非免疫性胎儿水肿10例临床分析

Clinical analysis of non-immune hydrops in 10 fetuses

目的探讨非免疫性胎儿水肿(NIHF)的临床特点、诊断及治疗。方法回顾分析2011年1月—2016年12月新生儿重症监护病房中10例诊断NIHF新生儿的临床资料,并复习相关文献。结果 10例NIHF中,男6例、女4例,出生胎龄32~42周,出生体质量2.25~3.95 kg。其中感染性疾病3例(巨细胞病毒、无乳链球菌、微小病毒感染各1例),胎儿心血管异常2例,染色体异常2例,胸腔结构异常1例,双胎输血综合征1例,病因不明1例;临床表现为2处及以上水肿(或积液)8例,仅皮肤水肿2例。最终治愈出院6例,自动出院2例,死亡2例。结论产前超声是诊断NIHF的可靠方法。孕早期胎儿水肿,尤其伴有先天畸形建议终止妊娠。出生后的NIHF应及时诊治,以避免或减少严重并发症。

Objective To explore the clinical features,diagnosis,and treatment of non-immunologic hydrops fetalis(NIHF).Methods The clinical data of10cases of NIHF in neonatal intensive case unit during January2011to December2016were analyzed retrospectively.The related literatures were reviewed.Results In10cases of NIHF(6males and4females).the gestational age were32-42weeks,and the birth weight was2.25-3.95kg.Among them,there were3cases of infectious diseases(cytomegalovirus,Streptococcus agalactiae,and parvovirus infection,one case each),2cases of fetal cardiovascular abnormalities,2cases of chromosomal abnormalities,1case of abnormal thoracic structures,1case of twin transfusion syndrome,and1case of etiology unknown of fetal hydrops.The clinical manifestations showed that there were8cases with2or more areas of edema(or hydrops),and only2cases with skin edema.Finally,6cases were cured and discharged,2cases were discharged by themself,and2cases died.Conclusions Prenatal ultrasound is a reliable method for the diagnosis of NIHF.Fetal edema in early pregnancy,especially with congenital malformations,is recommended for termination of pregnancy.After birth,NIHF should be diagnosed promptly so as to avoid or reduce severe complications.