超声引导下胎儿心肌壁注射KCl在KCl减胎术中的应用效果

目的 探讨超声引导下胎儿心肌壁注射氯化钾（KCl）在中孕期双绒毛膜双羊膜囊双胎妊娠KCl减胎术中的手术效果。方法 回顾性分析2017年9月至2020年1月安徽医科大学第一附属医院收治的因中孕期双绒毛膜双羊膜囊双胎妊娠伴有双胎之一异常行KCl减胎术的27例孕妇临床资料。根据术中KCl注射部位不同将研究对象分为心腔内注射组（超声引导下胎儿心腔内注射KCl）13例及心肌壁注射组（超声引导下胎儿心肌壁注射KCl）14例。比较两组手术时间、KCl用量和围产儿结局的差异。结果 心腔内注射组手术时间为（33.69±2.46）min，长于心肌壁注射组的（19.86±1.51）min，差异有统计学意义（P<0.05）；心腔内注射组KCl用量为（6.00±0.71）mL，多于心肌壁注射组的（2.79±0.54）mL，差异有统计学意义（P<0.05）；分娩28天后电话随访，两组孕妇的分娩孕周及新生儿体质量比较，差异均无统计学意义（P>0.05）。结论 在中孕期KCl减胎术中，心肌壁注射KCl较传统的心腔内注射KCl手术耗时更少，KCl用量更少，且不影响保留胎儿的分娩孕周及新生儿出生体质量。

Application effect of KCl injection into fetal myocardial wall under ultrasound guidance in fetal reduction by using potassium chloride

Objective To investigate the effect of potassium chloride (KCl) injection into fetal myocardial wall under ultrasound guidancein fetal reduction by using potassium chloride of double chorion and amniotic sac twins during the second trimester.Methods A retrospective analysis was performed on the clinical data of 27 pregnant women admitted to the First Affiliated Hospital of Anhui Medical University from September 2017 to July 2020 due to dichorionic double amniotic sac twin pregnancy in the second trimester accompanied by abnormality of one of the twins and undergoing fetal reduction by using potassium chloride.According to the different KCl injection sites during the operation, pregnant women were divided into 13 cases of intracardiac injection group (ultrasound guided intracardiac injection of KCl group) and 14 cases of myocardial wall injection group (ultrasound guided fetal intracardiac injection of KCl group).The differences in operation time, KCl dosage and perinatal outcome of the two surgical methodswere analyzed and compared. Results The average operation time was (33.69±2.46) min in intracardiac injection group and (19.86±1.51) min in myocardial wall injection group,and the difference was statistically significant(P<0.05).The average amount of KCl was (6.00±0.71) mL in intracardiac injection group and (2.79±0.54)mL in myocardial wall injection group, and the difference was statistically significant(P<0.05).Late follow-up found no significant difference in fetal gestational week and neonatal weight between the two groups of fetuses. Conclusions In fetal reduction by using potassium chloride surgery during the second trimester, myocardial wall injection of KCl is shorter in time and less in KCl volume compared with traditional KCl intracardiac injection,and itdoes not affect the gestational age of fetus and the birth weight of newborns.