超声引导下脐静脉穿刺出现胎心减慢的相关临床分析

目的探讨超声引导下经皮脐静脉穿刺术易出现胎心减慢的相关临床分析。方法对中山市博爱医院2009年1月至2012年7月期间行超声引导下经皮脐静脉穿刺术的1184例孕妇根据产前诊断指征分为6组进行回顾性分析。结果在中山市博爱医院1184例超声引导下经皮脐静脉穿刺术中,出现胎心减慢56例。胎心减慢病例中,因单脐动脉行脐静脉穿刺术10例,因胎儿其他超声软指标行脐静脉穿刺术11例,因胎儿结构发育异常行脐静脉穿刺术5例,因胎儿生长受限(fetal growth restriction,FGR)行脐静脉穿刺术2例,因羊水过多行脐静脉穿刺术8例,因其他产前诊断指征(超声暂未发现任何异常)行脐静脉穿刺术20例。因单脐动脉行超声引导下经皮脐静脉穿刺术,胎心减慢的发生率较其他组明显增高,差异有统计学意义(χ²=30.31,P<0.05)。结论对于单脐动脉的孕妇,应产前超声早期诊断,24周前行羊膜腔穿刺术,若必须行脐静脉穿刺者,术前需做好抢救准备。

Clinical analysis of relating factors about fetal bradycardia after B ultrasound-guided percutaneous umbilical vein puncture

Objective To explore the clinical factors of fetal bradycardia after B ultrasound - guided percutaneous umbilical vein puncture. Methods Clinical data of 1 184 cases of pregnant women by B ultrasound - guided percutaneous umbilical vein puncture from January 2009 to July 2012 in Boai Hospital of Zhongshan City divided into 6 groups according to the indication for prenatal diagnosis were retrospectively analyzed. Results Among 1 184 patients ,56 cases of patients occurred fetal bradycardia. Of these 56 patients performed percutaneous cutaneous umbilical vein puncture, the reason was single umbilical artery in 10 cases, other feta uhrasonographic soft marks in 11 cases ,fetal structural abnormalities in 5 cases ,fetal growth restriction（FGR） in 2 cases ,hydramnion or oligohydramnios in 8 cases and other indications for prenatal diagnosis （ ultrasound has not found any abnormal） in 20 cases. The rate of fetal bradycardia because of single umbilical artery under B ultrasound - guided percutaneous umbilical vein puncture was higher than that of other groups. The difference was statistics significance （X2 = 30. 31, P 〈 0.05 ）.Conclusion To the pregnant women with single umbilical artery, early diagnosed by prenatal ultrasonography, amniotic cavity puncture should be performed before 24 gestational weeks. If umbilical vein puncture is inevitable, rescue preparations before operation should be made fully.