本文選題：心臟超聲　切入點：胎兒　出處：《華北理工大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的探討心臟超聲在胎兒心臟的檢查以及胎兒、新生兒的先天性心臟病檢查和診治中的應用價值。方法時間上從2014年11月起直到2016年2月為止,在此期間在煤炭總醫(yī)院,選取在婦產(chǎn)科建立檔案并規(guī)律在本科進行產(chǎn)前檢查的身體健康的孕婦,并且胎兒行產(chǎn)前檢查無明顯異常,胎兒心臟行心臟超聲顯示大致正常者共176例,作為研究對象納入本研究。以孕周數(shù)作為分組依據(jù),共分為5組,分別為孕22周(n=50)、孕23周(n=50)、孕24周(n=50)、孕32周(n=17)、孕34周(n=9)。應用專業(yè)超聲心動圖儀器對胎兒心臟進行檢查,并對心臟結(jié)構及功能正常的胎兒心臟進行常規(guī)指標的測量及記錄,隨后對孕齡分別是22、23、24孕周數(shù)的正常胎兒的心臟各項測量指標進行專業(yè)的統(tǒng)計學分析,進而得到各測量指標的醫(yī)學參考值范圍。利用各個孕周數(shù)胎兒心臟各項指標的測量數(shù)值進行統(tǒng)計分析,從而比較相關指標間的差異,尋找內(nèi)在醫(yī)學規(guī)律。對研究期間煤炭總醫(yī)院胎兒(n=185)及新生兒(n=70)研究對象,經(jīng)心臟超聲確定存在先天性心臟病的病例進行收集整理,從而探討煤炭總醫(yī)院胎兒及新生兒的先天性心臟病的發(fā)病率及疾病特征、臨床應用價值等。對出生后24小時內(nèi)的新生兒行心臟超聲檢查,發(fā)現(xiàn)卵圓孔未閉的新生兒(n=13)進行定期隨訪,之后對閉合規(guī)律進行探討。結(jié)果1在課題研究期間,通過對符合條件的入組對象心臟超聲各常規(guī)指標進行測量及統(tǒng)計,得出了煤炭總醫(yī)院正常胎兒22、23、24孕周心臟超聲各指標的醫(yī)學參考值范圍。2胎兒的心臟在解剖學和功能學上顯示為右心占有優(yōu)勢,即與成人心臟的左心優(yōu)勢呈現(xiàn)相反的情況。在胎兒時期,人類心臟及大血管的各部位的內(nèi)徑測量值均隨著孕齡的增加而加大,在統(tǒng)計學上呈現(xiàn)線性相關。各孕周胎兒心臟超聲的Tei指數(shù)均在較恒定的范圍內(nèi)波動,不隨孕齡的變化而大幅度的改變,所以該指標是評價胎兒心臟功能的一個良好指標。3在病例收集期間,發(fā)現(xiàn)并確定了多例胎兒及新生兒先天性心臟病,這些典型病例包括了胎兒的完全型心內(nèi)膜墊缺損、完全型大動脈轉(zhuǎn)位合并房室間隔缺損及肺動脈瓣狹窄、法洛四聯(lián)征和新生兒的房、室間隔缺損等,并統(tǒng)計出了煤炭總醫(yī)院胎兒和新生兒先天性心臟病發(fā)病率約為0.4%,與目前國內(nèi)外統(tǒng)計出的公認的發(fā)病率相符。根據(jù)上述先心病病例分析并總結(jié)出本院先心病疾病譜有著自己的特征。還通過一個典型病例的診療經(jīng)過分析并確定了心臟超聲聯(lián)合嬰兒尸檢、基因檢測有著重要的應用價值。4出生后24小時內(nèi)存在卵圓孔未閉的新生兒在之后的1年內(nèi)是有閉合機會的,其中出生后7日內(nèi)閉合概率更大。即使1年內(nèi)未閉合也應繼續(xù)隨訪,不宜認定為房間隔缺損。結(jié)論1通過課題研究所得的正常胎兒心臟超聲心動圖指標的參考范圍可為煤炭總醫(yī)院胎兒心臟超聲檢查提供一定的參考依據(jù),尤其是在胎兒先天性心臟病的篩查過程中。2胎兒心臟有其自身的特殊性,其內(nèi)在的規(guī)律對檢查及臨床診治具有較高的指導意義。3目前,根據(jù)發(fā)病率的統(tǒng)計結(jié)果約為0.4%,認為煤炭總醫(yī)院胎兒及新生兒的先天性心臟病的發(fā)病率與國內(nèi)總體水平相似,也處于較高水平,并且疾病譜有其自身的特點。4出生后卵圓孔未閉應加強隨訪,以減少家庭及社會負擔。
[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.

【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R714.5;R722.1

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