CAJ | 학술논문

目的探讨多学科合作下的胎儿心脏病产前诊断与咨询一体化新模式以及“胎儿心脏病的分级量表”在先天性心脏病产前管理中的应用价值. 方法制订“胎儿心脏病的分级量表”及胎儿心脏病产前诊断与咨询一体化的新型服务模式,即由包括产科超声医师、胎儿医学专科医师、小儿心内科医师以及遗传学专家在内的围产医学团队,根据产前胎儿超声心动图检查结果,以及“胎儿心脏病的分级量表”分级结果,向孕妇家庭提供详尽的围产期咨询.2011年1月1日至2012年12月31日,对在同济大学附属第一妇婴保健院胎儿医学部接受胎儿超声心动图检查的孕妇提供该新型服务模式.分析该模式在先天性心脏病产前管理中的作用,不同心脏病分级组间引产率的差异比较采用Fisher精确概率法. 结果 “胎儿心脏病的分级量表”将胎儿心脏病分为4级:Ⅰ级指轻微心脏病,基本无需治疗;Ⅱ级指简单心脏病,出生后需要治疗,但生活质量与正常人无异;Ⅲ级指治疗效果良好的复杂性心脏病;Ⅳ级指严重复杂性心脏病.产前超声心动图共确诊胎儿有心脏病的孕妇54例,平均年龄(29±3)岁,平均孕周(28.0±3.8)周.共引产27例,胎儿心脏病Ⅳ级的孕妇引产率为17/19,明显高于Ⅰ～Ⅲ级者(分别为3/15、3/10和4/10),差异均有统计学意义(Fisher精确概率法,P均＜0.01).19例Ⅳ级病例中,共17例选择终止妊娠,另2例选择继续妊娠至分娩,原因均为双胎妊娠但另一胎儿正常.7例合并心外结构异常、染色体异常或遗传综合征的病例均选择引产终止妊娠. 结论在临床实践中构建多学科合作下的胎儿心脏病产前诊断与咨询一体化的新模式,推行“胎儿心脏病的分级量表”,有助于为心脏病胎儿孕妇及其家庭提供全面的、真实的疾病信息以及符合伦理学的个体化建议.
목적 탐토다학과합작하적태인심장병산전진단여자순일체화신모식이급“태인심장병적분급량표”재선천성심장병산전관리중적응용개치. 방법 제정“태인심장병적분급량표”급태인심장병산전진단여자순일체화적신형복무모식,즉유포괄산과초성의사、태인의학전과의사、소인심내과의사이급유전학전가재내적위산의학단대,근거산전태인초성심동도검사결과,이급“태인심장병적분급량표”분급결과,향잉부가정제공상진적위산기자순.2011년1월1일지2012년12월31일,대재동제대학부속제일부영보건원태인의학부접수태인초성심동도검사적잉부제공해신형복무모식.분석해모식재선천성심장병산전관리중적작용,불동심장병분급조간인산솔적차이비교채용Fisher정학개솔법. 결과 “태인심장병적분급량표”장태인심장병분위4급:Ⅰ급지경미심장병,기본무수치료;Ⅱ급지간단심장병,출생후수요치료,단생활질량여정상인무이;Ⅲ급지치료효과량호적복잡성심장병;Ⅳ급지엄중복잡성심장병.산전초성심동도공학진태인유심장병적잉부54례,평균년령(29±3)세,평균잉주(28.0±3.8)주.공인산27례,태인심장병Ⅳ급적잉부인산솔위17/19,명현고우Ⅰ～Ⅲ급자(분별위3/15、3/10화4/10),차이균유통계학의의(Fisher정학개솔법,P균＜0.01).19례Ⅳ급병례중,공17례선택종지임신,령2례선택계속임신지분면,원인균위쌍태임신단령일태인정상.7례합병심외결구이상、염색체이상혹유전종합정적병례균선택인산종지임신. 결론 재림상실천중구건다학과합작하적태인심장병산전진단여자순일체화적신모식,추행“태인심장병적분급량표”,유조우위심장병태인잉부급기가정제공전면적、진실적질병신식이급부합윤리학적개체화건의.
Objective To explore a new mode of prenatal diagnosis and counseling for congenital heart disease (CHD) by interdisciplinary cooperation and the value of "Grading scale of fetal echocardiography" in disease management.Methods The "Grading scale of fetal echocardiography" and a new integrative service mode of prenatal diagnosis and counseling for CHD with multidisciplinary team,including obstetric sonographers,obstetricians,pediatric cardiologists and geneticists,was established.For pregnant women referred to prenatal clinic in Shanghai First Maternity and Infant Hospital from January 1,2011 to December 31,2012,counseling about the diagnosis,severity,treatment options and long-term prognosis would be provided based on detailed fetal echocardiography and the grading scales.The significance of such mode in the prenatal management of CHD was analyzed and the rate of pregnancy termination was compared by Fisher exact test.Result According to the "Grading scale of fetal echocardiography",there were four categories:Class Ⅰ,minor anomalies probably without treatment requried; Class Ⅱ,simple defects with normal life quality following after-born therapy; Class Ⅲ,complex anomalies with reasonable life quality after treatment; Class Ⅳ,severe malformation requiring multiple stage surgical repair or with very poor prognosis.There were a total of 54 pregnancies confirmed to have fetal cardiac anomalies by echocardiography,among which 27 were terminated.The average age of pregnant women was (29±3) years old,the average gestational week was 28.0±3.8.The abortion rate in women with the fetuses diagnosed as Class Ⅳ CHD was 17/19,higher than that in Class Ⅰ,Ⅱ and Ⅲ (3/15,3/10 and 4/10,Fisher exact test,all P＜0.01).In 19 Class Ⅳ cases,only two twin pregnant women continued their pregnancies because the other fetuses were healthy.Abortion was conducted in all 7 fetuses associated with extra-cardiac,chromosome anomaly or genetic syndrome.Conclusion The establishment of new integrated mode of prenatal diagnosis and counseling for CHD and "Grading scale of fetal echocardiography" in a multidisciplinary manner could provide comprehensive and authentic information and ethical advices for the families.