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目的探讨系统产前超声(Ⅲ级)在中期筛查胎儿先天性心脏疾病的应用价值。方法选择2 540例接受产前检查的产妇进行超声检查和系统产前超声检查判断先天性心脏疾病,分娩后通过尸检或超声心动图确认先天性心脏疾病。结果经超声心动图或尸检确诊为先天性心脏疾病的患儿83例。系统产前超声检出79例,误诊1例、漏诊3例;常规产前超声检出51例,漏诊12例、误诊20例;常规产前超声灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为61.45%、99.59%、98.35%、83.61%、98.71%,系统产前超声分别为95.18%、99.92%、99.76%、97.53%、99.84%,系统产前超声灵敏度、阳性预测值均明显高于常规产前超声(P<0.05)。系统产前超声对大动脉转位、法洛四联症、主动脉病变、肺动脉瓣病变、室间隔缺损的误诊和漏诊率低于常规产前超声,二尖瓣病变、三尖瓣病变、房间隔缺损的误诊和漏诊率与常规产前超声差异无统计学意义(P>0.05)。结论系统产前超声(Ⅲ级)检查能够更为有效的筛查先天性心脏疾病,尤其对大动脉转位、法洛四联症、主动脉病变、肺动脉瓣病变、室间隔缺损的筛查具有重要价值。
Objective To investigate the value of system prenatal ultrasound (Ⅲ) in the screening of fetal congenital heart disease in the medium term. Methods: A total of 2540 pregnant women undergoing prenatal examinations were selected for ultrasound examination and prenatal ultrasound to determine congenital heart disease. Congenital heart disease was confirmed by autopsy or echocardiography after delivery. Results 83 cases of congenital heart disease diagnosed by echocardiography or autopsy. Prenatal ultrasound system detected 79 cases, 1 case of misdiagnosis, missed diagnosis in 3 cases; routine prenatal ultrasound in 51 cases, missed diagnosis in 12 cases, misdiagnosed 20 cases; routine prenatal ultrasound sensitivity, specificity, accuracy, positive predictive value, The negative predictive values were 61.45%, 99.59%, 98.35%, 83.61% and 98.71% respectively. The prenatal ultrasound was 95.18%, 99.92%, 99.76%, 97.53% and 99.84% respectively. The prenatal ultrasound sensitivity, positive predictive value Were significantly higher than the conventional prenatal ultrasound (P <0.05). Systemic prenatal ultrasound transposition, tetralogy of Fallot, aortic lesions, pulmonary valve disease, ventricular septal defect misdiagnosis and missed diagnosis rate of prenatal ultrasound, mitral valve disease, tricuspid valve disease, atrial septal Misdiagnosis and missed diagnosis of defects and conventional prenatal ultrasound was no significant difference (P> 0.05). Conclusion The system of prenatal ultrasound (Ⅲ grade) examination can more effectively screen congenital heart disease, especially for aortic transposition, tetralogy of Fallot, aortic lesions, pulmonary valve disease, ventricular septal defect screening is important value.