双胎输血综合征的超声诊断分析

目的 评价超声在双胎输血综合征(TTTS)中的作用.方法 回顾分析12例被确诊TTTS胎儿的超声检查结果.结果 12例胎儿中,孕20周确诊3倒,孕24～35周确诊8例,孕36周后确诊1例.其中有5例双胎之一为水肿儿,3例伴胸腹水,双胎之一为贴附儿2例.含死胎的有3例.结论 超声作为一种无创性的检查,在TTTS的早期诊断具有很高的应用价值,能为临床提供科学的诊治依据.     

双胎输血综合征宫内治疗的探讨

目的探讨双胎输血综合征（TTTS）的诊断、分期，评价宫内治疗的可行性及临床效果。方法对双胎输血综合征病例进行诊断分期，并且行系列羊水减量等宫内治疗。结果邢严重程度的分期是决定TTTs治疗效果和围产儿预后的重要因素。诊断时分期越高，围产儿死亡率越高。Ⅰ-Ⅱ期TTTs患者，经羊水减量术治疗后，孕龄延长，胎儿预后好。结论尽可能早地确立诊断和临床分期有助于评估预后和临床处理。羊水减量术治疗TTTs，可操作性强，有较好的治疗效果。     

产前超声检查对双胎输血综合征的价值

目的评价产前超声检查对双胎输血综合征(TTTS)的价值。方法对2005年1月-2010年6月在我院孕早期就判断为单绒毛膜性的12例TTTS患者进行分期、宫内监测等。结果在超声协助下,胎儿存活率为44.4%。结论超声对TTTS可作出早期诊断,并指导临床进行有效的宫内治疗、适时终止妊娠,提高围产儿存活率。     

14例新生儿双胎输血综合征临床超声影像观察研究

目的评价超声诊断双胎输血综合征应用价值;探讨新生儿双胎输血综合征临床表现及合并症等问题。方法应用二维及多普勒超声测定14例22～36周的双胎妊娠胎儿生长指标及脐动脉血流PI值、RI值、S/D值,观察活产和死胎所产双胎婴儿供血儿和受血儿的各项指标。结果超声诊断双胎输血综合征14例,诊断准确率92.8%（13/14）,双胎输血综合征具有一般双胎的临床共性,其中受血儿出现病理临床表现及合并症较供血儿多且严重。结论二维联合多普勒超声诊断双胎输血综合征有较高的准确率,是快捷诊断双胎输血综合征手段之一。双胎输血综合征对受血儿危害更大,临床一旦确诊为双胎输血综合征,应对受血儿进行严密监护,若出现临床表现并发红细胞增多症,应积极采取治疗措施以减少严重并发症及后遗症的发生。     

双胎输血综合征二例报道

一次妊娠同时有两个或两个以上胎儿妊娠称为多胎妊娠.因为多胎妊娠孕妇并发症围产期死亡率高,故临床作为异常妊娠对待.目前,所知多胎妊娠胎儿数目可达2～8个.以双胎妊娠最常见发生率11%左右.双胎妊娠分类:单卵双胎、双卵双胎两类.单卵双胎占20%～25%,双卵双胎占25%～80%.多胎妊娠孕产妇并发症多,围产儿死亡率明显升高.主要表现为早产,胎儿宫内发育迟缓、畸形,双胎输血综合征,脐带脱垂,胎头交锁,胎头碰撞等.本文介绍我院近10年来在多胎妊娠中,双羊膜囊,单绒毛膜、单卵双胎并发双胎输血综合征两例报道.     

双胎输血综合征产前超声诊断及分析

目的探讨双胎输血综合征(TTTS)的产前超声诊断及TTTS发现时间与围产儿结局的关系,目前采用的治疗方法,改善围产儿结局和降低围产儿死亡风险。方法采用回顾性分析的方法对1323对双胎的羊膜囊数目以及羊膜隔带厚度、胎盘位置、数目、两胎性别及早期超声绒毛膜囊数目进行分析判断为MCT193例,超声测量胎儿双顶径、头围、腹围、股骨长、羊水指数、膀胱、胎盘厚度、回声,脐动脉血流动力学参数等超声表现进行分析符合TTTS诊断的患者有21对。结果 TTTS是MCT胎儿宫内死亡的主要原因,TTTS发生越早围产儿生存的风险性越高,期别进展与围产儿结局有一定关系,分期系统在监测病情进展方面更为有效。结论 TTTS是双胎妊娠的一个严重并发症,围产儿发病率及病死率极高,超声技术作为一种无创、安全、简便、快捷、可靠的检查是目前诊断TTTS的重要手段。     

