目的:比较器质性和闭塞性单脐动脉在病史、超声表现、妊娠结局等方面的异同,明确产前超声诊断是否需要及如何对二者进行鉴别,以辅助产科临床的不同处理.方法:回顾性统计分析并比较两组间孕妇自然情况、脐血管超声图像特点、血流动力学指标异常率、胎盘羊水及其他合并异常发生率、胎儿生长受限(FGR)出现比率及出现孕周、妊娠结局等.结果:两组间孕妇的自然情况中辅助生殖、吸烟占比有统计学差异.器质性单脐动脉在孕早中期得以诊断,而闭塞性多在晚孕期诊断.器质性单脐动脉组脐动静脉内径比值更高.器质性单脐动脉合并染色体异常及伴发畸形的概率比闭塞性单脐动脉更高.器质性单脐动脉组早发型FGR(28周前)发病率更高,而闭塞组迟发型FGR发病率更高.相比器质性单脐动脉,闭塞性单脐动脉组血流动力学指标异常率、胎死宫内和紧急剖宫产发生率更高.结论:器质性和闭塞性单脐动脉是发病机制不同的两种情况,孕期应对脐动脉进行规范化扫查,早中孕期超声明确脐动脉数目是重要的,利于甄别晚孕期出现的闭塞性单脐动脉.

目的 探讨超声多参数对妊娠期糖尿病?(GDM)?患者中孕期胎儿心脏功能的评估价值.方法 选择2020年4月至2020年10月中国医科大学附属盛京医院诊断为GDM的中孕期孕妇62例作为GDM组,选择同期进行胎儿心脏超声检查的健康中孕期孕妇30例作为对照组.所有孕妇自愿参加本研究并签署了知情同意书.所有孕妇均进行空腹血糖、口服葡萄糖耐量测试,GDM组孕妇测量糖化血红蛋白值.采用GE公司的Voluson?E10超声诊断仪进行胎儿整体评估,并使用多参数评价胎儿心脏功能变化.结果 2组胎儿整体超声评估均未发现明显畸形,2组胎儿胎龄比较无统计学差异?(P?>?0.05?).与对照组比较,GDM组胎儿左、右心室的等容收缩时间?(IVCT)、等容舒张时间?(IVRT)、心肌性能指数?(MPI)?增大?(均P?0.05).而二尖瓣舒张早期血流速度,二尖瓣舒张晚期血流速度,二尖瓣舒张早、晚期流速比值,三尖瓣舒张早期血流速度,三尖瓣舒张晚期血流速度,三尖瓣舒张早、晚期流速比值,左心室射血时间2组比较无统计学差异?(均P?>?0.05).GDM组胎儿左心室IVCT、右心室IVCT、MPI均与胎龄正相关?(均P?0.05).?结论 与正常孕妇胎儿比较,GDM孕妇胎儿心室IVCT、IVRT、MPI增大,提示GDM胎儿心脏功能可能受损.组织多普勒超声下测量的IVCT、IVRT、MPI指标能够便捷快速评估胎儿心脏功能的改变.

目的:探讨应用实时双平面成像(Bi-plane)技术显示胎儿完整室间隔的可行性及临床应用价值.方法:利用实时Bi-plane技术观察150例正常组及29例异常组的胎儿心脏(包括21例单纯性室间隔缺损及8例房室间隔缺损).取胎儿心尖四腔心或心底四腔心切面,取样线通过室间隔,显示胎儿室间隔的全貌,评价室间隔完整性.此外,所有正常及异常胎儿另用时空影像关联(Spatiotemporal image correlation,STIC)技术采集胎心容积数据并行三维重建,获取室间隔影像.结果:实时Bi-plane技术与STIC技术相比,对胎儿完整室间隔的显示成功率显著提高(98.7％ vs.83.3％,P＜0.01);对异常组中室间隔缺损的显示率也显著提高(96.6％ vs.79.3％,P＜0.01),而获取室间隔切面的时间显著缩短((15.5±5.8)s vs.(58.1±13.3)s,P＜0.01).结论:实时Bi-plane技术可以显示胎儿室间隔的全貌,方法简单,操作方便,可作为常规二维超声心动图的辅助检查方法,具有重要的临床应用价值.

