谢燕华　孙　露四川省达州市中西医结合医院功能科，四川达州　635000

产前超声筛查胎儿先天性心脏病的临床意义及高危因素分析

谢燕华孙露
四川省达州市中西医结合医院功能科，四川达州635000

目的研究产前超声筛查胎儿先天性心脏病的临床意义及高危因素。 方法选取我院2013年1月～2016年1月收治的2035例孕妇为研究对象，对其进行超声筛查，并对其临床资料进行回顾性分析，采用单因素及Logistic回归多因素分析先天性心脏病相关因素。 结果产前超声筛查诊断为先天性心脏病20例，误诊2例，漏诊3例，应用产前超声筛查对先天性心脏病诊断敏感度、特异度、阳性预测值、阴性预测值、诊断准确率分别为85.7%（18/ 21）、99.9%（2012/2014）、90.0%（18/20）、99.9%（2012/2015）、99.8%（2030/2035）。经过单因素及多因素Logistic回归分析显示：流产史≥2次、妊娠期合并症、孕期被动吸烟、孕期使用抗生素、父母职业接触有害物质、纤维蛋白原＜3 g/L、24 h尿蛋白≥3 g/24 h是先天性心脏病的危险因素（P＜0.05）。结论超声筛查在诊断先天性心脏病方面具有一定临床价值，对于存在多次流产、妊娠期合并症、24 h尿蛋白偏高、纤维蛋白原偏低、胎位异常、胎膜早破等高危孕妇应该高度警惕，加强监护，做到早诊断早干预，以改善妊娠结局。

先天性心脏病；超声筛查；诊断价值；高危因素

[Abstract]Objective To study the c1inica1 significance and risk factors of prenata1 u1trasound screening for feta1 congenita1 heart disease.Methods A tota1 of 2035 cases of pregnant women in our hospita1 from January 2013 to January 2016 were se1ected as the research objects，which were examined by the u1trasound screening.The c1inica1 data were retrospective1y ana1yzed and factors associated with congenita1 heart disease were a1so ana1yzed by using a sing1e factor and Logistic mu1tivariate regression ana1ysis.Results 20 cases were diagnosed as congenita1 heart disease by prenata1 u1trasound screening，2 cases were misdiagnosed and 3 cases with missed diagnosis.By using prenata1 u1trasound screening in the diagnosis of congenita1 heart disease，the sensitivity，specificity，positive prediction va1ue and negative prediction va1ue and the accuracy rate of diagnosis were respective1y 85.7%（18/21），99.9%（2012/2014），90.0%（18/20），99.9%（2012/2015）and 99.8%（2030/2035）.The sing1e factor and mu1ti factor Logistic regression ana1ysis showed that the risk factors of congenita1 heart disease were the history of abortion≥2 times，pregnancy comp1ications，passive smoking during pregnancy，pregnancy using antibiotics，parents'occupation exposure to harmfu1 substances，fibrin origina1＜3 g/L and the urine protein≥3 g/24 h（P＜0.05）.Conclusion U1trasound screening in the diagnosis of congenita1 heart disease has certain c1inica1 va1ue for the existence of mu1tip1e miscarriages，pregnancy comp1ications，and the urine protein in 24 hours，1ow fibrinogen，abnorma1 feta1 position and premature rupture of feta1 membranes.The high risk pregnant women shou1d be high1y vigi1ant and the monitoring shou1d be strengthened，so ear1y diagnosis and ear1y intervention shou1d be carried out in order to improve the outcome of pregnancy.

[Key words]Congenita1 heart disease；U1trasound screening；Diagnostic va1ue；High risk factors

先天性心脏病是儿科常见的心血管疾病之一，也是造成孕妇流产或者儿童死亡的主要原因之一，给患者家庭造成极大痛苦及经济负担。研究表明［1-3］，及早发现、及早干预有助于降低其发生率，因此，如何早期发现，从其发病因素寻找干预措施是成为国内外医学界所热门关注的课题。……