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目的:探讨四腔心切面头侧偏斜法在基层医院筛查胎儿心脏畸形中的应用。方法:对2 688例孕20～32周的胎儿进行Ⅲ级产前超声检查时,检查心脏是采用四腔心切面头侧偏斜法,首先显示胎儿四腔心切面,然后顺序显示左室流出道切面、右室流出道切面、三血管-气管切面,对疑有心脏畸形送上级医院进行系统的胎儿超声心动图检查并且证实。结果:正常胎儿心脏检查时间(200±35)s,心脏畸形胎儿检查时间(23±10)min。2 688例胎儿筛查出的胎儿心脏畸形13例,检出率4.8‰,其中房室间隔缺损3例,法洛四联症1例,单心房1例,单心室1例,室间隔缺损2例,卵圆孔增宽1例,大动脉转为2例,永存动脉干1例,左心发育不良1例,误诊1例室间隔缺损,1例右室双出口误诊为大动脉转位,漏诊1例室间隔缺损,1例肺动脉狭窄。结论:四腔心切面头侧偏斜法可完成大部分的胎儿心脏畸形筛查,此方法简单、易学,时间短,可在基层医院推广。
Objective: To investigate the application of four-chamber corneal incision head-side skew method in screening fetal heart malformations in primary hospitals. Methods: A total of 2 688 pregnancies aged 20-32 weeks were examined with stage Ⅲ prenatal echocardiography. The heart was examined by four-chamber corneal incision. The fetal four-chamber coronal section was first displayed and then the left ventricular outflow was shown sequentially Road section, right ventricular outflow tract section, three vascular - tracheal section, the suspected cardiac malformations sent to the higher level hospital for fetal echocardiography and confirmed. Results: The time of normal fetal heart examination (200 ± 35) s, fetal heart malformation examination time (23 ± 10) min. Among the 2 688 fetuses, 13 cases of fetus heart deformity were detected, the detection rate was 4.8 ‰, including 3 cases of atrioventricular septal defect, 1 case of tetralogy of Fallot, 1 case of single atrium, 1 case of single heart, 2 cases of ventricular septal defect Cases, widened foramen ovale, 2 cases of aortic transposition, 1 case of persistent arterial trunk, 1 case of left ventricular dysplasia, 1 case of ventricular septal defect misdiagnosed, 1 case of right ventricular double outlet misdiagnosed as aortic transposition, 1 case of missed diagnosis Separation defect, 1 case of pulmonary stenosis. Conclusion: The four-chamber corneal incision head deflection method can be used to screen most of fetal heart malformations. This method is simple, easy to learn, short in time and can be promoted in primary hospitals.