目的 应用实时双平面成像技术观察正常胎儿主动脉瓣的瓣膜结构,探讨测量不同孕周胎儿主动脉瓣环面积的临床意义.方法 选取2018年6月至2019年6月在我院进行产前胎儿心脏超声检查的孕妇180例.应用常规二维超声心动图和实时双平面成像技术观察胎儿主动脉瓣,记录图像采集时间和成像率并比较分析.实时双平面成像技术测量胎儿主动脉瓣环面积,线性回归分析主动脉瓣环面积与孕周关系.结果 常规二维超声心动图和实时双平面成像技术的主动脉瓣成像率和采集时间比较差异均有统计学意义(均P<0.05).实时双平面成像技术测量的主动脉瓣环面积与孕周正相关(P<0.05).结论 实时双平面成像技术更容易观测胎儿主动脉瓣结构,主动脉瓣环面积与孕周正相关.实时双平面成像技术测量主动脉瓣环面积可为临床上评估胎儿心脏发育提供重要的参考.

肺动脉瓣缺如综合征(absent pulmonary valve syndrome,APVS)是以肺动脉瓣缺如或发育不良为特征的一种罕见且严重的先天性心脏异常,常伴有肺动脉反流及肺动脉分支不同程度扩张.病情较重的婴儿由于扩张的肺动脉压迫支气管导致严重的呼吸窘迫,在新生儿早期即发生夭折.APVS 表现不同,预后不同,故胎儿期超声心动图评价十分重要.

Objective]To investigate the application value of four-dimensional ultrasound with high definition flow(HD flow) in the observation of fetal pulmonary vein.[Methods]From June 2015 to June 2016,130 fetuses in our hospital underwent prenatal fetal echocardiography were included in this study. Color Doppler and high definition flow imaging were used to observe and count the number of pulmonary veins in the fetal four chamber view. In the condition of opening HD flow ,the 3D volume data was collected from the heart of the fetal four chamber view,and the 3D images of the fetal pulmonary vein were obtained by using the post processing software. Comparisons were made between the three methods for visualization numbers of the normal fetal pulmonary veins. For 5 cases of abnormal pulmonary venous drainage,STIC combined with HD flow technique was used to carry out three-dimensional reconstruction of pulmonary veins,to observe the abnormal drainage.[Results]The display rate of HD flow on fetal pulmonary veins was higher than that of color Doppler. For the 17~32 weeks fetal,four-dimensional ultrasound combined with HD flow could better observe the spatial location of pulmonary veins.[Conclusions]STIC combined with HD flow technology can display fetal pulmonary veins better in the second and early-third trimester of pregnancy ,and three-dimensional reconstruction of the image is more intuitive ,helpful to understand the spatial relationship.

Objective To explore the ultrasonographic method in fetal coronary sinus (CS) dilation.Methods Totally 145 normal fetuses (normal group) and 72 fetuses of CS dilation (CS group) diagnosed prenatally were retrospectively reviewed.The long axis of coronary sinus was displayed in the non-standard four chamber view and the area of the sagittal view of CS was measured.Transverses scans combined with color Doppler were used to acquire four chamber view,left and right ventricular outflow tract views,three vessel view.In addition,sagittal scans with color Doppler were used to get short-axis view at the level of great arteries,vena cava long axis view,aortic arch view,and ductal arch view.The characteristics of CS were observed.Results CS area of sagittal view was positively correlated with gestational age (normal group:r=0.954,P＜0.05;CSgroup:r=0.904,P＜0.05).In the samegestational weeks,the CS area of the sagittal view in the normal group was less than that in the CS group (all P＜0.01).In CS group,52 fetuses were persistent left superior vena cava,15 fetuses were total anomalous pulmonary venous connection,5 fetuses were associated with right heart pressure overload.Conclusion Fetal CS sagittal section area is positively correlated with gestational age.When the fetal heart ultrasonography found CS dilation,other intracardiac malformations should also be considered.The etilogies of CS dilation should be analyzed clinically through multi-slice,multi-angle scanning.

Objective To investigate the value of prenatal ultrasound in diagnosis of fetal posterior urethral valve (PUV) and the differential diagnosis of related diseases.Methods The antenatal ultrasonographic manifestations and the outcomes of 14 cases with congenital lower urinary tract obstruction (LUTO) in Shengjing Hospital of China Medical University from December 2014 to December 2016 were analyzed.The ultrasound features and differential diagnosis of fetal posterior urethral valve were summarized and analyzed.Results Fourteen male fetuses with LUTO were prenatally diagnosed.Eleven fetuses were diagnosed as PUV,I as urethral atresia,2 as megacystis and LUTO.Among the fourteen fetuses,11 were confirmed as PUV after delivery,1 as urethral atresia,2 as vesicoureteral reflux (VUR).One case among them was diagnosed as PUV,and latter proved to be VUR.In 2 cases among them,prenatal ultrasound indicated megacystis,but 1 case was proved to be PUV,and 1 case was VUR.The prenatal ultrasound of the PUV fetuses showed enlarged bladder and thickened bladder wall.Most of them were accompanied by the keyhole sign.Conclusion Prenatal ultrasound can assist in the diagnosis of PUV by analyzing the anatomy of the bladder and accompanying malformations,which provides valuable diagnostic information for the clinical practice.

