CAJ | 학술논문

目的：分析中孕期产前超声筛查漏诊的原因，寻找降低产前超声检查漏诊率的对策。方法收集2007年9月至2011年12月间参加广州市出生缺陷重点病种干预项目试点区的产前超声筛查孕妇随访资料，随访时间为产后1个月、3个月、1年，重点研究产前超声筛查漏诊的孕妇。结果符合纳入标准的49765位孕妇产后随访发现漏诊62例，其中21例为目标病种：心血管系统畸形8例(38.1%)、颜面部畸形5例(23.81%)、消化系统畸形4例(19.05%)、泌尿系统畸形3例(14.29%)、手足畸形1例(4.75%)；其余41例为非目标病种。漏诊原因包括客观因素的影响、操作者的技术熟练程度、未动态追踪观察、工作量大忽视可疑情况等。结论通过专业培训等途径提高产前超声检查技术水平、加强医务人员的责任心，重视低危人群的筛查、发现异常情况时连续追踪观察等是规避漏诊风险的重要措施。
목적：분석중잉기산전초성사사루진적원인，심조강저산전초성검사루진솔적대책。방법수집2007년9월지2011년12월간삼가엄주시출생결함중점병충간예항목시점구적산전초성사사잉부수방자료，수방시간위산후1개월、3개월、1년，중점연구산전초성사사루진적잉부。결과부합납입표준적49765위잉부산후수방발현루진62례，기중21례위목표병충：심혈관계통기형8례(38.1%)、안면부기형5례(23.81%)、소화계통기형4례(19.05%)、비뇨계통기형3례(14.29%)、수족기형1례(4.75%)；기여41례위비목표병충。루진원인포괄객관인소적영향、조작자적기술숙련정도、미동태추종관찰、공작량대홀시가의정황등。결론통과전업배훈등도경제고산전초성검사기술수평、가강의무인원적책임심，중시저위인군적사사、발현이상정황시련속추종관찰등시규피루진풍험적중요조시。
Objective To analyze the reasons for missed diagnosis in prenatal ultrasonograpy screening in the second trimester of pregnancy, and to search for countermeasures to reduce the rate of missed diagnosis. Methods Pregnant women in Guangzhou were given prenatal ultrasonography screening during their second trimes-ter of pregnancy from Sep. 2007 to Dec. 2011. They were followed up at one month, three month and one year after de-livery. All the data was collected, and the gravidas of missed diagnosis in prenatal ultrasonograpy screening were stud-ied especially. Results Among the 49 765 gravidas enrolled in the project, 62 were missed diagnosed during the fol-low-up, of which 21 were found with target diseases of the project:8 cases (38.1%) of cardio-vascular system malfor-mations, 5 cases (23.81%) of facial anomalies, 4 cases (19.05%) of digestive system anomalies, 3 cases (14.29%) of re-nal tract anomalies and 1 case (4.75%) of hand-foot deformities. The remaining 41 cases of missed diagnosis were not the target diseases of the project. The reasons of missed diagnosis included influences from objective factors, skill of the manipulator, lack of dynamic follow-up, overlook of doubtful cases due to heavy workload. Conclusion Pushing technical improvement in prenatal ultrasonograpy through training, intensifying sonographer’s responsibilities, devot-ing attention to the screening of low-risk people, and continuous observation with abnormities are useful ways to avoid missed diagnosis.