摘要
目的评价复杂性单绒毛膜双羊膜囊双胎射频消融减胎(RFA)术后保留胎心功能。方法选择2013年12月至2015年7月中山大学附属第一医院胎儿医学中心确诊复杂性单绒毛膜双羊膜囊双胎19例[双胎输血综合征(TTTS)10例、选择性宫内生长受限(sIUGR)9例]为研究对象,术前、术后24 h、术后3 d、术后1周、术后1个月、术后2个月测量保留胎心血管整体评分(CVPS),左、右心室Tei指数,每例研究对象按孕周匹配1例正常胎为对照组,同期测量上述参数。结果1.TTTS:CVPS术后3 d[(8.71±1.11)分]较术前[(6.86±2.12)分]明显升高,差异有统计学意义(t=2.571,P〈0.05),CVPS术后1个月[(9.29±0.95)分]与对照组[(10.00±0.00)分]比较,差异无统计学意义(P〉0.05);左、右心室Tei指数术后1个月(左心室:0.41±0.06,右心室:0.42±0.06)较术前(左心室:0.66±0.19,右心室:0.63±0.12)明显降低,差异有统计学意义(左心室:t=-3.193,P〈0.05;右心室:t=-3.565,P〈0.05),左、右心室Tei指数术后1个月与对照组(左心室:0.35±0.03,右心室:0.35±0.03)比较,差异均无统计学意义(均P〉0.05)。2.sIUGR:CVPS术后1周[(9.71±0.45)分]与对照组[(10.00±0.00)分]比较,差异无统计学意义(P〉0.05);左、右心室Tei指数术后1周(左心室:0.39±0.04,右心室:0.38±0.04)较术前(左心室:0.47±0.06,右心室:0.47±0.05)明显降低,差异均有统计学意义(左心室:t=-6.687,P〈0.01;右心室:t=-6.000,P〈0.01),右心室Tei指数术后1周(0.38±0.04)与对照组比较,差异无统计学意义(P〉0.05),左心室Tei指数术后1个月(0.36±0.02)与对照组比较,差异无统计学意义(P〉0.05)。结论TTTS和sIUGR RFA术后保留胎心功能均有明显恢复,TTTS保留胎心功能术后1个月基本正常,sIUGR保留胎心功能术后1周基本正常。
ObjectiveTo evaluate retained fetal cardiovascular function after radio frequency ablation in complicated monochorionic diamnionic twins.Methods A total of 19 complicated monochorionic diamnionic twins[10 twin-twin transfusion syndrome(TTTS)and 9 selective intrauterine growth restricted(sIUGR)]who were diagnosed at Fetal Medicine Center of the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to July 2015 were enrolled,and the cardiovascular profile score(CVPS)and Tei index of retained fetus were measured preoperatively and postoperatively at 24 h,3 days,1 week,1 month,2 months respectively.Each case was matched by normal fetuses with same gestational age as control group and the same parameters were measured.Results(1)TTTS:CVPS[(8.71±1.11)scores]was increased significantly at 3 days postoperatively compared with preoperation[(6.86±2.12)scores],and there was a statistical significance(t=2.571,P〈0.05);CVPS[(9.29±0.95)scores]had no statistical significance 1 month postoperatively(P〉0.05)as compared with controls[(10.00±0.00)scores].Tei indexes of the left ventricle(LV-Tei)(0.41±0.06)and Tei indexes of the right ventricle(RV-Tei)(0.42±0.06)decreased as compared with those before operation(LV-Tei:0.66±0.19,RV-Tei:0.63±0.12)with sig-nificant difference(LV:t=-3.193,P〈0.05;RV:t=-3.565,P〈0.05),but there was no statistical significance 1 month after operation(all P〉0.05)as compared with the controls(LV-Tei:0.35±0.03,RV-Tei:0.35±0.03).(2)sIUGR:CVPS[(9.71±0.45)scores]showed no statistical significance 1 week after operation(P〉0.05)as compared with controls[(10.00±0.00)scores].Tei indexes of the right and left ventricle 1 week after operation were lower than after operation with significant difference(LV-Tei:0.39±0.04 vs.0.47±0.06,t=-6.687,P〈0.01;RV-Tei:0.38±0.04 vs.0.47±0.05,t=-6.000,P〈0.01).Compared with the controls,RV-Tei(0.38±0.04)had no statistical significance 1 week after operation(P〉0.05),LV-Tei(0.36±0.02)showed no statistical significance 1 month after operation(P〉0.05).Conclusions Retained fetal cardiovascular function of TTTS and sIUGR can be restored obviously after operation.In TTTS,its cardiovascular function is recovered completely 1 month postope-ratively.In sIUGR,its cardiovascular function is recovered completely 1 week postoperatively.
作者
张兴
彭慧敏
巴宏军
李轩狄
王慧深
Zhang Xing;Peng Huimin;Ba Hongjun;Li Xuandi;Wang Huishen(Department of Pediatric Cardiology,the First Affiliated Hospital,Sun Yat—Sen University,Guangzhou 510080,China;Department f Cardiovasology,Kunming Children s Hospital Kunming 650100,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第13期986-989,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
单绒毛膜双羊膜囊双胎
射频消融
减胎
心功能
超声心动图
Monochorionic diamnionic twins
Radio frequency
Ablation
Cardiac function
Echocardiogram
