宫内输血治疗9例非免疫性因素导致胎儿贫血的临床观察和分析  

Clinical observation of intrauterine transfusions in the treatment of nine cases of fetal anemia caused by non-immune factors

作　　者：张可莹[1] 吴涛[3] 耿凌云[4] 李介岩[2] Zhang Keying;Wu Tao;Geng Lingyun;Li Jieyan(Department of Blood Transfusion,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院输血科,100026 [2]首都医科大学附属北京妇产医院/北京妇幼保健院围产医学部,100026 [3]解放军总医院第七医学中心输血科 [4]首都儿科研究所附属儿童医院输血科

出　　处：《北京医学》2024年第4期325-329,共5页Beijing Medical Journal

摘　　要：目的探讨非免疫性因素导致胎儿贫血的产前诊断、早期识别及宫内输血(intrauterine transfusions,IUT)治疗疗效。方法选取2012年1月至2023年12月首都医科大学附属北京妇产医院非免疫性因素导致胎儿贫血行IUT治疗的患者9例。分析孕妇、胎儿及新生儿的临床资料及输血相关检测指标。结果9例患者年龄29~38岁,均无输血史,分娩孕周≥30+周,末次IUT与分娩间隔0~69 d,外院转入6例。其中4例为胎母输血综合征,2例不良孕史,其余病例胎儿贫血原因不明确。病例3、5和7胎儿水肿,病例1、6、9胎儿体腔一处异常积液。IUT治疗后,胎儿Hb、红细胞比容或大脑中动脉收缩期血流峰值(middle cerebral artery peak systolic velocity,MCA-PSV)有好转,病例3第2次IUT后MCA-PSV稍高,仅病例5和7新生儿进行输血治疗,其余新生儿未输血仅光疗。病例1新生儿5年后体检体健。结论IUT治疗可改善非免疫性因素胎儿贫血情况,应加强对非免疫性因素胎儿贫血的产前诊断,早期识别胎儿贫血,为抢救新生儿和提高新生儿预后争取时间和机会。Objective To explore the prenatal diagnosis,early identification and intrauterine transfusions(IUT)effect of fetal anemia caused by non-immune factors.Methods A total of nine patients with fetal anemia caused by non-immune factors requiring IUT in Beijing Obstetrics and Gynecology Hospital from January 2012 to December 2023 were selected.Clinical data of the gravidas,fetuses and neonates and the blood transfusion related detection indicators were analyzed.Results The nine patients,aged from 29 to 38,had no history of blood transfusion,the gestational age of delivery was≥30+weeks,and the interval between the last IUT and delivery was 0-69 d,six patients were transferred from other hospitals.Among them,four patients were fetomaternal hemorrhage,two patients had bad pregnancy history,and the causes of fetal anemia in the rest patients were unclear.Patients 3,5 and 7 had hydrops fetalis,and patients 1,6,and 9 had an abnormal effusion in the fetuses body cavity.After IUT treatment,the fetal Hb,hematocrit or middle cerebral artery peak systolic velocity(MCA-PSV)were improved,and the MCA-PSV of patient 3 was slightly higher after the second IUT,only patients 5 and 7 newborns were treated with blood transfusion,and the rest newborns were only treated with phototherapy without blood transfusion.Patient 1 neonate was healthy after five years.Conclusions IUT treatment can improve the situation of fetal anemia with non-immune factors,so we should strengthen the prenatal diagnosis of fetal anemia with non-immune factors and identify fetal anemia early,so as to gain time and opportunities for rescuing newborns and improving their prognosis.

关 键 词：非免疫性因素 胎儿贫血 宫内输血 

分 类 号：R714.5[医药卫生—妇产科学]