大量胎母輸血綜合征致新生兒重度貧血臨床救治分析

［摘 要］" 目的" 分析大量胎母輸血綜合征（FMH）導致新生兒重度貧血的臨床特點及診治過程，以期提高對該疾病的認識及救治能力。 方法" 回顧分析2012年1月至2021年12月首都醫科大學附屬北京婦產醫院新生兒重癥監護病房（NICU）收治的大量FMH導致新生兒重度貧血病例的母嬰基本情況、疾病進程、治療經過及結局。 結果" 期間共39例孕婦確診為大量FMH，發病率為0.28‰（39/140 727）；最終有16例因大量FMH致新生兒重度貧血患兒納入研究，足月兒8例，早產兒8例。在16例大量FMH孕婦的臨床表現中，胎心監護均顯示異常，8例有胎動減少表現；對16例孕婦進行的KleihauerBetke酸洗脫試驗（KB試驗）中，14例為陽性，2例為陰性（KB試驗值分別為2.3%和1.2%）。在16例新生兒中，15例為急性剖宮產出生，1例自然分娩出生；新生兒出生后初始血紅蛋白（Hb）為20～70g/L；15例出生后積極進行輸血治療，1例因家屬放棄治療未輸血；其中4例合并新生兒顱內出血2級，2例合并重度新生兒血小板減少，1例合并失血性休克，1例合并胸腹腔積液和心力衰竭；有2例因家屬考慮預后不良放棄治療，其余14例均預后良好。 結論" 大量FMH是導致新生兒重度貧血的病因之一，在臨床中應加強對孕婦胎動的評估及宣教，孕晚期及時進行胎心監護，及早發現、盡早處理大量FMH，以及新生兒緊急輸血是改善圍產期兒預后的關鍵。

［關鍵詞］ 胎母輸血綜合征；新生兒貧血；輸血；機械通氣

Doi：10.3969/j.issn.1673-5293.2024.05.014

［中圖分類號］ R174"""" ［文獻標識碼］ A"""［文章編號］ 1673-5293（2024）05-0094-07

Clinical treatment analysis of severe neonatal anemia caused by massive fetomaternal hemorrhage

LI Minxia，ZHENG Haiyun，ZHANG Yanan，ZHANG Wei

（Beijing Obstetrics and Gynecology Hospital，Capital Medical University，Beijing 100026，China）

［Abstract］"" Objective" To analyze the clinical characteristics，diagnosis and treatment of severe neonatal anemia caused by massive fetomaternal hemorrhage （FMH），aim to improve understanding and treatment capabilities of this disease." Methods" We retrospectively analyzed the basic information，disease progression，treatment process，and outcomes of newborns with severe anemia due to massive FMH admitted to the neonatal intensive care unit （NICU） of Beijing Obstetrics and Gynecology Hospital，Capital Medical University，from January 2012 to December 2021." Results" During the study period，39 pregnant women were diagnosed massive FMH，with an incidence rate of 0.28‰ （39/140，727）.Ultimately，16 newborns with severe anemia due to massive FMH were included in the study，including 8 fullterm and 8 preterm infants.Among the clinical manifestations of the 16 pregnant women with massive FMH，8 exhibited reduced fetal movements，and abnormal fetal heart monitoring was observed in all cases.Among the 16 pregnant women who underwent KleihauerBetke acid elution tests （KB tests），14 were positive，and 2 were negative （with KB test values of 2.3% and 1.2%，respectively）.Among the 16 newborns，15 were born via emergency cesarean section，and 1 was delivered vaginally.Initial hemoglobin （Hb） levels at birth ranged from 20 to 70 g/L.15 newborns received blood transfusion therapy after birth，while 1 did not due to treatment refusal by the family.Among them，4 cases were complicated by grade 2 intracranial hemorrhage，2 cases by severe neonatal thrombocytopenia，1 case by hemorrhagic shock，and 1 case by pleural and abdominal effusion and heart failure.2 cases discontinued treatment due to poor prognosis consideration by the family，while the remaining 14 cases had a good prognosis." Conclusion" Massive FMH is one of the causes of severe anemia in newborns.Strengthening assessment and education on fetal movements in pregnant women，timely fetal heart monitoring in late pregnancy，early detection，and management of massive FMH，as well as emergency blood transfusion in newborns，are crucial for improving perinatal outcomes.

［Key words］" fetomaternal hemorrhage;neonatal anemia;blood transfusion;mechanical ventilation

胎母輸血綜合征（fetomaternal hemorrhage，FMH）是指孕產婦分娩前或分娩時胎兒紅細胞通過胎盤絨毛間隙進入母體血液循環，引起胎兒不同程度的失血及母體類似溶血性輸血反應的一類臨床癥候群 ［1］。……