Objective To analyze the abnormal fetal ductus arteriosus (DA) by echocardiography.Methods Seventy fetuses of abnormal DA diagnosed prenatally were retrospectively reviewed.Transverse scans combined with color Doppler were used to acquire four chamber view,left and right ventricular outflow tract views,three vessel view,and three-vesseltrachea view.In addition,sagittal scans with color Doppler were used to get vena cava long axis view,aortic arch view,and ductal arch view.The spatial relationship of the great arteries and trend of DA were observed.Results Abnormal fetal DA is mainly composed of DA absence,DA abnormal function and DA morphological abnormality.Among 70 cases of fetal DA,9 cases were diagnosed with DA absence,8 cases were DA atresia,11 cases were DA completed closure nearly,9 cases were shown with reverse DA blood perfusion,33 cases were shown with DA curvature and dilatation.Conclusion Prenatal diagnosis of DA absence and DA abnormal function is of great significance.Three-vessel-trachea view and ductal arch view combined with CDFI can make a definitive diagnosis.

Objective To explore the application value of the real-time three-dimensional ultrasound Bi plane technology in evaluation of the foramen ovale blood in fetus.Methods The coronal plane of inferior vena cava entering the right atrium in 186 normal fetuses were obtained.The dimensions of foramen ovale (DFO) and inferior vena cava at the entrance of right atrium (DIVC) were measured in the coronal plane.The ratio of DFO and DIVC (DFO/DIVC) was calculated.The correlation be tween DFO/DIVC and gestational age was analyzed.Results There was no correlation between DFo/DIvc and gestational age (r=0.228,P＞0.05).There were 155 cases during second trimester (21 28 weeks),and the DFO was (4.46±0.57)mm,DIVC was (4.55±1.22)mm,DFO/DIVC was 1.03±0.22.There were 31 cases during late pregnancy (29-36 weeks),and the DFO was (5.20±0.43)mm,DIVC was (5.90±1.33)mm,DFO/DIVC was 0.92±0.17.The mean 95％ confidence interval of DFO/DIVC was (0.98,1.04),the 95％ normal reference range was (0.80,1.44).Conclusion The coronal plane of inferior vena cava entering the right atrium can be obtained with real-time three-dimensional ultrasound Bi-plane technology,the flow from the inferior vena cava enters right atrium which is divided by the upper atrial septum can be observed,which is important in evaluating the foramen ovale blood.

目的 探讨胎儿主动脉弓离断的超声诊断特点.方法 回顾性分析产前超声诊断为胎儿主动脉弓离断的35胎胎儿资料,同时纳入180胎正常胎儿.二维超声判断胎儿内脏及心脏位置,获取四腔心切面、左右心室流出道切面、三血管切面及三血管-气管切面等横断面,并扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状切面.测量主动脉弓离断胎儿左右心室内径比值及主动脉与肺动脉内径比值,并与相应孕周的正常胎儿进行比较.结果 产前二维超声诊断A型、B型及C型主动脉弓离断分别为16、18及1胎,均伴室间隔缺损,共27胎经尸体检查或产后检查证实产前诊断,3胎诊断错误,余5例新生儿失访.四腔心切面及三血管切面发现主动脉弓离断胎儿左右心室内径比值和主动脉与肺动脉内径比值显著小于相应孕周正常胎儿,差异有统计学意义(P均＜0.01).矢状切面对主动脉追踪连续扫查可确定主动脉的分支及走行,可明确诊断及分型.A型、B型及C型离断升主动脉走行及分支分别呈现典型的“W型”、“Y型”及“Ⅰ型”.矢状面扫查及横断面扫查对胎儿主动脉弓离断的诊断率分别为90.00％(27/30)及56.67％(17/30),差异有统计学意义(P＜0.01).结论 产前二维超声可诊断胎儿主动脉弓离断,横断面扫查可发现某些线索,矢状面连续扫查对诊断胎儿主动脉弓离断具有重要意义.

