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目的探索穿刺成功率相关影响因素,正确评价脐血管穿刺术中医源性因素与术后胎儿丢失、胎盘出血、感染等并发症的关系。方法回顾性分析2012-2015年340例接受脐血管穿刺术的孕妇相关数据,穿刺术后由专人随访,随访自术后至分娩,共5次,记录B超检查结果及妊娠结局。结果 340例均穿刺成功,孕25+6周前首次穿刺成功率为90.00%,孕26周后首次穿刺成功率为94.17%。穿刺层面数为3层(腹壁、子宫壁、胎盘)穿刺成功率为84.62%,穿刺层面数为2层(腹壁、子宫壁)穿刺成功率为94.02%。穿刺点为脐带游离段者一次穿刺成功率为88.34%,穿刺点为脐带胎盘段者一次穿刺成功率为97.18%,以上成功率比较差异均有统计学意义(均P<0.05)。该研究共有2例医源性胎儿丢失,综合风险率为0.5%。结论脐血管穿刺术尽管为一种侵入性产前诊断方法,但操作方便、术后并发症发生率低、对母儿风险小,仍不失为一项安全可靠的产前诊断技术,能有效降低先天缺陷儿的出生。
Objective To explore the factors influencing the success rate of puncture and to correctly evaluate the relationship between the iatrogenic factors in umbilical cord blood perfusion and postoperative complications such as fetal loss, placental hemorrhage and infection. Methods The data of 340 pregnant women receiving umbilical vascular puncture between 2012 and 2015 were retrospectively analyzed. After the puncture, the patients were followed up from postoperative to childbirth for 5 times. The results of B-ultrasound and pregnancy outcome were recorded. Results All the 340 cases were successfully punctured. The successful rate of first puncture was 90.00% before 25 + 6 weeks ’gestation and 94.17% after 26 weeks’ gestation. The success rate of puncture level was 3 (the abdominal wall, uterine wall and placenta) was 84.62% and the puncture level was 2 (the abdominal wall and uterine wall) was 94.02%. The puncture point for the umbilical cord free segment puncture success rate was 88.34%, the puncture point for umbilical cord placenta puncture success rate was 97.18%, the above success rates were significantly different (all P <0.05). A total of 2 iatrogenic fetuses were lost in this study, with a combined risk of 0.5%. Conclusion Umbilical cord blood puncture is an invasive and prenatal diagnostic method, but it is easy to operate and has a low incidence of postoperative complications and low risk to the mother and child, so it is a safe and reliable prenatal diagnosis technique that can effectively reduce the risk of congenital Birth of a defective child.