脐血管穿刺术的医源性并发症研究

Study on iatrogenic complications of cordocentesis

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 related influencing factors of successful rate of cordocentesis, correctly evaluate the relationships between iatrogenic factors of cordocentesis and complications （postoperative fetus loss, placental hemorrhage, and infection, and so on） . Methods The related data of 340 pregnant women undergoing cordocentesis from 2012 to 2015 were analyzed retrospectively. All the cases were followed up after cordocentesis for five times from end of cordoeentesis to delivery. The results of uhrasonography and pregnancy out- comes were recorded. Results Cordocentesis was performed successfully in 340 cases. The successful rates of the first puncture before 25 ＋6 gestational week and after 26 gestational week were 90. 00% and 94. 17%, respectively. The successful rate of cordocentesis through thrust- ing abdominal wall, uterine wall, and placenta was 84. 62% ; the successful rate of cordocentesis through thrusting abdominal wall and uter- ine wall was 94. 02%. The successful rates of cordocentesis with puncture location away from and close to placenta were 88. 34% and 97. 18%, respectively. There were statistically significant differences in successful rates of cordocentesis （ all P〈0. 05） . In this study, two cases of iatrogenic fetal loss were found, the comprehensive risk rate was 0. 5%. Conclusion Cordocentesis has the advantages of conven- ience, low incidence rate of postoperative complications, and low maternal and infantile risk, although it is a kind of invasive prenatal diag- nosis method, cordocentesis is a safe and reliable technique for prenatal diagnosis, which can effectively reduce congenital birth defects.