心脏轴测定在胎儿先天性心脏病产前超声诊断中的临床意义

苏力其夫　曹爱红　马金虎

[摘要] 目的 探討心脏轴测定在胎儿先天性心脏病产前超声诊断中的临床意义。方法 方便选择于该院2016年10月—2017年9月进行产前检查的200例产妇作为研究对象，分为A组（正常胎儿组）和B组（先天性心脏病组），A组180例孕妇，B组20例孕妇。A组在心脏超声四腔观的基础上进行心脏轴测定，从多个切面观察胎儿的心内结构，以此诊断胎儿是否有先天性心脏病。观察两组胎儿的心轴角度、心轴位置。 结果 A组胎儿心轴角度为21.85～61.82°，平均心轴角度（41.84±5.69）°；B组胎儿心轴角度为15.50～92.01°，平均心轴角度（53.76±15.88）°组间数据对比差异有统计学意义（χ2=18.579，P<0.05）。A组1例（0.56%）胎儿发生心轴左偏，未发生心轴右偏；B组7例（35.00%）胎儿发生心轴左偏，心轴右偏3例（15.00%），其他胎儿处于正常范围内。A组胎儿心轴左偏、心轴右偏发生概率明显低于B组胎儿，组间数据对比差异有统计学意义（χ2=5.684，P<0.05）。结论 心脏轴测定应用于胎儿先天性心脏病产前超声诊断中临床作用显著，可全面探查胎儿心脏结构，可作为常规测量指标使用。

[关键词] 心脏轴测定；胎儿先天性心脏病；产前超声诊断

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）03（c）-0168-03

Clinical Significance of Cardiac Axis Determination in the Prenatal Ultrasound Diagnosis of Congenital Heart Disease

SULI Qi-fu， CAO Ai-hong， MA Jin-hu

Color Ultrasound Room， Imaging Center， Xuzhou Mining Group General Hospital， Xuzhou， Jiangsu Province， 221000 China [Abstract] Objective To study the clinical significance of cardiac axis determination in the prenatal ultrasound diagnosis of congenital heart disease. Methods 200 cases of delivery women for prenatal ultrasound examination in our hospital from October 2016 to September 2017 were convenient selected as the research objects and divided into two groups， the group A were the normal fetus group， while the group B were the congenital heart disease group， respectively 180 cases and 20 cases， and the group A used the cardiac axis determination on the basis of the echocardiography 4-chamber view， and the internal cardiac structure of fetuses was observed from multiple aspects， to diagnose whether the fetuses were with congenital heart disease， and the cardiac axis angle and site of fetuses of the two groups were observed. Results The cardiac axis angle in the group A was 21.85～61.82°，（41.84±5.69）° on average， and the cardiac axis angle in the group B was 15.50～92.01°， （53.76±15.88）° on average， and the difference was statistically significant（χ2=18.579，P<0.05）， in the group A， 1 case （0.56%） had left axis deviation， and 0 had right axis deviation， in the group B， 7 cases （35.00%） had the left axis deviation， and 3 cases had right axis deviation （15.00%）， and other fetuses were in the normal range， and the probability of left axis deviation and right axis deviation in the group A was obviously lower than that in the group B， and the difference was statistically significanct（χ2=5.684，P<0.05）. Conclusion The application effect of cardiac axis determination in the prenatal ultrasound diagnosis of congenital heart disease is obvious， which can comprehensively explore the cardiac structure of fetuses， which can be used a routine measurement indicator.

[Key words] Cardiac axis determination； Congenital heart disease； Prenatal ultrasound diagnosis

先天性心脏病是小儿常见的先天性疾病，在活产婴儿中的发病概率为4%～13%。该病症的发病机制为胎儿处于胎儿期时心脏以及大血管发育畸形，畸形血管导致胎儿循环系统无法正常运行，严重威胁着胎儿的生命安全[1]。伴随医疗技术的发展与进步，手术治疗先天性心脏病获得了良好的发展，但是效果较低。产前诊断对于防治先天性心脏病具有重要意义。产前超声的诊断有效提高了胎儿先天性心脏病的诊断率。但是超声诊断胎儿心脏结构受到胎龄、羊水量、胎位、母体腹部厚度的影响[2]。心脏轴测定的诊断因其便捷、简单在临床得到了广泛应用，同时也因其良好的诊断效果得到了产妇的认可。该文方便选取于该院2016年10月—2017年9月进行产前检查的200例产妇作为研究对象，探讨心脏轴测定在胎儿先天性心脏病产前超声诊断中的临床意义，现报道如下。……