羊膜腔穿刺术的医源性并发症研究

Iatrogenic complications research of amniocentesis

目的分析羊膜腔穿刺成功率的相关影响因素,正确评价羊膜腔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。方法通过大样本的回顾性研究,对孕16～24周要求产前诊断以及24周后要求行FISH检查的孕妇开展B超引导下羊膜腔穿刺术。分析2012年1月-2015年12月在青岛大学附属青岛妇女儿童医院接受羊膜腔穿刺术的6 484例(其中FISH 80例)孕妇的相关数据,穿刺术后由专人随访,随访至分娩,共5次,记录B超检查结果及妊娠结局。结果6 484例孕妇均穿刺成功,孕22+6周前首次穿刺成功率为97. 98%,孕23周后首次穿刺成功率为94. 17%。羊水指数≥8 cm者首次穿刺成功率为97. 60%,羊水指数<8 cm者首次穿刺成功率为92. 62%;穿刺层面数为3层(腹壁、子宫壁、胎盘)首次穿刺成功率为94. 96%,穿刺层面数为2层(腹壁、子宫壁)首次穿刺成功率为98. 46%。不同孕周、不同羊水指数、不同穿刺层面孕妇首次穿刺成功率比较差异均有统计学意义(P<0. 05)。共有医源性胎儿丢失4例,羊膜腔穿刺术导致胎膜早破1例、感染3例,综合风险率为0. 06%。结论羊膜腔穿刺术尽管为一种侵入性产前诊断方法,但其操作方便、术后并发症发生率低、对母儿影响小,是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率。

Objective To explore the influencing factors of the success rate of amniocentesis, and to evaluate the iatrogenic factors of amniocentesis resulting in fetal loss, bleeding, infection and so on. Methods A large sample of retrospective study was performed. The data of 6 484 pregnant women who received amnioeentesis from January 2012 to December 2015 were analyzed. All of the data come from the pregnant women required prenatal diagnosis between 16-24 weeks gestational （6 404 cases） and required fluorescence in situ hybridization （FISH） more than 24 weeks （ 80 cases） . Amniocenteses were guided by the ultrasound. After the puncture, the patients were followed up for 5 times, and the follow-up results （ results of Ultrasonic B and pregnancy outcomes） were recorded- Results The 6 484 amniocenteses were performed successfully. The success rate of first puncture before 22＋6 weeks gestational age was 97.98%, it was 94. 17% after 23 weeks. The success rate of first puncture for women whose amniotic fluid index （AFI） was larger than 8 em was 97.60%, it was 92. 62% for women whose AFI was less than 8 cm. When amniocenteses were finished through thrusting the abdominal wall, uterine wall, and the placenta, the success rate of first puncture was 94. 96%. When finished through thrusting the abdominal wall, uterine wall, it was 98. 46% - Above the differences were statistically significant （ P〈0. 05 ） . There were 4 cases of iatrogenic fetal loss, including 1 case of premature rupture of membranes （PROM） , 3 cases of infection. The comprehensive risk rate was 0. 062%. Conclusion Ahhough it is a kind of inva- sive prenatal diagnosis method, amniocenteses is convenient to operate, with lower incidence of postoperative complications and less effect on the mother and child. All above, amniocenteses is a safe and reliable technique for prenatal diagnosis, could effectively reduce the con- genital birth defects.