目的 探讨二维及三维容积超声结合彩色多普勒技术在显示正常胎儿主动脉弓及头臂血管发出中的价值.方法 随机选择2014年9月至2015年9月于中国医科大学附属盛京医院门诊进行常规产科超声检查的150例孕妇(150例正常胎儿)为研究对象.将胎儿按孕周分为19～22周、23～26周、27～30周、31～34周4组.胎儿矢状面连续超声检查,观察并计数主动脉弓及头臂血管;胎儿矢状面采集心脏三维容积数据,同时开启彩色多普勒功能.利用图像后处理软件对容积数据分析重建,获取胎儿主动脉弓及头臂血管的三维图像,观察并计数主动脉弓及头臂血管.比较两种方法显示主动脉弓及头臂血管情况.结果 孕＜31周胎儿三维容积超声较二维超声能够显示更多的头臂血管;而孕≥31周胎儿二维超声明显优于三维容积超声.结论 利用二维超声心动图对胎儿矢状面行连续超声检查可有效显示胎儿主动脉弓及头臂血管的发出.在孕周较小时,利用三维容积超声结合彩色多普勒技术可更好地显示胎儿主动脉弓及头臂血管的发出,且三维重建图像直观、立体,有助于理解心脏大血管的空间立体结构.

Objective To explore the reasons of fetal right atrial enlargement and to propose a proper diagnostic method.Methods Two hundred and twenty-five cases of fetal right atrial enlargement diagnosed prenatally were retrospectively reviewed.Transverse scans combined with color Doppler were used to acquire four chamber view,left and right ventricular outflow tract views,three vessel view,and three-vessel-trachea view.In addition,sagittal scans with color Doppler were used to get vena cava long axis view,aortic arch view,and ductal arch view.Sequential segmental analysis was used to exclude fetal congenital heart disease.Results In total,139 cases (61.8％) of physiological right atrial enlargement,11 cases (4.9％) of Ebstein's anomaly,21 cases (9.3％) of congenital heart disease (CHD) associated with right atrial volume overload,41 cases (18.2％) of CHD associated with right heart pressure overload,and 11 cases (4.9％) of idiopathic dilation of the right atrium were correctly diagnosed in the current study.Enlargement of right atrium in neonates were found in two cases (0.9％) who were prenatally diagnosed as physiological right atrial enlargement.Conclusions Sonographers should look into the nature of the phenomenon during examination.Secondary changes caused by cardiac anomalies should be considered when asymmetric chambers are identified.Sequential segmental analysis should be used in the diagnosis of fetal CHD while fetal cardiac hemodynamics changes should serve as the main clue during the exam ination.

目的:系统评价三维超声成像技术在诊断先天性泪囊突出中的应用价值.方法:回顾性分析18例先天性泪囊突出胎儿的产前超声图像特点,并与产后结果进行对比分析.全部病例均从眼科医生或直接从患儿父母处获得随访结果.结果:胎儿先天性泪囊突出超声图像特点:二维超声扫查可见胎儿眼眶内眦部内下方类圆形,边界清晰的无回声液性区,CDFI未检出血流信号.应用三维超声成像技术同时在A(矢状切面)、B(横切面)、C(冠状面)平面显示该液性区,多层面分析病灶与周围组织的毗邻关系,利用三维表面成像技术可直观显示内眦部向表面突出的包块.产前共18例胎儿怀疑为先天性泪囊突出,产后均得到证实.囊肿直径在0.3～1.2 cm之间,均无眼球受压移位现象.结论:三维超声成像技术可对先天性泪囊突出病灶处做出全面的评估,包括病变位置,病灶各个径线的大小,血运情况,与周围软组织及骨性结构的毗邻关系等.本研究发现先天性泪囊突出病灶最长径线大于或等于1.0 cm,且多次复查未见明显减小者,自愈率低,预后相对较差.三维超声成像技术在诊断胎儿先天性泪囊突出中有重要的临床应用价值.

目的 探讨三维超声在产前诊断胎儿膀胱增大及相关疾病鉴别诊断中的应用价值.方法 回顾性分析20胎经引产后尸体解剖或出生后随访证实膀胱增大的胎儿临床及声像图资料.结果 20胎中,8胎后尿道瓣膜,2胎尿道闭锁,7胎梅干腹综合征,1胎膀胱输尿管反流,1胎肛门闭锁、尿道下裂,1胎正常.膀胱增大胎儿超声均表现为下腹部巨大无回声区,不同原因所致膀胱增大的声像图表现各具特征.结论 三维超声可清晰显示胎儿膀胱的解剖形态,有助于诊断膀胱增大相关疾病.

