遇建东

【摘要】 目的：探討产前二维联合四维超声用于产前胎儿畸形筛查中的临床价值。方法：回顾性分析2018年6月-2019年6月于本院进行产前检查的3 000例孕妇的临床资料，均行产前二维和四维超声检查，并以引产或分娩结果为金标准，分析二维超声联合四维超声、单纯二维超声对胎儿各类畸形的检出率、对不同孕期胎儿畸形的检出率。结果：引产或分娩结果显示胎儿畸形率为4.57%（137/3 000）。137例阳性病例中，二维超声联合四维超声对胎儿畸形检出符合率为91.24%高于单纯二维超声的67.15%（P<0.05）;二维超声联合四维超声对孕早期、孕中期胎儿畸形检出符合率为18.98%、62.77%，高于单纯二维超声的9.49%、50.36%（P<0.05），二维超声联合四维超声对孕晚期胎儿畸形检出符合率（9.49%）与单纯二维超声（7.30%）比较，差异无统计学意义（P>0.05）;二维超声联合四维超声诊断胎儿畸形的灵敏度、特异度、诊断准确率分别为91.24%、99.55%、99.17%，高于单纯二维超声的67.15%、98.25%、96.83%（P<0.05）。结论：产前二维联合四维超声能够提高胎儿畸形检出率，并提高对孕早期、孕中期胎儿畸形检出率，在产前胎儿畸形筛查中具有较高的应用价值。

【关键词】 产前 二维超声 四维超声 胎儿畸形 筛查

Application Value of Prenatal Two-dimensional Combined with Four-dimensional Ultrasound in Fetal Malformation Screening/YU Jiandong. //Medical Innovation of China， 2021， 18（13）： -138

[Abstract] Objective： To investigate the clinical value of prenatal two-dimensional combined with four-dimensional ultrasound in prenatal fetal malformation screening. Method： The clinical data of 3 000 pregnant women underwent prenatal examination in our hospital from June 2018 to June 2019 were retrospectively analyzed， all of them underwent prenatal two-dimensional and four-dimensional ultrasound examination， and the detection rate of various fetal malformations and fetal malformations in different gestational periods by two-dimensional ultrasound combined with four-dimensional ultrasound， two-dimensional ultrasound alone were analyzed with the results of induced labor or delivery as the gold standard. Result： Results of induced labor or delivery showed that the rate of fetal malformation was 4.57% （137/3 000）. In 137 positive cases， the detection coincidence rate of fetal malformation by two-dimensional ultrasound combined with four-dimensional ultrasound was 91.24% higher than 67.15% by two-dimensional ultrasound alone （P<0.05）. The detection coincidence rates of fetal malformations in the first and second trimester were 18.98% and 62.77%， which were higher than those of 9.49% and 50.36% by two-dimensional ultrasound alone （P<0.05）. There was no significant difference between two-dimensional ultrasound combined with four-dimensional ultrasound in the detection coincidence rate of fetal malformation in the late trimester （9.49%） and two-dimensional ultrasound alone （7.30%） （P>0.05）. The sensitivity， specificity and accuracy of two-dimensional ultrasound combined with four-dimensional ultrasound in the diagnosis of fetal malformation were 91.24%， 99.55% and 99.17%， respectively， which were higher than 67.15%， 98.25% and 96.83% of two-dimensional ultrasound alone （P<0.05）. Conclusion： Prenatal two-dimensional ultrasound combined with four-dimensional ultrasound can improve the detection rate of fetal malformations， and improve the detection rate of fetal malformations in the first and second trimesters of pregnancy， which has a high application value in prenatal fetal malformation screening.

[Key words] Prenatal Two-dimensional ultrasound Four-dimensional ultrasound Fetal malformation Screening

First-authors address： Jiamusi Maternal and Child Health Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.13.033

胎儿畸形与遗传、环境、生物因素等密切相关，近年来随着环境污染加剧、生育年龄推迟，胎儿畸形不断增多[1-3]。胎儿畸形可增加胎儿宫内死亡风险，并给孕妇及其家庭造成巨大负担[4-5]。孕期进行胎儿畸形筛查有助于早发现、早治疗，减少出生缺陷，实现优生优育[6]。二维超声能够提供胎儿的断面、平面图像;四维超声能够提供立体化、动态化的图像，为胎儿生长状况提供清晰的图像[7-8]。本研究以孕妇最终引产和分娩结果为金标准，分析产前二维及二维联合四维超声在胎儿畸形筛查中的应用效果，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2018年6月-2019年6月于本院进行产前检查的3 000例孕妇的临床资料。纳入标准：（1）单活胎妊娠;（2）健康孕妇;（3）资料完整。……