摘要
目的:探讨超声引导下经皮脐血管穿刺(PUBS)的方法并随访.方法:将 993 个行PUBS的胎儿依据是否抽吸出脐带血分为穿刺成功组和穿刺失败组,分析穿刺成功及失败的原因并随访.结果:PUBS的成功率为 95.77%(951/993).穿刺成功组和穿刺失败组孕妇的平均年龄、平均孕周间差异没有统计学意义(P>0.05).胎盘位于前壁时,PUBS的成功率高于位于宫底及后壁(P=0.036).PUBS原因包括心血管异常、颅脑异常、泌尿系统异常、消化系统异常、高龄、骨骼系统异常、羊水过多、单脐动脉、鼻骨异常、羊水少和胸腔异常等,其中羊水过多是导致PUBS失败的原因(P=0.006).PUBS穿刺时间 50～182 s,平均(89.12±32.95)s.42 例(4.42%)孕妇因染色体异常行引产手术.22 例(2.31%)发生胎膜早破.5 例(0.53%)穿刺后宫缩频繁.1 例穿刺后当晚破膜流产.1 例穿刺后 2 周顺产,孕妇因胎盘植入发生大出血,胎儿夭折.结论:超声引导下PUBS阳性率较高,但存在胎儿丢失等风险.
Abstract
Objective:To explore the method of ultrasound-guided percutaneous umbilical blood sampling(PUBS)and fol-low up.Methods:A total of 993 fetuses undergoing PUBS were divided into successful puncture group and failed puncture group based on whether umbilical cord blood was extracted.The reasons for successful and failure puncture were analyzed and followed up.Results:The success rate of PUBS puncture was 95.77%(951/993).There was no statistically significant dif-ference in average age and gestational age between the successful puncture group and the failed punctured group(P>0.05).When the placenta located on the front wall,the success rate of PUBS puncture was higher than that located on the fundus and posterior wall(P=0.036).The indications of PUBS were cardiovascular abnormalities,cranial abnormalities,urinary system abnormalities,digestive system abnormalities,advanced age,skeletal system abnormalities,polyhydramnios,single umbilical artery,nasal bone abnormalities,oligohydramnios,and thoracic abnormalities.Among them,polyhydramnios was the cause of PUBS failure(P=0.006).The time of PUBS was 50～182 s,and the average time was(89.12±32.95)s.Forty-two cases(4.42%)of pregnant women underwent induced abortion surgery due to chromosomal abnormalities.Twenty-two cases(2.31%)experienced premature rupture of membranes,and 5 cases(0.53%)had frequent uterine contractions after puncture.One case was aborted at night after puncture.One case had a natural delivery 2 weeks after puncture,and the pregnant woman experienced severe bleeding due to placental implantation,resulting in fetal death.Conclusion:Ultrasound guided PUBS has a higher positive rate,but there is a risk of fetal loss.
维普
万方数据