超声心动图联合心电图对妊娠中期心脏畸形胎儿的诊断价值

摘要 目的：探讨超声心动图联合心电图对妊娠中期心脏畸形胎儿的诊断价值。方法：回顾性分析我院2019年1月到2021年1月出生后确诊与尸检确诊为心脏畸形的80例胎儿的临床相关指标，分析80例胎儿超声心动图检查与胎儿心电图检查结果，并分析超声心动图联合心电图对妊娠中期心脏畸形胎儿的诊断价值。结果：80例胎儿有56例出现不同程度的心电图异常现象，其中胎心早搏3例、FQRS振幅增高12例、ST段改变15例、FQRS时限增宽3例、胎心不齐4例、胎心过缓3例、胎心过速16例；80例胎儿通过尸检和出生后随访最终确定左心发育不良综合征（HLHS）4例，单心室6例，完全性心内膜垫缺损（ECD）8例，法洛四联症（TOF）14例，卵圆孔直径大于 6 mm 17例，室间隔缺损（VSD）31例，与超声心动图诊断结果对比无显著差异（P＞0.05），超声心动图有7例漏诊；联合诊断与超声心动图和心电图对左心发育不良综合征、单心室、完全性心内膜垫缺损胎儿的诊断对比无明显差异（P＞0.05），对法洛四联症、卵圆孔直径大于 6 mm、室间隔缺损和心脏畸形诊断总数方面联合诊断优于超声心动图和心电图单一诊断（P＜0.05）；通过不同检查的检测价值对比发现，超声心动图联合心电图检查的准确度、敏感度、特异度、阳性预测值和阴性预测值明显高于超声心动图与心电图单一检查。结论：超声心动图和心电图对于妊娠中期心脏畸形胎儿的诊断均具有重要价值。心脏畸形胎儿在妊娠中期进行心电图检查会出现异常现象，但是并不能确诊为心脏畸形，还需后续继续应用超声心动图进行检查，最终确诊胎儿是否存在心脏畸形现象。

Diagnostic Value of Echocardiography Combined with Electrocardiography for Fetal Heart Malformation in the Second Trimester of Pregnancy

ABSTRACT Objective: To explore the diagnostic value of echocardiography combined with electrocardiogram in the second trimester of pregnancy. Methods: The clinical related indicators of 80 foeti, who were diagnosed as heart malformation after birth and autopsy in the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2019 to January 2021, were retrospectively analysed. The echocardiography and fetal ECG examination results of 80 foeti were analysed, and the value of echocardiography combined with ECG in the diagnosis of fetal heart malformation in the second trimester of pregnancy was analysed. Results: In the 80 feti, there were 56 cases of ECG abnormalities of varying degrees, including 3 cases of premature fetal heart beats, 12 cases of increased FQRS amplitude, 15 cases of ST segment changes, 3 cases of FQRS time limit widening, 4 cases of fetal heartbeat, 4 cases of fetal heartbeat 3 cases of fetal bradycardia, and 16 cases of fetal tachycardia. In the 80 feti, through autopsy and post-natal follow-up, there were 4 cases of left heart dysplasia syndrome (HLHS), 6 cases of single atrium, 8 cases of complete endocardial cushion defect (ECD), and 14 cases of tetralogy of Fallot (TOF), 17 cases of the diameter of the foramen ovale being greater than 6 mm, and 31 cases of ventricular septal defect(VSD). There was no significant difference compared with the diagnosis result of echocardiography(P>0.05). There were 7 cases of missed diagnosis in echocardiography. There was no significant difference between combined diagnosis and echocardiography and electrocardiogram in the diagnosis of left heart dysplasia syndrome, single ventricle, and total endocardial cushion defect in feti (P>0.05). For tetralogy of Fallot, greater than 6 mm of diameter of foramen ovale, ventricular septal defect, and cardiac malformation,the combined diagnosis is superior to the single diagnosis of echocardiography and electrocardiography (P<0.05). Through the comparison of the detection value of different examinations, it was found that the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of echocardiography combined with ECG were significantly higher than that of echocardiography and ECG alone. Conclusion: Echocardiography and electrocardiography are of great value in the diagnosis of fetal heart malformations in the second trimester of pregnancy. For cardiac malformation fetus in the second trimester of pregnancy, ECG examination shows abnormal phenomenon, but can not be diagnosed as cardiac malformation, still needs further to use echocardiography to diagnose whether or not there is fetal cardiac malformation in the second trimester of pregnancy.