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目的探讨超声引导下经皮脐静脉穿刺术易出现胎心减慢的相关临床分析。方法对中山市博爱医院2009年1月至2012年7月期间行超声引导下经皮脐静脉穿刺术的1184例孕妇根据产前诊断指征分为6组进行回顾性分析。结果在中山市博爱医院1184例超声引导下经皮脐静脉穿刺术中,出现胎心减慢56例。胎心减慢病例中,因单脐动脉行脐静脉穿刺术10例,因胎儿其他超声软指标行脐静脉穿刺术11例,因胎儿结构发育异常行脐静脉穿刺术5例,因胎儿生长受限(fetal growth restriction,FGR)行脐静脉穿刺术2例,因羊水过多行脐静脉穿刺术8例,因其他产前诊断指征(超声暂未发现任何异常)行脐静脉穿刺术20例。因单脐动脉行超声引导下经皮脐静脉穿刺术,胎心减慢的发生率较其他组明显增高,差异有统计学意义(χ~2=30.31,P<0.05)。结论对于单脐动脉的孕妇,应产前超声早期诊断,24周前行羊膜腔穿刺术,若必须行脐静脉穿刺者,术前需做好抢救准备。
Objective To investigate the clinical application of ultrasound-guided percutaneous umbilical vein puncture to reduce fetal heart rate. Methods From January 2009 to July 2012, 1184 pregnant women undergoing percutaneous umbilical vein puncture guided by ultrasound in Pok Oi Hospital of Zhongshan were analyzed retrospectively according to prenatal diagnosis indications. Results In the Pok Oi Hospital, Zhongshan City, 1184 cases of ultrasound-guided percutaneous umbilical vein puncture, there were 56 cases of fetal heart rate decreased. Fetal slowing cases, due to single umbilical artery line umbilical vein puncture in 10 cases, due to other fetal soft ultrasound index line umbilical vein puncture in 11 cases, due to fetal structural abnormalities line umbilical vein puncture in 5 cases, due to fetal growth (FGR) underwent 2 cases of umbilical venipuncture. Because of excessive amniotic fluid, umbilical vein puncture was performed in 8 cases. Because of other prenatal diagnosis indications (no abnormalities were found by ultrasound), 20 cases of umbilical vein puncture . Due to the single umbilical artery under ultrasound-guided percutaneous umbilical vein puncture, the incidence of fetal heart rate slowed down significantly higher than the other groups, the difference was statistically significant (χ ~ 2 = 30.31, P <0.05). Conclusion For pregnant women with single umbilical artery, early diagnosis of prenatal ultrasound should be performed and amniocentesis performed 24 weeks before. If it is necessary to perform umbilical vein puncture, preoperative rescue preparation is required.