超声引导下经腹脐静脉穿刺术的应用969例分析

Analysis and application of 969 cases of abdominal umbilical venopuncture by B-ultrasound guiding

目的探讨B超下经腹脐静脉穿刺术的安全性和临床应用价值。方法回顾性分析2002年1月-2009年12月间在我院进行B超引导下经腹脐静脉穿刺术的969例孕妇,包括穿刺成功率、手术时间及并发症。结果一次穿刺成功率96.8%,二次穿刺成功率99.38%。穿刺时间10m in内934例;10m in^15m in 28例。>30m in 7例,并发症:发生脐带渗血(>15 s)148例,发生率15.27%(148/969);穿刺经胎盘338例,胎盘渗血(>30 s)146例占43.19%(146/338),穿刺术中胎心减慢38例,发生率3.92%(38/969)成功抢救37例,2例胎心减慢胎死宫内,流产2例;早产9例。绒毛羊膜炎1例,胎儿丢失8例,占0.825%。结论经腹脐静脉穿刺是产前诊断安全、简便、可行的方法。熟练掌握穿刺手术技巧,配合默契是手术成功的关键。

Objective：To approach the safety and the value in clinical application of abdominal umbilical venopuncture by B-ultrasound guiding.Methods：To retrospective analyze 969 pregnant women who had done abdominal umbilical venopuncture bare-handed by B-ultrasound guiding during 2002.1-2009.12,including puncture achievement rate,time of operation and complication.Results：Puncture achievement rate first order is 96.8%,the rate second order is 99.38%.Time of puncture less than 10 minutes are 934 cases.In those cases,28 cases during 10-25 minutes,7 cases more than 30 minutes.Operative complication： There are 148 cases occurred umbilical errhysis（15 seconds）,the incidence rate is 15.27%（148/969）.There are 338 cases had done through the placenta,146 cases of those occurred placenta errhysis（30 seconds）,the rate is 43.19%（146/969）.Fetal heart stepped down during operation in 38 cases,the rate is 3.92%（38/969）.Salvage successfully in 37 cases,2 cases occurred dead fetus in uterus.2 cases occurred abortion,9 cases occurred premature delivery.1 case occurred chorioamnionitis,8 cases occurred fetal loss（0.825%）.Conclusion：Abdominal umbilical venopuncture by B-ultrasound guiding is a safe,convenient,feasible way in prenatal diagnosis.Master proficiently of operative technique,and combination tacit agreement is important turning point of success.