多学科会诊387例胎儿先天性心脏病的临床结局分析

doi:10.12280/gjfckx.20210648

摘要/Abstract

摘要：

目的：探讨多学科会诊管理模式下胎儿先天性心脏病（congenital heart disease,CHD）的临床处理及经验。方法：选取2017年1月—2020年1月在河南省人民医院行胎儿超声心动图提示胎儿CHD后进行多学科会诊及遗传学检查的单胎妊娠孕妇共387例,对胎儿CHD的分类及处理进行回顾性分析。结果：常见的CHD有永存左上腔静脉、主动脉缩窄、室间隔缺损、大动脉转位、心内膜垫缺损和法洛四联症等。根据超声心动图检查、CHD的复杂性和是否伴发心外异常分为3组：单一CHD组132例,多发CHD组159例,合并心外异常CHD组96例。遗传学检查发现57例染色体异常者均引产,最终孕妇及家属选择终止妊娠270例（69.8%）;继续妊娠的117例（30.2%）孕妇失访8例,余109例获得随访。随访者中,2例行宫内治疗;3例胎死宫内;8例出生后夭折;43例出生后行手术治疗,其中5例术后死亡,38例预后良好;余53例仍在随访观察中,一般情况良好。结论：产前多学科会诊有助于胎儿CHD的管理,简化就诊流程,为孕妇提供更合理的处理意见、避免盲目引产或继续妊娠,并指导出生后的随访及治疗,改善保留胎儿的预后。

关键词: 超声检查,产前, 心脏缺损,先天性, 妊娠结局, 随访研究, 多学科会诊

Abstract:

Objective：To explore the clinical management and experience of fetal congenital heart disease (CHD) under multidisciplinary consultation management mode. Methods：A total of 387 singleton pregnant women were selected from Henan Provincial People′s Hospital from January 2017 to January 2020, who underwent multi-disciplinary consultation and genetic examination after echocardiography of fetal CHD, the classification and management of fetal CHD were analyzed retrospectively. Results：The common CHD includes permanent left superior vena cava, aortic coarctation, ventricular septal defect, transposition of the great artery, endocardial pad defect, tetralogy of Fallot, etc. According to the echocardiography, the complexity of CHD and the presence or absence of extracardiac abnormalities, the fetuses with CHD were divided into three groups: single CHD group (132 cases), multiple CHD group (159 cases), and combined extracardiac CHD group (96 cases), Genetic examination found that 57 cases of chromosome abnormality were induced labor. Finally, 270 cases (69.8%) pregnant women and their family members chose to terminate pregnancy, 117 cases (30.2%) continued pregnancy, of which 8 cases were lost to follow-up, and the remaining 109 cases were followed up. Among the follow-up group, 2 cases received intrauterine treatment, 3 cases died intrauterine, 8 cases died after birth, 43 cases received surgical treatment after birth, of which 5 cases died after operation, 38 cases had good prognosis, and the remaining 53 cases of CHD were generally in good condition during follow-up observation. Conclusions：Prenatal multidisciplinary consultation is helpful to the management of fetal CHD, simplify the procedure of prenatal consultation, provide more reasonable treatment advice for pregnant women, avoid blind induction of labor or continued pregnancy, guide the follow-up and treatment after birth, and improve the prognosis of retained fetus.

Key words: Ultrasonography,prenatal, Heart defects,congenital, Pregnancy outcome, Follow-up studies, Multidisciplinary consultation

焦晓杰, 刘侃, 王秋明, 宋婉玉, 张敬丽, 李林源, 万平, 武海英. 多学科会诊387例胎儿先天性心脏病的临床结局分析[J]. 国际妇产科学杂志, 2022, 49(1): 101-105.

JIAO Xiao-jie, LIU Kan, WANG Qiu-ming, SONG Wan-yu, ZHANG Jing-li, LI Lin-yuan, WAN Ping, WU Hai-ying. Analysis of Clinical Outcome of Multidisciplinary Consultation in 387 Cases of Fetal Congenital Heart Disease[J]. Journal of International Obstetrics and Gynecology, 2022, 49(1): 101-105.

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CHD分类	例（构成比）	CHD分类	例（构成比）
永存左上腔静脉	24（6.2%）	交叉肺动脉	9（2.3%）
法洛四联症	18（4.7%）	主动脉弓离断	8（2.1%）
主动脉缩窄	12（3.1%）	肺动脉瓣狭窄	8（2.1%）
室间隔缺损	12（3.1%）	肺动脉闭锁	4（1.0%）
大动脉转位	12（3.1%）	房间隔缺损	2（0.5%）
心内膜垫缺损	12（3.1%）	心包畸胎瘤	1（0.3%）
完全性肺静脉异位引流	9（2.3%）	阵发性室上性心动过速	1（0.3%）

CHD分类	例（构成比）	CHD分类	例（构成比）
永存左上腔静脉	24（6.2%）	交叉肺动脉	9（2.3%）
法洛四联症	18（4.7%）	主动脉弓离断	8（2.1%）
主动脉缩窄	12（3.1%）	肺动脉瓣狭窄	8（2.1%）
室间隔缺损	12（3.1%）	肺动脉闭锁	4（1.0%）
大动脉转位	12（3.1%）	房间隔缺损	2（0.5%）
心内膜垫缺损	12（3.1%）	心包畸胎瘤	1（0.3%）
完全性肺静脉异位引流	9（2.3%）	阵发性室上性心动过速	1（0.3%）

CHD分类	例（构成比）	CHD分类	例（构成比）
脉络丛囊肿	15（3.9%）	胸腺缺如或发育不良	6（1.6%）
侧脑室增宽	13（3.4%）	内脏反位	6（1.6%）
腹腔或胸腔积液	12（3.1%）	胼胝体发育不良	6（1.6%）
四肢或脊柱异常	12（3.1%）	肾脏发育不良	4（1.0%）
胎儿生长受限	9（2.3%）	脐膨出	3（0.8%）
肾盂分离	8（2.1%）	水平肝	2（0.5%）

CHD分类	例（构成比）	CHD分类	例（构成比）
脉络丛囊肿	15（3.9%）	胸腺缺如或发育不良	6（1.6%）
侧脑室增宽	13（3.4%）	内脏反位	6（1.6%）
腹腔或胸腔积液	12（3.1%）	胼胝体发育不良	6（1.6%）
四肢或脊柱异常	12（3.1%）	肾脏发育不良	4（1.0%）
胎儿生长受限	9（2.3%）	脐膨出	3（0.8%）
肾盂分离	8（2.1%）	水平肝	2（0.5%）

组别	n	年龄（岁）	诊断孕周（周）	遗传检查结果异常	终止妊娠率
单一CHD组	132	30.00±4.44	25.07±3.17	11（8.3）*	91（68.9）
多发CHD组	159	30.04±3.96	26.43±4.27	19（11.9）*	111（69.8）
合并心外异常CHD组	96	32.16±5.24	27.16±3.85	27（28.1）	68（70.8）
F或χ²		2.751	3.021	18.994	0.095
P		0.068	0.052	0.000	0.954