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目的探讨双胎反向动脉灌注序列征(TRAP)中泵血儿与无心畸胎脐动脉血流阻力指数(RI)差值对预测泵血儿预后的临床价值。方法选择2009年至2014年在中国医科大学附属盛京医院超声科进行产前检查并诊断为TRAP的孕妇15例,年龄19~36岁,平均年龄26.53岁。孕周13~27周,平均孕周21.73周。应用超声分别测量泵血儿与无心畸胎脐动脉血流RI,并计算两者脐动脉血流RI差值。结果 3例泵血儿超声检查时出现心力衰竭表现,其脐动脉血流RI差值较小,分别约0.05、0.07、0.13,1周后复查发现胎死宫内;8例进行了射频消融术治疗,7例脐动脉血流RI差值为0.16~0.30,泵血儿存活;1例脐动脉血流RI差值为0.17,术后胎死宫内。1例脐动脉血流RI差值为0.34,因无心畸胎体内血流不丰富,而选择保守治疗。1例脐动脉血流RI差值为0.10,因母体妊娠中毒症而终止妊娠。1例泵血儿染色体异常,脐动脉血流RI差值为0.20。1例因孕周较小而选择引产。结论在TRAP的病例中,泵血儿与无心畸胎脐动脉血流RI的差值对于评估泵血儿的预后有重要意义,差值越大,预后相对较好。
Objective To investigate the clinical value of predicting the prognosis of pump blood by comparing the RI difference between umbilical artery and non-cardiac teratogenicity in twin reverse arterial perfusion sequence (TRAP). Methods From 2009 to 2014, 15 pregnant women were enrolled in the Department of Ultrasound, Shengjing Hospital Affiliated to China Medical University, and were diagnosed as TRAP. The age ranged from 19 to 36 years with a mean age of 26.53 years. 13-27 weeks gestational age, the average gestational age 21.73 weeks. The umbilical arterial blood flow RI and the umbilical artery RI were measured respectively by ultrasound and pump. Results The results of heart failure showed that the RI of the umbilical artery blood flow was small in three cases of pump blood sonography. The differences of RI in the umbilical artery blood flow were less than 0.05,0.07,0.13 respectively. The difference of RI in seven cases of umbilical artery blood flow was 0.16-0.30, and the pump blood vessel survived. In one case, the RI difference of umbilical artery blood flow was 0.17 and the intrauterine fetal death occurred after operation. 1 case of umbilical artery RI difference of 0.34, because of heartless teratogenic in vivo blood flow is not rich, and choose conservative treatment. 1 case of umbilical artery RI RI value of 0.10, termination of pregnancy due to maternal gestosis. One case of pump blood chromosomal abnormalities, umbilical artery RI RI value of 0.20.1 cases due to smaller gestational weeks choose to induce labor. Conclusion In TRAP cases, the difference of RI between pump blood and unartificial teratoid umbilical artery blood flow is of great significance in assessing the prognosis of pump blood. The bigger the difference is, the better the prognosis is.