女性尿道综合征12例护理体会

目的探讨护理因素在治疗女性尿道综合征中的作用。方法对12例女性尿道综合征患者进行普通护理和手术护理,并进行出院健康指导。结果12例均好转出院,随访1年,1例复发。结论女性尿道综合征易复发,经药物治疗、膀胱训练和护理后恢复较快,且复发率低。     

25例肾病综合征综合护理体会

肾病综合征（nephritic syndrome，NS）是指由各种原因引起的肾小球毛细血管通透性增高导致大量蛋白尿的临床症候群。临床以大量蛋白尿、低蛋白症、高度水肿、高血脂为主要表现。2007年来我科共收治肾病综合征25例，现将综合护理体会总结如下。     

Early prediction of severe twin-to-twin transfusion syndrome

This extended series of 303 monochorionic twin pregnancies examined at 10-14 weeks gestation explores the possible association of increased fetal nuchal translucency thickness (NT) in the early prediction of severe twin-to-twin transfusion syndrome (TTS). Of 303 pregnancies, there were 16 in which at least one fetus was structurally or chromosomally abnormal and in the remaining 287 ongoing pregnancies there were 43 (15%) which developed severe TTS. The median fetal NT was 1.0 multiples of the median (MOM) and NT was >95th centile in 47 (8.2%) fetuses and in at least one fetus in 37 (12.9%) pregnancies. The prevalence of increased NT in the pregnancies that developed TTS [17.4% (n = 15) of fetuses and 28% (n = 12) of pregnancies] was significantly higher than in the non-TTS group [6.6% (n = 32) and 10.2% (n = 25) respectively; Z: = -3.4, P: < 0.001 and Z: = 3.2, P: < 0.001 respectively], likelihood ratio of increased fetal NT for prediction of TTS = 3.5 [95% confidence interval (CI) 1.9-6.2]. In 153 of the pregnancies, an ultrasound examination was also performed at 15-17 weeks gestation and intertwin membrane folding was seen in 49 (32%) cases; 21 of these (43%) subsequently developed TTS compared to two (1.9%) of the 104 pregnancies without membrane folding (Z: = 6.6, P: < 0.001), likelihood ratio of membrane folding for prediction of TTS = 4.2 (95% CI 3.0-6.0).     

慢性肾小球肾炎综合护理临床护理体会

目的：探讨分析综合护理干预在慢性肾小球肾炎治疗护理应用中的临床效果。方法：以随机数字表法将150例慢性肾小球肾炎患者分为对照组和观察组,对照组患者75例,观察组患者75例。对照组患者给予常规护理,观察组在对照组的基础上给予综合护理干预,对比分析两组患者治疗前后的护理效果。结果：治疗护理后,观察组患者焦虑缓解状况和抑郁缓解状况显著高于对照组(P<0.05);两组患者血肌酐、尿素氮均有所下降,血浆白蛋白均有所提高,观察组患者血肌酐、尿素氮水平下降幅度和血浆白蛋白升高水平更为显著(P<0.05);观察组患者生活满意度和对照组相比较更高,情感指数和健康指数更高(P<0.05)。结论：综合护理可以有效提高慢性肾小球肾炎患者的治疗效果,提高患者满意度。     

综合性护理在重症颅脑损伤患者术后护理中的应用

目的：探讨综合性护理在重症颅脑损伤患者术后护理中的应用价值。方法：将60例重症颅脑损伤的患者用随机数字表法分为观察组和对照组,对照组围手术期采用常规护理,观察组术后采用综合护理,比较两组患者的并发症、生命体征、住院时间以及护理满意度。结果：观察组护理后的SOFA、APACHEII评分低于对照组,GCS评分高于对照组,有统计学意义(P<0.05)。观察组的并发症少于对照组,焦虑评分低于对照组,入住ICU、住院时间短于对照组,护理满意度高于对照组,有统计学意义(P<0.05)。结论：综合性护理能减少重症颅脑手术患者术后并发症,改善预后。     

