中国全科医学 ›› 2018, Vol. 21 ›› Issue (35): 4289-4294.DOI: 10.12114/j.issn.1007-9572.2018.00.365

所属专题: 指南/共识最新文章合集

• 专题研究 •    下一篇

非免疫性胎儿水肿的诊疗新进展——2018年《非免疫性胎儿水肿的调查和管理指南》解读

侯磊,王欣*   

  1. 100026北京市,首都医科大学附属北京妇产医院
    *通信作者:王欣,主任医师,教授;E-mail:wx1501@aliyun.com
  • 出版日期:2018-12-15 发布日期:2018-12-15

Interpretation of SOGC Clinical Practice Guideline:No. 363—Investigation and Management of Non-immune Fetal Hydrops 

HOU Lei,WANG Xin*   

  1. Beijing Obstetrics & Gynecology Hospital,Capital Medical University,Beijing 100026,China
    *Corresponding author:WANG Xin,Chief physician,Professor;E-mail:wx1501@aliyun.com
  • Published:2018-12-15 Online:2018-12-15

摘要: 胎儿水肿是较为棘手的胎儿医学问题,2018年加拿大妇产科医生协会(SOGC)发布了《非免疫性胎儿水肿的调查和管理指南》(以下简称2018版指南),与2014年美国母胎医学会发布的指南相比较,2018版指南结合近年来的主要研究成果,对非免疫性胎儿水肿(NIFH)进行总结,并提出了一些新的诊治意见。快速及时的诊治可显著改善胎儿贫血、胎儿心律失常等原因导致的水肿胎儿的预后,2018版指南更加强调了水肿胎儿及时转诊的重要性,建议一旦发现胎儿水肿立即转诊到三级医院进行诊疗;推荐对所有NIFH胎儿进行微阵列比较基因组杂交技术检测及大脑中动脉血流超声评估以明确病因;2018版指南还强调了对死亡胎儿或新生儿尸检的重要性,对代谢病引起的胎儿水肿进行了详细的描述。本指南是近4年来唯一发表的NIFH专题指南,对临床有一定指导意义。

关键词: 胎儿水肿, 疾病管理, 诊断, 治疗, 指南

Abstract: Fetal hydrops is a rather challenging clinical problem.In 2018,the Society of Obstetricians and Gynaecologists of Canada(SOGC) published a clinical practice guideline named No. 363—Investigation and Management of Non-immune Fetal Hydrops(hereinafter referred to as 2018 version guideline).Compared with the Society for Maternal-Fetal Medicine(SMFM) clinical guideline #7:nonimmune hydrops fetalis issued in 2014,the 2018 version guideline puts forward some new recommendations on the management of non-immune fetal hydrops on the basis of summarizing the major evidences provided by recent studies.The 2018 version guideline emphasizes the great significance of timely referral for fetal hydrops and suggests that all patients with fetal hydrops should be referred promptly to a tertiary care centre for evaluation,because rapid and timely diagnosis and treatment can significantly improve the prognosis of fetal hydrops caused by fetal anemia,arrhythmia and other factors.Moreover,it suggests that the array CGH(microarray) molecular testing and Doppler measurement of the middle cerebral artery peak systolic velocity should be performed in all hydropic fetuses in order to identify the causes of this disease.Autopsy is strongly recommended for all cases of fetal or neonatal death for which no diagnosis is reached prenatally.Furthermore,non-immune fetal hydrops associated with metabolic disorders are detailed.This guideline is the only one concerning non-immune fetal hydrops published in these 4 years,demonstrating great significance of guidance in clinical practice.

Key words: Hydrops fetalis, Disease management, Diagnosis, Therapy, Guidebooks