不同孕周及心理干预对单绒毛膜双胎射频消融减胎术后妊娠结局的影响  

Pregnancy outcome analysis after radiofrequency ablation of monochorionic twin pregnancy in different gestational weeks and psychological intervention

作　　者：程露瑶 杨丽[1] 李明明[1] 李亚歌 张轶乐[1] Cheng Luyao;Yang Li;Li Mingming;Li Yage;Zhang Yile(Reproductive Medicine Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院生殖医学中心,郑州450052

出　　处：《中华医学杂志》2023年第16期1236-1241,共6页National Medical Journal of China

基　　金：国家自然科学基金(31970799)

摘　　要：目的探讨单绒毛膜双胎射频消融减胎术患者减胎孕周及心理干预对妊娠结局的影响。方法回顾性分析2017年3月至2021年4月在郑州大学第一附属医院行射频消融减胎治疗的孕中、晚期单绒毛膜源性双胎妊娠患者的临床资料,共68例,其中单绒毛膜单羊膜囊患者54例、单绒毛膜双羊膜囊患者14例。按照减胎时孕周分为<20周(36例)、20~23周(17例)、≥24周(15例)3组;按照术前是否进行心理干预,分为干预组(40例)和对照组(28例),分析减胎孕周、心理干预对患者妊娠结局的影响。结果68例患者的年龄为(30.2±4.6)岁,孕周为(22.2±3.2)周,减胎后活产60例(88.2%)。减胎时孕<20、20~23、≥24周组患者的年龄分别为(31.8±4.7)、(28.3±5.0)、(30.3±4.0)岁(P=0.098),流产率、早产率、活产率、分娩方式、早产孕周、分娩孕周、新生儿体重差异均无统计学意义(均P>0.05)。干预组和对照组患者年龄分别为(30.6±4.7)、(29.4±4.0)岁(P=0.352)。干预组进行心理干预后,减胎后比减胎前焦虑评分由(54.8±6.8)分降为(37.3±7.3)分(P<0.001),而抑郁评分由(62.7±7.2)分降低至(33.2±2.40)分(P<0.001)。与对照组患者(12.5%,5例)相比,干预组患者术后不适发生的比例较高(53.6%,15例)(P<0.001)。对照组与干预组患者术后早产率、流产率、活产率、分娩方式、早产孕周、分娩孕周、新生儿体重差异也均无统计学意义(均P>0.05)。结论射频消融减胎术是一种安全、有效的微创技术。对于复杂单绒毛膜双胎妊娠,在孕<20周进行减胎,并进行术前心理干预,可以获得良好的妊娠结局。Objective To investigate the effect of different gestational weeks and psychological intervention on pregnancy outcome in patients with monochorionic twin pregnancy.Methods The clinical data of 68 patients with monochorionic twin pregnancy in the middle and late pregnancy who were treated with radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from March 2017 to April 2021 were retrospectively analyzed,including 54 patients with single chorionic and single amniotic sac and 14 patients with single chorionic and double amniotic sac.Patients were divided into three groups according to the gestational weeks:<20 weeks(n=36),20-23 weeks(n=17)and≥24 weeks(n=15);and were divided into intervention group(n=40)and control group(n=28)according to the preoperative psychological intervention.The pregnancy outcome of patients with different pregnancy reduction and the effect of psychological intervention on pregnancy outcome was analyzed.Results The age of 68 patients was(30.2±4.6)years old,the gestational age was(22.2±3.2)weeks,and 60 cases(88.2%)were live births after fetal reduction.There were no significant difference in age[(31.8±4.7),(28.3±5.0),(30.3±4.0)years old](P=0.098),abortion rate,preterm birth rate,live birth rate,delivery mode,gestational week of preterm birth,gestational week of delivery,and neonatal weight between the two groups at different gestational weeks(all P>0.05).The ages of the intervention group and the control group were(30.6±4.7)and(29.4±4.0)years old(P=0.352).After psychological intervention for 40 patients in the intervention group,the anxiety score after pregnancy reduction was reduced from(54.8±6.8)to(37.3±7.3)(P<0.001),while the depression score decreased from(62.7±7.2)to(33.2±2.4)(P<0.001).Compared with patients in the control group(12.5%,n=5),the proportion of postoperative discomfort in the intervention group was higher(53.6%,n=15)(P<0.001).Compared with the control group,there were no statistically significant difference in the postoperative preter

关 键 词：妊娠 单绒毛膜双胎妊娠 射频消融技术 减胎 中期妊娠 

分 类 号：R714.23[医药卫生—妇产科学]