综合护理对慢性肾功能衰竭患者生存质量和情绪影响研究

目的:研究综合护理对慢性肾功能衰竭患生存质量和情绪的影响.方法:将82例慢性肾功能衰竭患随机分为综合护理组41例和对照组41例,综合护理组应用综合护理进行干预,对照组采用常规护理.对两组患的生存质量及情绪影响进行统计学分析比较.结果:经不同护理干预后,综合护理组患的治疗依从性和积极性显著优于对照组,差异具有统计学意义(P<0.05);综合护理组患生存质量指标健康指数、生活满意度、情感得分、感情指数分别为(13.58±1.21)、(10.10±1.74)、(50.62±6.12)和(9.34±1.08)分,而对照组分别为(8.16±1.65)、(6.91±1.03)、(33.81±6.48)和(5.24±1.01)分,对应的t值分别为5.61、4.01、7.42和2.79,对应的P值分别为0.014、0.020、0.009和0.037,差异均具有统计学意义(P<0.05);综合护理组患情绪焦虑自评量表(self-ratinganxietyscale,SAS)和抑郁自评量表(self-ratingdepressionscale,SDS)评分分别为(46.67±3.87)和(48.71±3.62)分,对照组分别为(55.85±2.61)和(57.43±3.14)分,对应的t值分别为5.17和4.01,对应的P值分别为0.017和0.020,差异具有统计学意义(P<0.05).结论:综合护理能够显著提高慢性肾功能衰竭患的生存质量,改善慢性肾功能衰竭患的焦虑、抑郁等不良情绪,值得临床推广应用.     

Iron metabolism in monochorionic twin pregnancies in relation to twin--twin transfusion syndrome

Fetal iron metabolism was investigated in monochorionic (MC) twin pregnancies in relation to twin-twin transfusion syndrome (TTTS). Matched maternal and fetal blood samples were obtained both in utero and at birth from MC twins with TTTS (n = 23) and without TTTS (n = 18). In a second group of 30 twin pairs (15 with and 15 without TTTS), liver iron content was assessed by using archived paraffin wax-embedded blocks. Serum ferritin was determined by radioimmunoassay and values are given as gestation independent Z-scores and expressed as mean with 95% confidence intervals. Ferritin concentrations in the recipients were higher than in the donors both in utero (P < 0.01) and at birth (P < 0.01). Fetal serum ferritin in non-TTTS twins were similar to the recipient twins but higher than the donor twins (P < 0.05). A significant association was found between ferritin concentrations, the total red blood cell count and haemoglobin in the TTTS twin pairs (P < 0.01) and the non-TTTS twins as a group (P < 0.01). The total stainable liver iron was comparable between twin pairs in the TTTS and non-TTTS groups. This study fails to provide evidence of iron overload in the recipient and depletion in the donor twins and, thereby, questions the validity of the conventional theory of inter-twin transfusion as the cause of TTTS.     

Congenital focal glomerular lesions in only one monozygotic twin related to a probable twin transfusion syndrome

A case of congenital focal glomerular lesions involving crescent formation in only one monozygotic twin is reported. The possible effect of chronic hypotension in the pathogenesis of the lesion is discussed, considering the fact that the affected twin was probably the donor in a feto-fetal transfusion syndrome.     

Multiple thromboembolic events in fetofetal transfusion syndrome in triplets contributing to the understanding of pathogenesis of hydranencephaly in combination with polymicrogyria

Over the last 180 years, several theories concerning the origin of hydranencephaly have been proposed with an emphasis on infectious, aplastic, and vascular etiologies. In this report, we present a case of triplets with fetofetal transfusion syndrome of which 2 fetuses (1 and 2) developed almost similar hydranencephaly, whereas the third exhibited the features of a fetus papyraceus (3). In the monochorial triamniotic placenta, multiple arteriovenous anastomoses were detected, representing a probable route for the transmission of thrombi originating from fetus 3 causing visceral lesions in fetus 2. Hydranencephaly was histologically characterized by necrosis, macrophage invasion, and endothelial proliferation. In addition, polymicrogyria was seen in fetuses 1 and 2. The combination of multiple visceral thromboembolic events and the death of fetus 3 approximately in the 11th week of gestation suggested a vascular thrombotic pathogenesis of hydranencephaly. Polymicrogyria can be considered as postmigratory laminar necrosis. Our findings contribute to the pathogenetic understanding of combined hydranencephaly and polymicrogyria.