彩色多普勒超声诊断小儿先天性心脏病的临床价值

程昭琦

摘 要 目的：分析彩色多普勒超声在诊断小儿先天性心脏病中的临床价值。方法：对4 614例小儿进行先天性心脏病超声筛查诊断，49例确诊为先天性心脏病并随访。结果：发病率1.1%。首次超声诊断的灵敏度69.4%、特异度99.9%。动脉导管未闭的超声阳性率最低50.0%，其他类型的先天性心脏病主要为复杂心脏病，阳性率最高达到100.0%。绝大多数的先天性心脏病获得随访，其中室间隔缺损及房间隔缺损超声自然转阴、好转率在60%以上，复杂心脏病超声自然转阴、好转率为0%，整体自然转阴、好转率57.1%。结论：彩色多普勒超声诊断小儿先天性心脏病效用尚可，误诊率较低，但诊断效率仍有待提高，漏诊率也较高，轻微间隔缺、房间隔缺损、动脉导管未闭是漏诊的主要原因，但绝大多数可自行闭合好转。

关键词 小儿先天性心脏病 彩色多普勒超声 诊断

中图分类号：R445.1； R725.4 文献标志码：A 文章编号：1006-1533（2019）01-0044-03

Clinical value of color Doppler ultrasonography in the diagnosis of children with congenital heart disease

CHENG Zhaoqi

（Department of Ultrasonography， the Peoples Hospital of Leping City， Jiangxi Leping 333300， China）

ABSTRACT Objective： To analyze the clinical value of color Doppler ultrasonography in the diagnosis of children with congenital heart disease. Methods： The congenital heart disease was diagnosed by ultrasonography screening in 4 614 children， in which 49 cases were diagnosed as congenital heart disease and followed up. Results： Its incidence was 1.1% and the sensitivity of the first ultrasonography diagnosis was 69.4% with the specificity of 99.9%. The ultrasonography positive rate was the lowest for patent ductus arteriosus （50.0 %） and the highest （100.0%） mainly for congenital heart disease. The majority of the subjects were followed up， in which the rates with the naturally turning negative and the improvement were over 60% for ventricular septal defect （VSD） and atrial septal defect （ASD） and zero for complex heart disease， and the rates with the whole naturally turning negative and the improvement were 57.1%. Conclusion： Color Doppler ultrasonography is effective in the diagnosis of children with congenital heart disease， and the misdiagnosis rate is low， however， the diagnostic efficiency still needs to be improved， and the missed diagnosis rate is remained to be reduced. The main causes of missed diagnosis are slight septal defect， atrial septal defect and patent ductus arteriosus.

KEy WORDS children with congenital heart disease； color Doppler ultrasonography； diagnosis

先天性心臟病简称先心病，是一种常见的解剖结构异常，发生率约为1%，近年来因心脏病学、心胸外科学、麻醉学等相关领域的发展，先心病的发生率明显下降，90%的先心病新生儿可以存活至成人，准确地评估小儿先心病非常必要[1]。传统的心血管造影是诊断先心病的“金标准”，但创伤性强、具有辐射性，患者及家属的接受率较低。超声诊断方便、安全、普及性好，现成为小儿先心病筛查、诊断的主要方法[2]。但超声诊断先心病的效用影响因素较多，对医师的经验、技术水平依赖性较强，总结诊断经验非常必要。……