胎儿镜激光凝固胎盘吻合血管术治疗双胎输血综合征对孕妇血液稀释状态的影响  

Effect on maternal blood dilution of fetoscopic laser occlusion of chorioangiopagous vessels in treating twin to twin transfusion syndrome

作　　者：王学举[1] 魏瑗[1] 原鹏波[1] 赵扬玉[1] 

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华妇产科杂志》2016年第1期13-17,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨双胎输血综合征（TTTS）孕妇行胎儿镜激光凝固胎盘吻合血管（FLOC）术对于孕妇血液稀释状态的影响。方法收集2009年5月至2014年11月在北京大学第三医院产科接受FLOC术治疗的TTTS孕妇共71例，对TTTS孕妇进行Quintero临床分期，并回顾性分析FLOC术围手术期24h内TTTS孕妇的液体净入量，术前及术后血常规、血压及心率的变化。结果（1）71例TTTS孕妇Quintero临床分期I期9例、Ⅱ期24例、Ⅲ期28例、Ⅳ期10例。（2）71例孕妇FLOC术时间平均为（64．0±16．3）min，剔除术中发生胎盘浅表血管破裂1例、术后发生胎盘早剥1例和术后未复查血常规者6例，余63例于术后24h内复查血常规等指标。（3）TTTS孕妇术中的中位出血量3ml，围手术期24h内中位液体入量为2050ml，中位尿量为2300ml，中位羊水引流量为1900ml。围手术期24h内液体中位净入量为-1760ml（-100ml- -3350ml）。（4）63例孕妇FLOC术前及术后红细胞计数分别为（3．47±0．36）及（3．01±0．37）×10^12／L、血红蛋白水平分别为（107．8±12．1）及（95．1±11．2）g／L、血细胞比容中位数分别为0．313及0．276，术后较术前均明显下降，差异均有统计学意义（P=0．000）；术后孕妇的收缩压、舒张压及心率分别与术前比较，差异均无统计学意义（P〉0．05）。（5）羊水引流量为l000～1999ml的孕妇术前与术后的红细胞计数差值为（0．37±0．25）×10^12／L、血红蛋白水平差值为（8．7±8．5）g／L，血细胞比容中位数差值为0．027；羊水引流量为2000～3000ml的孕妇分别为（0．47±0．31）×10^12／L、（14．3±10．9）g／L及0．043，两者的血细胞比容中位数差值比较，差异有统计学意义（P〈0．05）；两者的红细胞计数差值、血红蛋白水平差值、收缩压及舒张压、心率差值分别比较，差异均无统计学意义（P〉0．05）。结论。TTTS孕妇FLOC术后�Objective To evaluate the effect on maternal blood dilution of fetoscopic laser occlusion of chorioangiopagous vessels （FLOC） in treating twin to twin transfusion syndrome （TTTS）. Methods The clinical data of 71 cases of TTTS who had FLOC in Peking University Third Hospital were reviewed. Fluid intake, blood pressure, heart rate, red blood cell count, hemoglobin and hematocrit in perioperative 24 hours were analyzed. Results （1） According to the Quintero staging, 9 cases were stage I , 24 were stage I] , 28 were stage ~I and l0 cases were stage IV. （2） The average operation time of FLOC was （64.0＋ 16.3） minutes. One case had placental abruption after the procedure; one had placental vessel rupture and 6 women refused to take blood counting. These 8 cases were excluded and 63 cases were included in the study. （3） The perioperative bleeding volume was 3 （1, 5） ml, and the volume of fluid intake, urine, amniotie fluid drainage and net fluid intake in the perioperative 24 hours was 2 050 ml（1 530 ml, 3 700 ml）, 2 300 ml （1100 ml, 3 500 ml）, 1 900 ml （1 400 ml, 2 700 ml） and-1 760 ml （-100 ml,-3 350 ml）, respectively. There was no significant difference between maternal blood pressure or heart rate preoperatively and postoperatively. （4） The maternal red blood cell count [（3.47±0.36）×10^12/L versus （3.01±0.37）×10^12/L, P=0.000], hemoglobin [（107.8±12.1） g/L versus （95.1±11.2） g/L, P=0.000] and hematocrit [0.313（0.238, 0.387） versus 0.276（0.213, 0.800）, P=0.000] decreased significantly 24 hours after FLOC. （5） The postoperative hematocrit decreased more in the group which the amniotic fluid drainage volume was 2 000- 3 000 ml than that in the group which the amniotie fluid drainage volume was 1 000- 1 999 ml. Conclusions The blood dilution can not be ignored after the FLOC in TITS patients. The more the amniodrainage volume during the FLOC, the more the maternal blood dilution would be. It might result from amniodrainage during the FLOC

关 键 词：双胎输血综合征 胎儿镜检查 激光凝固术 吻合术 外科 血液稀释 

分 类 号：R714.5[医药卫生—妇产科学]