目的 探讨应用超声引导自由手技术行脐静脉穿刺在产前诊断中的可行性、成功率及临床价值.方法 2008年9月至2010年3月于上海交通大学医学院附属国际和平妇幼保健院,应用超声引导自由手技术对134例有产前诊断指征的中晚孕孕妇行脐静脉穿刺术(自由手组),明确界定穿刺1次成功的评判标准,并与81例经穿刺架引导行脐静脉穿刺者(穿刺架组)进行对照研究,分析应用自由手技术的优势、影响其一次穿刺成功的因素以及穿刺并发症.结果 自由手组与穿刺架组总穿刺成功率及一次进针成功率差异无统计学意义(96.3%、95.1%;64.3%、61.0%),当1次进针穿刺失败,需再次穿刺时,自由手技术可明显减少经皮肤穿刺的次数.穿刺熟练程度、脐静脉直径、前壁胎盘、穿刺路径的长短是影响自由手一次穿刺成功的主要因素,穿刺次数与并发症明显相关.结论 超声引导自由手技术经严格训练后可有效提高脐静脉穿刺质量,值得临床推广.%Objective To discuss the feasibility, the rate of success and clinical value in cordocentesis by ultrasoundguided free-hand puncture for prenatal diaguosis. Methods Cordocentesis by ultrasound-guided free-hand technique and guidance support system were respectively performed in 134 and 81 pregnancy women at second or third trimester for prenatal diagnosis. Clearly set down standard for puncture times. Discussed the advantage, influencing factors for one times successful puncture,and complications when cordocentesis was performed by ultrasound-guided free-hand puncture. Results The total successful rate of puncture was 96. 3％ ,95. 1％ and one puncture was 64. 3％ ,61.0％ ,which both have no significant difference in two methods. When one puncture was failure and the second puncture should be done again,cordocentesis by free-hand would greatly reduce the puncture times through the skin. Proficiency degree, umbilical vein diameter, anterior placenta and the length of puncture path were major factors for influencing successful puncture. The puncture times was correlative with complications. Conclusion There are many merits by ultrasound-guided free-hand puncture such as only common ultrasound probe used with one-off asepsis plastic sheath, which could reduce probe spoilage and the possibility of infection. Simultaneously, the operator independently can operate cordocentesis by strictly training which means that one cerebellum is better than two for coordination.
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