摘要
目的应用超声评估孕期焦虑的孕妇其胎儿非结构性心血管异常的发生率以及转归预后。方法2018年6月至2020年2月,选取于孕早、中、晚期接受胎儿超声心动图检查并进行心理筛查的孕妇,经精神科再诊且均完成孕早、中、晚3个阶段焦虑自评量表评估,完成1周岁婴儿超声心动图复查者共807例,其中筛查出整个孕期均存在焦虑的218例作为焦虑组;整个孕期均不存在焦虑的233例作为对照组。胎儿在出生前或出生后超声所见心脏结构性异常的病例均排除。对2组胎儿非结构性心血管异常发生率及其出生1周岁后的预后情况进行对比分析。结果焦虑组胎儿非结构性心血管异常的总发生率和心律不齐的发生率分别为29.4%(64/218)、9.6%(21/218),对照组分别为9.0%(21/233)、3.4%(8/233),差异均有统计学意义(P均<0.01)。焦虑组胎儿三尖瓣中量及大量反流和右心房增大的发生率分别为4.1%(9/218)、6.4%(14/218),对照组分别为0.9%(2/233)、2.1%(5/233),差异均有统计学意义(P均<0.05)。胎儿出生1周岁后2组各项非结构性心血管异常(心律不齐、心包积液、右心室增大、左心室增大、右心房增大、左心房增大、三尖瓣中量及大量反流)的发生率比较,差异均无统计学意义(P均>0.05)。结论存在孕期焦虑的孕妇胎儿心脏非结构性异常发生率更高,临床应重视妊娠期孕妇的心理疏导,部分胎儿心脏非结构性异常出生后可恢复正常,因此不可过度解读,以免加重孕妇的孕期焦虑,造成过度引产。
Objective To investigate the incidence and prognosis of fetal non-structural cardiovascular abnormalities in pregnant women with anxiety during pregnancy by ultrasonography.Methods From June 2018 to February 2020,807 pregnant women who underwent fetal echocardiography and psychological screening in the early,middle,and late pregnancy were selected and re-examined at the psychiatric department,and all of them completed the self-rating scale evaluation for pregnancy anxiety in the early,middle,and late stages of pregnancy.Echocardiography was also performed in the 1-year-old infants.Among the woman included,218 with anxiety during pregnancy were included in an anxiety group,and 233 with no anxiety during pregnancy were included in a control group.Cases with fetal cardiac structural abnormalities detected by ultrasound before or after birth were excluded.A comparative analysis was performed on the incidence of non-structural cardiovascular abnormalities in the two groups of fetuses and their prognosis after the first year of life.Results The total incidence of fetal non-structural cardiovascular abnormalities and arrhythmia in the anxiety group were 29.4%(64/218)and 9.6%(21/218),respectively,which were significantly higher than those in the control group were[9.0%(21/233)and 3.4%(8/233),respectively](P<0.01 for both).The incidence of moderate tricuspid regurgitation and enlargement of the right atrium was also significantly higher in the anxiety group than in the control group[4.1%(9/218)vs 0.9%(2/233),P<0.05;6.4%(14/218)vs 2.1%(5/233),P<0.05].There was no significant difference in the incidence of non-structural cardiovascular abnormalities(arrhythmia,pericardial effusion,right ventricular enlargement,left ventricular enlargement,right atrial enlargement,left atrial enlargement,left atrial enlargement,and moderate tricuspid regurgitation and above)between the two groups after the first year of life of the fetus(P>0.05 for all).Conclusion The incidence of fetal non-structural cardiac abnormalities is higher in pregnant women with gestational anxiety.Clinical attention should be paid to the psychological counseling of pregnant women during pregnancy.Some non-structural abnormalities in the heart of the fetus can return to normal after birth,so it should not be over-interpreted,so as not to aggravate the anxiety of pregnant women during pregnancy and cause excessive induction of labor.
作者
刘宏强
董凤群
王义成
杨瑞敏
温德惠
王思思
张力维
尹佳园
Liu Hongqiang;Dong Fengqun;Wang Yicheng;Yang Ruimin;Wen Dehui;Wang Sisi;Zhang Liwei;Yin Jiayuan(Department of Ultrasound,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Obstetrics,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Fetal Heart Ultrasonography,Hebei Maternity Hospital,Shijiazhuang 050000,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2022年第2期137-141,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
河北省医学科学研究课题计划(20210893)。
