腹部超声凸阵探头可视化下加压推离胎臀提高无麻醉外倒转术成功率的研究  

Ultrasonic convex array probe applied to increase success rate of external cephalic version without anesthesia

作　　者：刘乐南 杨倩 刘丽萍 姜海风 张曙萱[2] 郜翠 晋柏 Liu Lenan;Yang Qian;Liu Liping;Jiang Haifeng;Zhang Shuxuan;Gao Cui;Jin Bai(Department of Obstetrics,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China;Department of Obstetrics,the First People′s Hospital of Xuzhou,Xuzhou 221002,China;Department of Obstetrics,Jinhu County People′s Hospital,Huaian 211600,China)

机构地区：[1]南京医科大学第一附属医院江苏省人民医院产科,南京210029 [2]徐州市第一人民医院产科,徐州221002 [3]江苏省金湖县人民医院产科,淮安211600

出　　处：《中华妇产科杂志》2024年第6期427-433,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：江苏省卫生健康委医学科研重点项目 (ZD2022023)。

摘　　要：目的:探讨腹部超声凸阵探头可视化下加压推离胎臀提高无麻醉下足月及近足月臀位外倒转术(ECV)成功率的可行性。方法:收集2019年4月至2023年8月南京医科大学第一附属医院190例妊娠36~39+4周、单胎臀位行ECV孕妇的临床资料,根据是否应用腹部超声凸阵探头可视化下加压(即探头加压法)推离胎臀分为加压组(81例,其中初产妇61例、经产妇20例)及未加压组(109例,其中初产妇72例、经产妇37例)。分析比较加压组与未加压组孕妇的临床特点、ECV成功率、并发症及分娩结局。结果:(1)总体ECV成功率为64.2%(122/190),其中,加压组与未加压组孕妇的ECV成功率分别为69.1%(56/81)与60.6%(66/109),两组比较,差异无统计学意义(χ^(2)=1.490,P=0.222)。ECV成功后阴道分娩率为81.1%(99/122),其中,经产妇与初产妇的阴道分娩率分别为97.8%(45/46)、71.1%(54/76)。(2)加压组初产妇的ECV成功率高于未加压组初产妇[分别为70.5%(43/61)、45.8%(33/72)],且加压组初产妇的身高更高、行ECV时孕周更小,分别比较,差异均有统计学意义(P均<0.05);加压组经产妇的ECV成功率(65.0%,13/20)低于未加压组经产妇(89.2%,33/37),但两组比较,差异无统计学意义(P>0.05)。(3)初产妇ECV成功率的多因素logistic回归分析结果显示,采用探头加压法(OR=2.601,95%CI为1.113~6.075;P=0.027)、羊水指数(OR=1.010,95%CI为1.001~1.020;P=0.028)均是初产妇ECV成功的影响因素。(4)ECV的并发症主要为一过性胎心率减慢(8.9%,17/190),其中,加压组的发生率显著高于未加压组[分别为14.8%(12/81)、4.6%(5/109);χ^(2)=5.967,P=0.015]。其他并发症在ECV成功与失败孕妇中、加压组与未加压组孕妇中分别比较,差异均无统计学意义(P均>0.05)。所有孕产妇及新生儿未发生与ECV相关的不良母儿结局。结论:采用探头加压法可明显提高初产妇的ECV成功率,且不增加母儿不良结局的发生,初产妇ECV成功率受操作方法和羊水Objective To explore the feasibility of using ultrasonic convex array probe compressing abdominal wall to increase success rate of external cephalic version(ECV)without anesthesia in full-term and near-term pregnancy.Methods Totally 190 singleton and non‐cephalic presentation pregnant women in 36-39+4 weeks of gestation performed ECV from April 2019 to August 2023 in the First Affiliated Hospital of Nanjing Medical University were analyzed.According to whether use the ultrasound probe compressing fetal breech or not,the pregnant women were divided into two groups:81 cases in the probe-compressing group(including primipara 61 cases and multipara 20 cases)and 109 cases in the non-probe-compressing group(including primipara 72 cases and multipara 37 cases).Clinical data,ECV related factors and complications were analyzed and compared between the two groups.Results(1)The overall success rate of ECV was 64.2%(122/190).There was no significant difference in the success rate of ECV between probe-compressing group and non-probe-compressing group[69.1%(56/81)vs 60.6%(66/109),χ^(2)=1.490,P=0.222].The total vaginal delivery rate after successful ECV was 81.1%(99/122),while 71.1%(54/76)in primipara and 97.8%(45/46)in multipara,respectively.(2)Compare to the non-probe-compressing group,the success rate of ECV in primipara was significantly higher in the probe-compressing group[45.8%(33/72)vs 70.5%(43/61)],but the gestational age was shorter and the height was higher in the probe-compressing group(all P<0.05).The success rate of ECV of multipara in the probe-compressing group(65.0%,13/20)was lower than that in the non-probe-compressing group(89.2%,33/37),but there was no significant difference between the two groups(P>0.05).(3)Multivariate logistic regression analysis showed that abdominal wall compressed by ultrasound probe(OR=2.601,95%CI:1.113-6.075;P=0.027)and amniotic fluid index(AFI;OR=1.010,95%CI:1.001-1.020;P=0.028)were positive factors for the successful rate of ECV in primipara pregnant women.(4)The main complicati

关 键 词：倒转术 胎位 产科外科手术 超声检查 介入性 

分 类 号：R614[医药卫生—麻醉学]