镜像综合征6例临床分析——减少或避免妊娠期严重并发症的探讨  

Clinical analysis of 6 cases of mirror syndrome——Discussion on reducing or avoiding serious complications during pregnancy

作　　者：李涵 顾宁[1] 江源[1] 戴毅敏[1] LI Han;GU Ning;JIANG Yuan;DAI Yimin(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing Jiangsu 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,江苏南京210008

出　　处：《中国计划生育和妇产科》2021年第5期40-44,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨镜像综合征的临床特征、诊断治疗以及妊娠结局。方法收集2015年1月至2020年1月南京鼓楼医院收治的54例胎儿水肿病历,分析其中发生镜像综合征的6例孕妇临床资料,其中包括化验检查、图像学和病理学诊断、产后42 d母儿随访记录以及母儿并发症情况等。结果 (1) 2015年1月至2018年1月期间,胎儿水肿孕妇42例,2例(4.8%)接受胎儿治疗,6例(14.3%)诊断为镜像综合征。2018年1月至2020年1月期间胎儿水肿12例,3例(25.0%)接受胎儿治疗,无镜像综合征发生,差异无统计学意义(P>0.05)。(2)母体临床特征以及并发症:6例均出现水肿(1+~3+),稀释性贫血[血红蛋白:(90.0±11.1)g/L,红细胞压积:(27.8±2.9)%]、蛋白尿和低蛋白血症[白蛋白:(28.0±3.8) g/L]。并发重度子痫前期4例,心功能不全4例,2例患者围产期因严重脏器功能损害入住ICU治疗,总的母体严重并发症发生率为83.3%(5/6例)。(3)超声检查:6例均有胎儿水肿,5例羊水过多。5例胎盘增厚[(53.3±6.2)mm]。6例胎盘的平均重量为(649.0±127.8)g,是同孕周胎盘重量的(174.0±44.4)%。(4)母儿围产结局:7例围产儿中,2例胎死宫内,3例新生儿死亡,2例健存,总的围产儿死亡率71.4%(5/7例)。(5)病因:胎儿因素占66.7%(4例),分别为先天性乳糜胸或乳糜腹3例,胎儿颈部血管瘤1例;胎盘因素和双胎并发症各1例(16.7%),分别为:绒毛膜血管瘤1例,双胎输血综合征1例。结论镜像综合征可出现类似子痫前期的表现,血液稀释是最重要的特征,也是与子痫前期鉴别的关键点。镜像综合征确诊后应积极纠正病因,如不可逆,需及时终止妊娠。Objective To investigate the clinical features, diagnosis, treatment and pregnancy outcome of mirror syndrome.Methods We collected the medical records of 54 cases of fetal edema in Nanjing Drum Tower Hospital from January 2015 to January 2020,and analyzed the clinical data of 6 cases of pregnant women with mirror syndrome, including laboratory examination, imaging and pathological diagnosis, follow up records of 42 days postpartum and complications of mother and child.Results(1) From January 2015 to January 2018,42 pregnant women with fetal edema, 2(4.8%) received fetal treatment, and 6(14.3%) were diagnosed with mirror syndrome.From January 2018 to January 2020,12 cases of fetal edema, 3 cases(25.0%) received fetal treatment, no mirror syndrome occurred, there were no significant differences between the two groups.(2) Maternal clinical features and complications: Maternal edema(1+~3+),dilution anemia[hemoglobin:(90.0±11.1) g/L,hematocrit:(27.8±2.9)%],proteinuria and hypoproteinemia[albumin:(28.0±3.8) g/L] were found in 6 cases.Complicated with severe preeclampsia in 4 cases, cardiac insufficiency in 4 cases, and perinatal treatment for severe organ function damage of 2 patients were in ICU.The overall incidence of maternal severe complications was 83.3%(5/6).(3) Ultrasound examination: 6 cases had fetal edema and 5 cases had polyhydramnios.Placenta thickening in 5 cases [(53.3±6.2)mm].The mean weight of placenta in 6 cases was(649.0±127.8)g, which was(174.0±44.4)% of the same gestational week.(4) Maternal perinatal outcome: Of the 7 perinatal infants, 2 were stillborn, 3 were neonatal death, 2 were healthy, and the overall perinatal mortality rate was 71.4%(5/7).(5) Etiology: fetal factors accounted for 66.7%(4 cases),congenital chylothorax or chylous abdomen 3 cases, fetal neck hemangioma 1 case, placental factors and twin complications 1 case(16.7%),respectively: 1 was chorionic hemangioma, 1 was twin transfusion syndrome.Conclusion Mirror syndrome can appear similar to preeclampsia.Hemodilution is the m

关 键 词：镜像综合症 胎儿水肿 母体水肿 诊断及治疗 

分 类 号：R714.2[医药卫生—妇产科学]