彩超引导胎儿心脏穿刺术取血用于产前诊断的意义评价

Prenatal diagnosis by color Doppler ultrasound-guided cardiocentesis fetal blood sampling

目的彩超引导下对脐静脉穿刺术困难经腹胎儿心脏穿刺术取胎血检测胎儿染色体核型等产前诊断。方法使用22G穿刺针对6例胎儿超声心动图检出心脏异常的胎儿脐血穿刺失败后在彩超引导下心脏穿刺术抽取胎血检测，平均孕周31．5w，孕妇平均年龄29．5岁，术前超声检查见心脏畸形或扩大外伴羊水过多或过少。结果6例均成功穿刺取血，术后1例出现心包积液，5例出现心动过缓，心率30—80／min，持续时间4—8min。胎血细胞培养成功5例，检出染色体异常核型13-三体1例。结论当脐静脉穿刺困难时可行胎儿心脏穿刺术，彩超引导可清晰显示胎儿心内血流变化并缩短穿刺时间。胎儿心脏穿刺术有一定的风险性应慎重选择病例。该技术可用于为未来的胎儿基因治疗。

Objective： To perform fetal karyotyping by cardiocentesis blood sampling guided by color Doppler uhrasonography in fetuses with congenital anomalies. Methods： Fetal blood samples obtained by color Doppler ultrasound - guided heat centesis in 6 fetuses with cardiac abnormalities detected by fetal echocardiography were taken for karyotyping. Fetuses were monitored post operation. Resuits： The procedures were successfully performed in 6 cases and no procedure - related severity complications occurred. One case with abnormal karyotypes for trisomy 13 were identified and pre -operation uhrasonography detected multiple system anomalies besides cardiac anomalies in them. Conclusion： Color Doppler uhrasonography facilitated cardiocentesis sampling by clear 2D and color imaging and shortening the operation time. Cardiocentesis sampling is an alternative choice when cordocentesis has failed.