双胎反向动脉灌注序列征血流自然阻断后泵血儿自然妊娠结局分析  

Analysis of natural pregnancy outcome of pump twin after spontaneous cessation of blood flow in the umbilical artery of the acardiac twin with reverse arterial perfusion sequence

作　　者：易仁凤 鲁力[1] 成晨 赵胜[1] 杨小红[1] Yi Renfeng;Lu Li;Cheng Chen;Zhao Sheng;Yang Xiaohong(Department of Ultrasonography,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院超声影像科,武汉430070

出　　处：《中华超声影像学杂志》2025年第1期74-78,共5页Chinese Journal of Ultrasonography

摘　　要：目的分析产前超声监测双胎反向动脉灌注序列征(TRAPs)中无心畸胎儿血流自然阻断后泵血儿的生长发育和血流参数的改变与泵血儿自然妊娠结局的关系。方法回顾性分析2001年1月至2023年8月于湖北省妇幼保健院产前确诊TRAPs,超声随访监测到无心畸胎儿体内血流自然阻断的病例共23例。根据泵血儿妊娠结局分为妊娠结局不良组(6例)和妊娠结局良好组(17例),比较两组间泵血儿和无心畸胎儿相关超声生长指标及血流参数变化。筛选两组间差异有统计学意义的血流参数,通过ROC曲线分析其对TRAPs妊娠结局的诊断效能。结果两组中无心畸胎儿结构发育情况,包括皮肤水肿、半心畸形、头颅结构、躯干结构、上肢及下肢是否存在以及泵血儿的心胸比值、羊水、性别及双胎的羊膜性比较差异无统计学意义(均P>0.05);而无心畸胎儿的下肢显示在妊娠结局不良组(6/6)高于妊娠结局良好组(7/17),差异有统计学意义(P<0.05)。两组中超声血流相关参数显示TRAPs无心畸胎儿血流自然阻断前,泵血儿大脑中动脉搏动指数(PI)和脐动脉PI比较差异无统计学意义(均P>0.05);而妊娠结局良好组泵血儿与无心畸胎儿脐带直径比值高于妊娠结局不良组,差异有统计学意义(P<0.05)。绘制两组泵血儿与无心畸胎儿脐带直径比值散点图,通过ROC曲线分析,以2.125为截值,曲线下面积(AUC)为0.961,敏感性为94.10%,特异性为100%,约登指数为0.94。结论在TRAPs中泵血儿与无心畸胎儿脐带直径比值对预测泵血儿妊娠结局有一定意义。ObjectiveTo analyze the relationship between the growth and development of pump twin and the changes of blood flow parameters and the natural pregnancy outcome of pump twin after pontaneous cessation of blood flow in the umbilical artery of the acardiac twin with reverse arterial perfusion sequence(TRAPs)detected by prenatal ultrasound.MethodsFrom January 2001 to August 2023,a total of 23 cases of TRAPs diagnosed in Hubei Maternal and Child Health Hospital were retrospectively collected and detected by ultrasound follow-up.According to the pregnancy outcome of the pump twin,23 patients were divided into the poor pregnancy outcome group(6 cases)and the good pregnancy outcome group(17 cases).The changes of ultrasound growth indexes and blood flow parameters of the pump twin and acardia twin were compared between the two groups.The hemodynamic parameters with statistically significant differences between the two groups were selected,and the diagnostic efficacy for TRAPs pregnancy outcomes was analyzed using ROC analysis.ResultsThere were no statistically significant differences in the structural development of acardiac fetus between the two groups,including skin edema,hemicardia,skull structure,trunk structure,upper and lower limbs,cardiothoracic ratio,amniotic fluid,sex and amniotic nature of twins(all P>0.05).The lower limbs of acardia twin was significantly higher in the poor pregnancy outcome group(6/6)than in the good pregnancy outcome group(7/17),and the difference was statistically significant(P<0.05).The relevant parameters of ultrasound blood flow were shown in both groups,there were no significant differences in middle cerebral artery pulsation index(PI)and umbilical artery PI between the two groups before natural occlusion of fetal blood flow with TRAPs(all P>0.05).In the good pregnancy outcome group,the ratio of umbilical cord diameter between pump twin and acardia twin was higher than that in the poor pregnancy outcome group,the difference was statistically significant(P<0.05).The scatter plot of the ra

关 键 词：超声检查 产前 双胎反向灌注序列征 无心畸胎儿的血流自然阻断 

分 类 号：R714.5[医药卫生—妇产科学]