县、乡级超声医生开展胎儿期复杂先天性心脏病超声筛查的可行性研究

摘要/Abstract

摘要： 目的：探讨我国县、乡（社区）级超声医生经过培训是否可以承担胎儿复杂先天性心脏病的筛查任务。方法：在苏州市、常熟市、嘉兴市和海宁市4个地区，共选择1个县级市医院（常熟）以及13个乡镇卫生院（或社区医院）参加胎儿B超筛查任务，选择4家市（县）级医院参加胎儿超声心动图检查任务，对超声医生进行集中培训和6个月的独立练习，考核合格后正式开始筛查任务。要求对每例胎儿心脏进行胎儿B超筛查、胎儿超声心动图检查和新生儿超声心动图检查，以最终专家诊断的新生儿或胎儿超声心动图检查结果为金标准，计算当地医疗机构胎儿期先天性心脏病筛查的灵敏度和特异度，以此评价该项目的可行性。结果：2004年4月1日至2005年12月31日共筛查3 425例胎儿。B超筛查的图像有165例由于采集质量不合格而不能给出诊断结果，不合格图像全部来自乡级，占4.9%。胎儿超声心动图检查的图像有56例不合格不能给出诊断结果，仅占全部图像的1.7%。乡级、县级的筛查灵敏度分别为30%和0，筛查特异度分别为99.3%和99.9%。胎儿超声心动图诊断11例复杂先天性心脏病，经专家最终确认9例诊断正确，2例判断错误，另外漏诊2例。胎儿超声心动图筛查总的灵敏度和特异度分别为81.8%和99.9%；县级和市级的筛查灵敏度分别为66.7%和100%，筛查特异度分别为99.9%和100%。结论：县、乡超声人员经系统培训后基本能掌握复杂先天性心脏病的两级筛查技术，但在我国现有条件下，由于受到仪器设备及医生水平的限制，乡级卫生院暂时不具备开展胎儿心脏筛查工作的条件，建议在县、市级医疗机构开展胎儿复杂先天性心脏病筛查工作。

关键词: 产前诊断, 心脏缺损, 先天性, 超声检查, 产前, 超声心动描记术, 培训

Abstract: Objective：To explore the feasibility of screening for major fetal heart disease by training sonographers in township or county level hospitals. Methods: Training of B ultrasound scan for congenital heart defects was given to the sonographers from one county hospital, and thirteen township hospitals (or the district hospitals), and training of fetal echocardiography was given to sonographers from four city/county hospitals. The trained sonographers who had passed the examinations and had obtained qualifications after six months of independent practice began to screen fetal congenital heart defects. To evaluate the effectiveness, sensitivity and specificity of screening was calculated by using the diagnosis of expert neonatal/fetal echocardiographers as the gold standard. Results: A total of 3 425 fetuses received one fetal B ultrasound screening, one fetal echocardiography and one neonatal echocardiography from April 1, 2004 to December 31, 2005. One hundred and sixtyfive B ultrasound screening images (4.9%) from township hospitals and fifty-six fetal echocardiography images (1.7%) from county or city centers couldn’t be reviewed because of poor quality. The sensitivity of fetal B ultrasound screening in the township and county hospitals was 30% and 0, and the specificity 93.3% and 99.9%, respectively. Nine fetuses with a major congenital heart disease were eventually found by the trained sonographers, and two cases were misdiagnosed and two unnoticed. The total sensitivity and specificity of fetal echocardiography were 81.8% and 99.9%, respectively. The sensitivity in the county and city hospitals was 66.7% and 100%, respectively. The specificity in the county and city hospitals was 99.9% and 100%, respectively. Conclusion: Under the current circumstances, township hospitals are unable to perform effective fetal cardiac screening. Screening on fetal congenital heart disease is suggested to be taken by trained sonographers in county and city level medical centers.

Key words: Prenatal diagnosis, Heart defects, congenital, Ultrasonography, prenatal, Echocardiography, Training

张乐, 孙美平, 高卫线, 洪世欣, 张亚黎. 县、乡级超声医生开展胎儿期复杂先天性心脏病超声筛查的可行性研究[J]. 北京大学学报（医学版）, 2014, 46(3): 373-378.

ZHANG Le, SUN Mei-Ping, GAO Wei-Xian, HONG Shi-Xin, ZHANG Ya-Li. Prenatal screening for major fetal heart defects by training sonographers in township hospitals and county health centers: a feasibility study[J]. Journal of Peking University(Health Sciences), 2014, 46(3): 373-378.

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