本文選題：胎兒畸形　切入點(diǎn)：超聲軟指標(biāo)　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的分析3 000例妊娠婦女(單胎)系統(tǒng)產(chǎn)前超聲篩查胎兒結(jié)構(gòu)畸形及超聲軟指標(biāo)的靈敏度、特異度,分析超聲軟指標(biāo)與胎兒結(jié)構(gòu)畸形的相關(guān)性。加強(qiáng)規(guī)范性系統(tǒng)產(chǎn)前超聲篩查質(zhì)量控制,規(guī)范應(yīng)用超聲軟指標(biāo),提高對(duì)系統(tǒng)產(chǎn)前超聲篩查及超聲軟指標(biāo)的臨床正確認(rèn)識(shí)。方法選取2013年7月1日至2014年12月31日來(lái)天津市塘沽婦產(chǎn)醫(yī)院進(jìn)行孕中期系統(tǒng)產(chǎn)前超聲篩查的3 000例妊娠婦女(單胎),收集妊娠婦女臨床資料,與擬進(jìn)行系統(tǒng)產(chǎn)前超聲篩查的妊娠婦女簽署知情同意書(shū)。按規(guī)范要求進(jìn)行系統(tǒng)產(chǎn)前超聲篩查,存儲(chǔ)標(biāo)準(zhǔn)切面及異常切面圖像并測(cè)量所需數(shù)據(jù),出具報(bào)告。所有相關(guān)圖像及數(shù)據(jù)均保存三年以上。對(duì)所有病例進(jìn)行妊娠結(jié)局追蹤及隨訪(fǎng)至產(chǎn)后6個(gè)月。應(yīng)用靈敏度、特異度分析系統(tǒng)產(chǎn)前超聲篩查及超聲軟指標(biāo)臨床意義。所有資料均采用SPSS17.0軟件進(jìn)行X~2檢驗(yàn)分析數(shù)據(jù),期望值1用確切概率法;1≤期望值5用連續(xù)校正法,均以P0.05表示差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果3 000例妊娠婦女(單胎)通過(guò)產(chǎn)后隨訪(fǎng)證實(shí)胎兒結(jié)構(gòu)畸形50例,胎兒結(jié)構(gòu)畸形發(fā)生率為1.67%(50/3 000)。胎兒結(jié)構(gòu)畸形50例中有42例通過(guò)系統(tǒng)產(chǎn)前超聲篩查確定,并經(jīng)新生兒手術(shù)或引產(chǎn)胎兒組織病理學(xué)證實(shí)。系統(tǒng)產(chǎn)前超聲篩查胎兒結(jié)構(gòu)畸形靈敏度為84%(42/50),特異度為100%(2950/2950)。假陰性8例均為胎兒?jiǎn)伟l(fā)畸形且無(wú)致死性畸形,分別為單純性室間隔缺損2例、肺動(dòng)脈瓣狹窄1例、肛門(mén)閉鎖1例、單純腭裂1例、多指2例和并指1例。3 000例妊娠婦女(單胎)通過(guò)系統(tǒng)產(chǎn)前超聲篩查共檢出超聲軟指標(biāo)胎兒425例,其中證實(shí)胎兒結(jié)構(gòu)畸形30例,超聲軟指標(biāo)發(fā)生率14.16%(425/3000),靈敏度60%(30/50),特異度86.6%(2555/2950),其中心內(nèi)點(diǎn)狀強(qiáng)回聲特異度最低93.9%(2771/2950),脈絡(luò)叢囊腫靈敏度最低4%(2/50)。具有≥2個(gè)超聲軟指標(biāo)的胎兒比單個(gè)超聲軟指標(biāo)胎兒發(fā)生結(jié)構(gòu)畸形相關(guān)性高。胎兒頸部皮膚增厚、鼻骨發(fā)育異常、心內(nèi)點(diǎn)狀強(qiáng)回聲、側(cè)腦室增寬、腎盂擴(kuò)張、腸管回聲增強(qiáng)、單臍動(dòng)脈均與胎兒結(jié)構(gòu)畸形有相關(guān)性,脈絡(luò)叢囊腫與胎兒結(jié)構(gòu)畸形無(wú)相關(guān)性。結(jié)論1.規(guī)范性系統(tǒng)產(chǎn)前超聲篩查能夠有效的篩查出胎兒結(jié)構(gòu)畸形,避免嚴(yán)重致死、致畸結(jié)構(gòu)異常兒出生,客觀評(píng)價(jià)系統(tǒng)產(chǎn)前超聲篩查是非常必要的。2.超聲軟指標(biāo)與胎兒結(jié)構(gòu)畸形有一定的相關(guān)性,具有多個(gè)超聲軟指標(biāo)胎兒結(jié)構(gòu)畸形明顯高于單一超聲軟指標(biāo)。加強(qiáng)對(duì)超聲軟指標(biāo)的正確認(rèn)識(shí),合理應(yīng)用超聲軟指標(biāo),能夠提高胎兒結(jié)構(gòu)畸形檢出率。3.加強(qiáng)系統(tǒng)產(chǎn)前超聲篩查質(zhì)量控制,規(guī)范系統(tǒng)產(chǎn)前超聲篩查,既能最大程度篩查胎兒結(jié)構(gòu)畸形同時(shí)也可規(guī)避醫(yī)療風(fēng)險(xiǎn)。
[Abstract]:Objective to analyze the sensitivity and specificity of prenatal ultrasound screening in 3 000 pregnant women (single fetus) for fetal structural abnormalities and soft indexes of ultrasound. To analyze the correlation between ultrasonic soft index and fetal structural malformation, to strengthen the quality control of prenatal ultrasound screening in standard system, and to standardize the application of ultrasonic soft index. Methods from July 1st 2013 to December 31st 2014, 3 000 cases of pregnancy were selected from Tianjin Tanggu Obstetrics and Gynaecology Hospital for systematic prenatal ultrasound screening. Pregnant women (single pregnancy, collect clinical data of pregnant women, Sign an informed consent form with a pregnant woman who intends to undergo systematic prenatal ultrasound screening. Perform systematic prenatal ultrasound screening in accordance with the specifications, store standard section and abnormal section images, and measure the required data. All relevant images and data were kept for more than three years. Pregnancy outcome was tracked and followed up to 6 months after delivery. Sensitivity was applied. The clinical significance of prenatal ultrasound screening and ultrasonic soft index in specificity analysis system. All the data were analyzed by X2 test using SPSS17.0 software, and the expected value 1 was determined by the exact probability method and 1 鈮，

本文編號(hào)：1585096