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已有报导,对于患重度Rh溶血病胎儿,在超声引导下经脐静脉穿刺,并在肝内脐静脉插入导管后施行直接血管内输血的治疗。本文报告1例32岁孕妇,胎次2,产次2-0-0-2,因Rh溶血(抗D)于28孕周时超声发现严重胎儿水肿,穿刺羊水光密度于450nm处为0.495,于是由外院转诊至北卡罗来纳纪念医院。来院后经多次超声检查,证实存在大量胎儿腹水,中度皮肤水肿,未见胸膜腔或心包腔积液,胎盘厚度为8.2cm,鉴于病情严重即决定在超声引导下作静脉穿刺与直接输血治疗。患者经注射镇静剂和局麻后先在超声下找到脐静脉胎盘附着处,选择静脉穿刺点。然后将19号导管经皮穿刺入羊膜腔,抽出针芯,使用26号针头带18cm长的21号输血针管沿导管进入羊膜腔,超声引导下穿刺
It has been reported that for severe Rh hemolytic disease fetuses, ultrasound-guided percutaneous umbilical vein puncture and catheterization into the intrahepatic umbilical vein are performed after direct intravascular transfusions. This article reports a 32-year-old pregnant woman, parity 2, the production of 2-0-0-2, due to Rh hemolysis (anti-D) in 28 gestational weeks found severe fetal edema ultrasound, the amniotic fluid optical density at 450nm at 0.495, So referral from the outer court to North Carolina Memorial Hospital. To hospital after repeated ultrasound examination, confirmed the existence of a large number of fetal ascites, moderate skin edema, no pleural cavity or pericardial effusion, placental thickness of 8.2cm, in view of the serious condition that is determined under ultrasound-guided venipuncture and direct transfusion treatment. After the patient was injected with sedatives and local anesthesia, umbilical vein placental attachment was found under ultrasound and venipuncture points were selected. Then the 19 catheter percutaneous puncture into the amniotic cavity, the needle out, the use of a 26-gauge needle with a 18cm long 21-gauge transfusion tube along the catheter into the amniotic cavity, ultrasound-guided puncture