目的 探讨三维超声计算机辅助虚拟脏器分析(VOCAL)技术对评价胎儿透明隔腔(CSP)发育的应用价值.方法 应用三维超声VOCAL技术对20～38周正常胎儿共212胎进行CSP容积测量,评价胎儿CSP的发育情况.结果 对212胎正常胎儿均应用VOCAL技术成功测得CSP容积数据.胎儿CSP宽度与胎儿孕周、双顶径(BPD)、头围(HC)及小脑横径存在相关性(r=0.47、0.50、0.46、0.50,P均＜0.05);胎儿CSP前后径与胎儿孕周、BPD、HC及小脑横径存在相关性(r=0.57、0.61、0.55、0.61,P均＜0.05);胎儿CSP容积与胎儿孕周、BPD、HC及小脑横径存在相关性(r=0.45、0.48、0.44、0.50,P均＜0.05).结论 通过三维超声VOCAL技术可立体显示胎儿CSP,从而评价其发育情况.

目的:探讨测量足底平面第一与第五跖骨夹角在诊断先天性足内翻中的价值.方法:对照组选择孕周为19～37周的117例胎儿共186只胎足,病例组选择先天性足内翻的24例胎儿37只胎足,应用TUI模式显示足底平面并测量第一与第五跖骨夹角,分析正常胎儿该角度与其孕周的相关性,并比较两组之间该角度的差异;同时利用ROC曲线判断其诊断价值.对病例组胎儿于其出生或引产后进行随访并进行DR检查,于正位片上测量第一与第五跖骨夹角,并将超声测量结果与DR测量结果进行对比分析及一致性检验.结果:对照组第一与第五跖骨夹角为(22.83±2.07)°,与孕周无明显相关性(r=0.104,P=0.158＞0.05).病例组第一与第五跖骨夹角的测量结果为(32.91±3.30)°,与对照组相比差异有统计学意义(P=0.000＜0.05).ROC曲线下面积为0.978,曲线上的最佳临界点为27.47°,对应的敏感度为94.6％,特异度为97.8％.正常足与内翻足的DR正位片测量结果分别为(23.28±1.16)°、(33.59±3.02)°,超声测量结果与之相比差异均无统计学意义(P=0.471＞0.05,P=0.281＞0.05).一致性检验所得Kappa值分别为0.811和0.894(P=0.000＜0.05),说明二者诊断的一致性较好.结论:正常胎儿足底平面第一与第五跖骨夹角与孕周无明显相关性.先天性足内翻胎儿第一与第五跖骨夹角与正常胎儿相比角度明显增大.

目的 观察不同孕周正常胎儿主动脉弓形态的变化规律,并探讨大动脉转位(TGA)胎儿主动脉弓形态变化.方法 收集150胎正常胎儿(正常组,21～40周,每4个孕周为一个亚组,每亚组30胎)和29例TGA胎儿(病例组,21～24周12例,25～28周12例,29～36周5例)主动脉弓切面图像,利用曲率测量软件分别测量主动脉弓曲率等指标,分析其与孕周的相关性,并对两组相同孕周的胎儿进行统计学分析.结果 正常胎儿主动脉弓最大曲率位置随孕周增加呈上移趋势(P＜0.05),二者呈直线正相关(r=0.86,P＜0.001),孕周与最大曲率位置的线性方程为Y=0.86X+ 15.75.随孕周增加TGA胎儿最大曲率位置也呈上移趋势,二者呈正相关(r=0.88,P＜0.001),但与相同孕周的正常胎儿相比,其主动脉弓最大曲率位置下移(P均＜0.05).结论 随着孕周的增长,胎儿主动脉弓形态发生显著变化.采用胎儿主动脉弓切面曲率量化主动脉弓形态,有利于丰富胎儿大动脉转位的诊断信息和提高诊断信心.

目的 探讨三维超声时空关联成像(STIC)技术在胎儿完全型房室间隔缺损(AVSD)诊断中的临床应用价值.方法 回顾性分析32例诊断为完全型AVSD的胎儿超声心动图特点,应用STIC技术显示共同房室瓣及乳头肌,与尸检或生后超声心动图的结果进行比较.结果 三维超声STIC技术与二维超声相比在胎儿完全型AVSD的检出率上没有明显差别.通过STIC技术可显示共同房室瓣的形态特征及乳头肌的位置的异常等.结论 三维超声STIC技术为观察共同房室瓣提供了新视野,是一种能准确、简便地诊断胎儿完全型AVSD的新方法.

<正>大学生生涯规划教育与就业指导本土化的主要内涵朱辉荣在其《本土化大学生职业生涯规划教育研究》一文中认为,大学生生涯规划教育与就业指导本土化,是指以大学生的成长特点和中国人特有的文化、价值观为基础,根据我国当前社会发展需求,职场人才选聘标准,把西方职业生涯规划和就业指导理论与高校教育环境相结合,创新理论与方法,形成本土化大学生职业生