双胎输血综合征胎儿和生后2天脑损伤的队列研究

发布时间：2018-07-18 07:45

【摘要】：目的验证双胎输血综合征(TTTS)新生儿脑损伤起源于宫内还是宫外。方法前瞻性队列研究设计,在同一医院以超声作为TTTS、颅内出血和脑室周围白质软化的诊断工具,纳入孕34周前分娩的接受双胎儿颅脑超声和生后2 d内新生儿颅脑超声检查的TTTS孕妇。排除双胎儿均宫内死亡和双胎之一严重结构异常或染色体异常。结果 47例TTTS孕妇的94例胎儿进入本文分析,孕妇中位年龄31(18~46)岁,TTTS诊断孕周16~28周,终止妊娠孕周28~33+5周。QuinteroⅠ、Ⅱ、Ⅲ、Ⅳ和Ⅴ期分别为7、9、17、8和6例。Ⅴ期6例胎儿期死亡,6例存活胎儿均发生颅内出血合并脑白质软化。88例胎儿超声发现19例脑损伤(21.6%),受血儿5例,供血儿14例,受血儿26.3%vs供血儿73.6%,差异有统计学意义(P0.05)。TTTS的Ⅲ~Ⅴ级脑损伤17例,Ⅰ~Ⅱ级2例,Ⅲ~Ⅴ级30.3%vsⅠ~Ⅱ6.2%,差异有统计学意义(P0.05)。孕19~28周接受羊水减量术治疗13/47例(27.7%),均未在治疗后新发现脑损伤。88例均为早产儿,胎龄(30.5±4.5)周。受血儿体重(1 607±438)g,供血儿体重(1 257±403)g,生后24 h因新生儿窒息死亡4例。84例早产儿中头颅超声发现24例脑损伤(28.6%),受血儿9例,供血儿15例,受血儿37.5%vs供血儿62.5%,差异有统计学意义(P0.05)。颅内出血Ⅰ级5例,均为生后诊断且不合并脑白质软化。颅内出血Ⅱ级中,胎儿阶段11例,新生儿阶段增加了4例颅内出血Ⅱ级,其中1例合并脑白质软化,3例转为颅内出血Ⅲ级伴脑白质软化,无死亡。颅内出血Ⅲ级中,胎儿阶段5例均合并脑白质软化,新生儿阶段5例,3例由颅内出血Ⅱ级进展,死亡1例。颅内出血Ⅳ级中,胎儿阶段3例均合并脑白质软化,新生儿阶段2例均由颅内出血Ⅲ级进展,均死亡。结论 TTTS胎儿产前脑受损已出现,与早产共同造成脑损伤,以脑室出血、脑室白质软化为多见。对于所有存活儿都应该进行产前规范的超声监测及生后及时的新生儿头颅超声筛查。
[Abstract]:Objective to verify the origin of neonatal brain injury in twin transfusion syndrome (TTTS). Methods A prospective cohort study was designed to use ultrasound as a diagnostic tool for TTTS, intracranial hemorrhage and periventricular leukomalacia in the same hospital. Before 34 weeks of gestation, TTTS pregnant women who received double fetal craniocerebral ultrasound and neonatal craniocerebral ultrasound examination within 2 days after birth were included. Both intrauterine death and serious structural or chromosomal abnormalities were excluded. Results 94 fetuses of 47 pregnant women with TTTS were included in this analysis. The median age of pregnant women was 31 (18 ~ 46) years old. The diagnosis of TTTS was performed at 16 to 28 weeks of gestation, and the termination of gestational weeks was 2 833 5 weeks. Quintero 鈪，

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