胎儿心脏病治疗的伦理学困境与挑战  

Current ethical status and challenges in fetal cardiac intervention

作　　者：李一飞[1,2] 周开宇[1,3] 华益民[1,3] 

机构地区：[1]四川大学华西第二医院儿童心血管科,成都610041 [2]四川大学华西临床医学院 [3]妇儿疾病与出生缺陷教育部重点实验室

出　　处：《中华实用儿科临床杂志》2014年第1期57-60,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：基金项目：国家自然科学基金（81070136、81270226）;长江学者和创新团队发展计划项目（IRT0935）

摘　　要：随着胎儿医学影像学及微创介入治疗技术的发展，严重心血管畸形的胎儿期干预已在全球少数几个医学中心实施。该技术通过缓解或改变异常血流动力学状态，从而可能促进发育不良的心脏再次发育，形成双心室循环，重塑流出道梗阻的肺血管床，以期改善患儿的早期及远期预后。但是，由于技术本身的局限性及相关风险性，同时涉及胎儿、母亲／家长和医师／医疗机构多方面的利益，从一开始就受到伦理学的质疑。随着研究逐步深入，技术相关风险正被有效控制，如何平衡三方利益及为胎儿形成最佳的诊疗决策成为伦理学所面临的严峻挑战。With the development of fetal medical imaging and minimal invasive interventional therapy, fetal cardiac intervention has taken into clinical practice in few medical centers. Fetal cardiac therapy may alter the abnormal hemodynamies of fetal circulation, which can lead to recruit hypoplastic ventricle, to create a two-ventricle circulation after birth, to remodel the fetal pulmonary vascular bed whose outlet is obstructed, and to provide a better prognosis for the suffered children. However, according to the limitations and risks of this cutting edge technique, as well as the dilemmas to balance the interests among fetus, mother/parents and doctor/medical institution, ethical challenges never fade away ever since the first beginning in this rising field. Following the encouraging research results published, the risk of the technique has been partly taken control. So in current status, how to balance the interests among three participants and to establish optimal routine clinical practice are the most challenging problems.

关 键 词：胎儿心脏病 产前治疗 伦理学 

分 类 号：R714.5[医药卫生—妇产科学]