【摘要】 目的分析脐静脉穿刺术导致的胎心率减慢（fetal bradycardia following cordocentesis,FBFC）病例的临床特点和妊娠结局,评估阿托品的使用对FBFC妊娠结局的影响。方法回顾性分析2010年5月至2016年12月在中山市博爱医院产前诊断中心行脐静脉穿刺术的产前诊断病例2 110例,其中发生FBFC 120例。发生FBFC的孕妇采取左侧卧位、加大吸氧、必要时静脉推注阿托品及静脉滴注碳酸氢钠溶液等临床处理,并用超声连续观察胎心率恢复情况。总结FBFC发生率、胎心率恢复时间、胎儿丢失率。比较术中发生的FBFC和术后发生的FBFC病例的阿托品使用率和胎心率恢复时间。用早产率、剖宫产率、分娩孕周及新生儿出生体重等指标评估妊娠结局。结果 FBFC发生率为5. 7%（120/2 110）。胎心率平均恢复时间为6. 6 min（1～20 min）,胎儿丢失率为0. 8%（1/120）。与FBFC术后发生组比较,术中发生组的阿托品使用率更高（69%vs41%,P=0. 003）、胎心率恢复时间更长（8. 3 min vs 5. 7 min,P=0. 003）。除13例因产前诊断异常或胎儿超声异常而终止妊娠外,其余病例早产率为13. 6%,剖宫产率为38. 8%,平均分娩孕周为38. 8周(31⁺⁴～42⁺¹周),平均新生儿出生体重为3. 0 kg（1. 6～4. 1 kg）。使用阿托品和未使用阿托品的FBFC在早产率、剖宫产率、分娩孕周及新生儿出生体重上比较,差异无统计学意义（P> 0. 05）。结论胎心率减慢是脐静脉穿刺术常见的并发症之一。FBFC的胎儿丢失率低,且不影响妊娠结局。术中发生的胎心率减慢比术后发生的更难恢复,应尽量减少术中发生FBFC。使用阿托品帮助胎心率快速恢复不增加不良妊娠结局发生的风险。更多还原

【Abstract】 Objective To perform retrospective analysis of the clinical characteristics and pregnancy outcomes of fetal bradycardia following cordocentesis（ FBFC）,and assess the effects of atropine on pregnancy outcomes after FBFC. Methods 120 cases of FBFC from May 2010 to December 2016 in Boai Hospital of Zhongshan were recruited. The pregnant women with FBFC were treated with the left lateral recumbent position and increased oxygen supplementation,and if necessary,intravenous administration of atropine and sodium bicarbonate solution. Meanwhile the fetal heart rate（ FHR） was monitored before it returned to normal by the continuous ultrasound. Incidence,FHR recovery time and fetal loss rate of FBFC were measured. Comparative analysis of the rate of atropine usage and the FHR recovery time was performed between intraoperative and postoperative FBFC. Preterm birth rate,cesarean section rate,gestational age of delivery and birth weight were used to assess the pregnancy outcomes of FBFC. Results The incidence of FBFC was 5. 7 %（ 120/2 110）. The average FHR recovery time was 6. 6 min（ 1 ～ 20 min）. The fetal loss rate was 0. 8 %（ 1/120）.Comparing with the postoperative FBFC group,in the intraoperative group,the usage rate of atropine was higher（ 69 % vs 41 %,P =0. 003） and the FHR recovery time was longer（ 8. 3 min vs 5. 7 min,P = 0. 003）. Pregnancy was terminated in 13 cases,which were excluded from further analysis,due to fetal abnormalities diagnosed by genetic testing or ultrasound. Of the rest cases,the premature birth rate and the cesarean section rate were 13. 6 % and 38. 8 % respectively,with the average gestational age of delivery at 38. 8weeks( 31⁺ 4～42^{+ 1}week) and the average birth weight at 3. 0 kg（ 1. 6 ～ 4. 1 kg）. There were no statistically significant differences between groups of FBFC treated with and without atropine on the preterm birth rate,cesarean section rate,gestational age of delivery and birth weight. Conclusion Fetal bradycardia is one of the common complications of cordocentesis,with low fetal loss rate and no adverse pregnancy outcome. The outcome of intraoperative FBFC may be more severe than that of postoperative one,and therefore intraoperative FBFC should be put under strict control. Administration of atropine to help FHR recovery probably does not increase the risks of adverse pregnancy outcomes.更多还原