双胎输血综合征早产儿合并心脏发育异常的临床分析

Clinical analysis of twin-twin transfusion syndrome complicated by cardiac abnormalities in preterm infants

摘要:

目的 探讨双胎输血综合征（TTTS）早产儿合并症发生情况，分析TTTS受血者合并心脏发育异常的临床情况及预后。方法 对2009年6月至2012年12月收治的17对确诊TTTS的早产儿进行回顾性分析。结果 TTTS早产儿供血者体重（1.4±0.6 kg）较受血者体重（1.9±0.6 kg）明显减轻（P<0.05）。经过孕期干预治疗，17对TTTS早产儿中，发生心脏合并症（14例）和脑损伤（12例）患儿较多，其中受血者合并心脏发育异常比例（60%）较供血者高（24%）。10例发生了心脏合并症的受血者中，心脏发育异常主要类型为瓣膜增厚、狭窄或闭锁（50%）。结论 TTTS受血者心脏瓣膜病变和心肌病变合并症发生率高，受血者应该尽早完善胎儿超声心动图，评估心功能，早期治疗以改善预后。

Abstract:

Objective To investigate the complications of twin-twin transfusion syndrome (TTTS) in preterm infants and to analyze the clinical conditions and prognosis of cardiac abnormalities in TTTS recipients. Methods A retrospective analysis was performed on the clinical data of 17 pairs of preterm infants with TTTS born between June 2009 and December 2012. Results Compared with the recipients, the donors had significantly lower body weights (1.4±0.6 kg vs 1.9±0.6 kg; P<0.05). With treatment during pregnancy, cardiac complications were found in 14 cases, and brain injuries in 12 cases. The proportion of recipients with cardiac abnormalities (60%) was higher than that of donors (24%). Among 10 recipients who had cardiac complications, cardiac abnormalities mainly included valve thickening, stenosis, or atresia (50%). Conclusions Among preterm infants with TTTS, the recipients are more susceptible to complications of valvular heart disease and cardiomyopathy. Fetal echocardiography, evaluation of cardiac function, and treatment should be performed for recipients as early as possible to improve the prognosis.