)篩查出心臟結(jié)構(gòu)異常的胎兒,繼續(xù)妊娠者,在胎兒出生后的半月內(nèi)均進(jìn)行新生兒的彩色多普勒超聲心動(dòng)圖復(fù)查,終止妊娠者,在孕婦及家屬知情同意前提下,對(duì)引產(chǎn)兒進(jìn)行尸檢。結(jié)果1.16204胎兒中,經(jīng)產(chǎn)前超聲篩查出先天性心臟病165例,檢出率為10.2‰。2.16204胎兒中,2015年3763例,2016年12441例,篩查出畸形例數(shù)分別為25例、140例,檢出率分別為6.6‰、11‰。3.16204例胎兒中,4CV在總體顯示率最高,其次是3VT、LVOT、RVOT,顯示率分別為99.21%、98.57%、97.96%、97.88%。拓展切面主動(dòng)脈弓/動(dòng)脈導(dǎo)管弓切面顯示率為96.77%,上下腔靜脈切面顯示率為96.33%。4.比較三個(gè)不同孕周階段中標(biāo)準(zhǔn)切面顯示率,顯示率最高的孕周階段是孕23-27周,其中孕23-27周、孕18-22周與孕28-32周標(biāo)準(zhǔn)切面顯示率對(duì)比分析,發(fā)現(xiàn)差別均具有統(tǒng)計(jì)學(xué)意義,孕18-22周與孕23-27周標(biāo)準(zhǔn)切面顯示率比較無(wú)顯著差異,無(wú)明顯統(tǒng)計(jì)學(xué)意義。5.本課題研究中,使用A方案的敏感性為84.24%,特異性為99.90%;使用B方案的敏感性為89.69%,特異性為99.86%;使用方案C的敏感性為93.93%,特異性為99.83%。三種方案分別與臨床隨訪結(jié)果進(jìn)行一致性比較,kappa值分別為0.868、0.882、0.892,三種方案與臨床結(jié)果一致性均較滿意,其中方案C與臨床隨訪結(jié)果一致性最好。結(jié)論1本研究發(fā)現(xiàn),超聲對(duì)胎兒先天性心臟畸形檢出率高(10.2‰),超聲對(duì)胎兒心臟畸形產(chǎn)前診斷具有重要價(jià)值。2本研究認(rèn)為,孕18-22周及孕23-27周是胎兒心臟畸形篩查的最合適檢查時(shí)間,尤以孕23-27周為最好,但是在妊娠晚期仍按照妊娠中期指南篩查胎兒心臟畸形,可更大程度上減少漏誤診,同時(shí)對(duì)胎兒先心病的檢出也具有重要意義。3本研究認(rèn)為4CV+3VT+LVOT+RVOT(簡(jiǎn)稱C方案)作為臨床常規(guī)胎兒心臟篩查切面,稍有疑問(wèn)者,加用拓展切面(主動(dòng)脈弓/動(dòng)脈導(dǎo)管弓切面及上下腔靜脈切面)進(jìn)行補(bǔ)充檢查,同時(shí)結(jié)合彩色多普勒血流及頻譜的優(yōu)勢(shì),全面動(dòng)態(tài)觀察,有益于進(jìn)一步明確胎兒心臟結(jié)構(gòu)畸形的診斷。將有助于先心病的診斷。
[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.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R714.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張?chǎng)?劉凱波;徐宏燕;張璐;王t，

本文編號(hào)：1419707