双胎输血综合征患者的围产结局分析

摘要

Objective To investigate the perinatal outcomes of twin-twin transfusion syndrome (TTTS)and the management.Methods During Nov 1, 2002 to Sep 30, 2005, 24 cases of TTTS in Beijing Obstetrics and Gynecology Hospital were analyzed.The outcomes of them were compared with the pregnancy without TTTS in all twins and in monozygotic twins.The outcomes of the blood-supplying fetus and the blood-recepter were compared.Results 6.8%cases had TTTS in all twins.The group of TTTS had more maternal,fetal and neonatal complications than twins pregnancy without TTTS :polyhydramnios [37.5%(9/24)vs 2.1%(7/328),P＜0.01],gestational hypertension[20.8%(5/24)vs 7.0%(23/328),P=0.043],premature labor[66.7%(16/24)vs 36.3%(119/328),P=0.003],perinatal dead fetus in uterus[18.8%(6/32)vs 1.1%(7/540),P＜0.01],neonatal asphyxia[73.1%(19/26)vs 3.0%(19/632),P＜0.01],the proportion of NICU[88.5%(23/26)vs 23.4%(148/632),P＜0.01],neonatal death [15.4%(4/26)vs 1.7%(11/632),P=0.002 ]and the rate of perinatal mortality [31.2%(0/32)vs 2.8%(18/632)].Compared with the monozygotic twins without TTTS,in TTTS group there were more complications of the mother,the fetus and the neonates:gestational hypertension[20.8%(5/24)vs 9.9%(14/142),P=0.224],premature labor[66.7%(16/24)vs 49.3%(70/142),P=0.115 ],perinatal dead fetus in uterus [ 18.8%(6/32)vs 0.7%(2/282),P＜0.01 ],neonatal asphyxia [73.1%(19/26)vs3.9%(11/280),P＜0.01 ],the proportion of NICU[88.5%(23/26)vs 29.3%(82/280),P＜0.01],neonatal death[15.4%(4/26) vs 2.1%(6/280),P:0.006]and the rate of perinatal mortality[31.3%(10/32) vs 3.2%(8/282)].The perinatal outcomes were better in those cases that the grades of TTTS were below 3 in the first diagnosis.Conclusions We should try to diagnose and treat TTTS as early as possible because the outcome is poor.%目的 探讨双胎输血综合征患者的围产结局分析.方法 选择2002年11月1日-2005年9月30日在北京妇产医院住院分娩的双胎妊娠孕妇352例,其中合并双胎输血综合征(TTTS)的24例患者及其双胎儿为TTTS组,不合并TTTS的328例患者及其双胎儿为对照组,比较两组围产结局;比较对照组中单卵双胎与TTTS组的母儿预后差异;比较TTTS组中供血儿和受血儿的预后差异;探讨TTTS分级对围产结局的影响;按照2004年Bajoria提出的诊断标准进行TTTS的诊断和分级.结果 (1)TTTS发生率:TTTS的发生率为6.8%(24/352).(2)合并症及并发症:TTTS组羊水过多[37.5%(9/24)]、妊娠期高血压疾病[20.8%(5/24)]和早产[66.7%(16/24)]的发生率明显高于对照组[分别为2.1%(7/328)、7.0%(23/328)、36.3%(119/328)],两组比较,差异有统计学意义(P＜0.05).(3)围产儿结局:TTTS组围产儿胎死宫内[18.8%(6/32)]、新生儿窒息[73.1%(19/26)]、转入新生儿ICU[88.5%(23/26)]、新生儿死亡[15.4%(4/26)]和围产儿死亡的发生率[31.3%(10/32)]也明显高于对照组[分别为1.1%(7/640)、3.0%(19/632)、23.4%(148/632)、1.7%(11/632)、2.8%(18/632)],两组比较,差异均无统计学意义(P＞0.01).(4)与对照组中单卵双胎患者的合并症及并发症比较:TTTS组妊娠期高血压疾病和早产的发生率明显高于对照组中单卵双胎[分别为9.9%(14/142)和49.3%(70/142)],两者比较,差异均无统计学意义(P＞0.05).(5)与对照组中单卵双胎围产儿结局比较:TTTS组围产儿胎死宫内、新生儿窒息、转入新生儿ICU、新生儿死亡和围产儿死亡率均明显高于对照组中单卵双胎[分别为0.7%(2/282)、3.9%(11/280)、29.3%(82/280)、2.1%(6/280)、3.2%(8/282)],差异均有统计学意义(P＜0.01).(6)TTTS分级对围产结局的影响:TTTS Ⅰ～Ⅲ级者的围产结局优于Ⅳ～Ⅴ级者,但差异无统计学意义(P＞0.05).结论 双胎妊娠合并TTTS患者的围产结局不良,应及早诊治.