超声引导下经皮脐静脉穿刺术导致胎心率减慢的危险因素分析

Risk factor analysis of fetal bradycardia following percutaneous cordocentesis guided by ultrasound

目的分析超声引导下经皮脐静脉穿刺术所致胎心率减慢(fetal bradycardia following percutaneous cordocentesis,FBFC)的危险因素,为制定预防措施提供依据。方法回顾性分析2010年5月至2017年6月在中山市博爱医院进行超声引导下经皮脐静脉穿刺术的2181例孕妇的临床资料,根据是否发生FBFC分为FBFC组和胎心率正常组。对两组病例的母体因素、胎儿因素及手术因素进行单因素和多因素统计分析。结果FBFC组109例,胎心率正常组2072例,FBFC总发生率5.0%。单因素分析显示,与FBFC发生相关的因素包括:胎儿心血管系统异常、进针次数、穿刺时间、超声医师经验。多因素Logistic分析显示:穿刺进针2次、穿刺时间长、胎儿心血管系统异常及超声医师经验少(独立完成操作不足200例)可能是FBFC发生的独立危险因素。结论FBFC是超声引导下脐静脉穿刺术常见并发症,FBFC的发生受母体、胎儿及手术等诸多因素影响。应重视超声异常胎儿的脐静脉穿刺术,特别是心血管系统异常胎儿,提高医师超声定位技能,缩短穿刺时间和减少进针次数可减少FBFC的发生。

Objective To analyze the clinical risk factors of fetal bradycardia following percutaneous cordocentesis( FBFC) guided by ultrasound,and to provide the basis for the development of prevention. Methods Clinical data of 2 181 cases of ultrasound guided percutaneous cordocentesis performed in Boai Hospital from May 2010 to June 2017 were retrospectively analyzed. The patients were divided into FBFC group and normal fetal heart rate group( normal group) according to whether they had FBFC. Univariate and multivariate statistical analysis was performed on maternal,fetal,and surgical factors in the two groups. Results There were 109 cases in the FBFC group and 2 072 cases in the normal group. The overall incidence of FBFC was 5. 0 %. Univariate analysis showed that factors related to the occurrence of FBFC include: abnormal fetal cardiovascular system,number of needle insertions,puncture time,and ultrasound physician experience. Multivariate Logistic analysis showed that 2 times of puncture attempts,long puncture time,abnormal fetal cardiovascular system,and little experience of the ultrasound physician( less than 200 cases of independent operation)were independent risk factors for FBFC. Conclusion FBFC was a common complication of ultrasound guided percutaneous cordocentesis. A variety of factors such as maternal,fetal and operative variables have considerable impacts on FBFC. More attention should be paid to cordocentesis in abnormal fetuses detected by ultrasound,especially those with cardiovascular abnormality. The occurrence of FBFC could be reduced by improving the ultrasonic localization skills of physicians,shortening the operative duration and reducing the number of puncture attempts.