【摘要】：目的驗(yàn)證雙胎輸血綜合征(TTTS)新生兒腦損傷起源于宮內(nèi)還是宮外。方法前瞻性隊(duì)列研究設(shè)計(jì),在同一醫(yī)院以超聲作為TTTS、顱內(nèi)出血和腦室周圍白質(zhì)軟化的診斷工具,納入孕34周前分娩的接受雙胎兒顱腦超聲和生后2 d內(nèi)新生兒顱腦超聲檢查的TTTS孕婦。排除雙胎兒均宮內(nèi)死亡和雙胎之一嚴(yán)重結(jié)構(gòu)異�；蛉旧w異常。結(jié)果 47例TTTS孕婦的94例胎兒進(jìn)入本文分析,孕婦中位年齡31(18~46)歲,TTTS診斷孕周16~28周,終止妊娠孕周28~33+5周。QuinteroⅠ、Ⅱ、Ⅲ、Ⅳ和Ⅴ期分別為7、9、17、8和6例。Ⅴ期6例胎兒期死亡,6例存活胎兒均發(fā)生顱內(nèi)出血合并腦白質(zhì)軟化。88例胎兒超聲發(fā)現(xiàn)19例腦損傷(21.6%),受血兒5例,供血兒14例,受血兒26.3%vs供血兒73.6%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。TTTS的Ⅲ~Ⅴ級(jí)腦損傷17例,Ⅰ~Ⅱ級(jí)2例,Ⅲ~Ⅴ級(jí)30.3%vsⅠ~Ⅱ6.2%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。孕19~28周接受羊水減量術(shù)治療13/47例(27.7%),均未在治療后新發(fā)現(xiàn)腦損傷。88例均為早產(chǎn)兒,胎齡(30.5±4.5)周。受血兒體重(1 607±438)g,供血兒體重(1 257±403)g,生后24 h因新生兒窒息死亡4例。84例早產(chǎn)兒中頭顱超聲發(fā)現(xiàn)24例腦損傷(28.6%),受血兒9例,供血兒15例,受血兒37.5%vs供血兒62.5%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。顱內(nèi)出血Ⅰ級(jí)5例,均為生后診斷且不合并腦白質(zhì)軟化。顱內(nèi)出血Ⅱ級(jí)中,胎兒階段11例,新生兒階段增加了4例顱內(nèi)出血Ⅱ級(jí),其中1例合并腦白質(zhì)軟化,3例轉(zhuǎn)為顱內(nèi)出血Ⅲ級(jí)伴腦白質(zhì)軟化,無(wú)死亡。顱內(nèi)出血Ⅲ級(jí)中,胎兒階段5例均合并腦白質(zhì)軟化,新生兒階段5例,3例由顱內(nèi)出血Ⅱ級(jí)進(jìn)展,死亡1例。顱內(nèi)出血Ⅳ級(jí)中,胎兒階段3例均合并腦白質(zhì)軟化,新生兒階段2例均由顱內(nèi)出血Ⅲ級(jí)進(jìn)展,均死亡。結(jié)論 TTTS胎兒產(chǎn)前腦受損已出現(xiàn),與早產(chǎn)共同造成腦損傷,以腦室出血、腦室白質(zhì)軟化為多見(jiàn)。對(duì)于所有存活兒都應(yīng)該進(jìn)行產(chǎn)前規(guī)范的超聲監(jiān)測(cè)及生后及時(shí)的新生兒頭顱超聲篩查。
[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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