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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (05) : 334 -341. doi: 10.3877/cma.j.issn.1672-6448.2017.05.002

所属专题: 总编推荐 妇产科超声影像学 ISUOG超声共识解读 文献 指南共识 妇产科超声

指南与规范

ISUOG临床应用指南:双胎妊娠超声诊断规范解读
徐金玉1, 吴青青1,()   
  1. 1. 100026 首都医科大学附属北京妇产医院超声医学科
  • 收稿日期:2016-10-31 出版日期:2017-05-01
  • 通信作者: 吴青青
  • 基金资助:
    北京市医院管理局"登峰"计划专项经费资助(DFL20151302); 首都卫生发展科研专项基金(2014-2-2113); 首都医科大学基础-临床科研合作基金项目(14JL08)

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy

Jinyu Xu1, Qingqing Wu1()   

  • Received:2016-10-31 Published:2017-05-01
  • Corresponding author: Qingqing Wu
引用本文:

徐金玉, 吴青青. ISUOG临床应用指南:双胎妊娠超声诊断规范解读[J]. 中华医学超声杂志(电子版), 2017, 14(05): 334-341.

Jinyu Xu, Qingqing Wu. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(05): 334-341.

表1 指南中使用的推荐等级及证据等级分类标准
证据等级 分类标准
1++ 高质量的Meta分析、随机对照试验的系统回顾或偏倚风险极低的随机对照试验
1+ 管理完善的Meta分析、随机对照试验的系统回顾或偏倚风险低的随机对照试验
1- Meta分析、随机对照试验的系统回顾或偏倚风险高的随机对照试验
2++ 高质量的病例对照或队列研究的系统回顾;高质量的混杂偏倚风险极低的病例对照研究或队列研究,且具有高度可能性的因果关系
2+ 管理完善的混杂偏倚风险低的病例对照研究或队列研究,且具有中等可能性的因果关系
2- 混杂偏倚风险高的病例对照研究或队列研究,且具有高度不明确的因果关系的风险
3 非分析研究,如病例报道、病例分析
4 专家意见
推荐等级 分类标准
A 至少一项证据等级1++的Meta分析、系统回顾或随机对照试验,直接针对目标人群,或主要由证据等级1+的研究构成的系列证据,直接针对目标人群并证明结果一致
B 证据等级2++的系列研究证据,直接针对目标人群并证明结果一致,或根据证据等级1++或1+研究推断的证据
C 证据等级2+的系列研究证据,直接针对目标人群并证明结果一致,或根据证据等级2++研究推断的证据
D 证据等级3级或4级,或根据证据等级2+研究推断的证据
良好的实践参考 基于指南制定小组专家的临床经验和观点,推荐的最佳临床实践
图1,2 双羊膜囊双胎妊娠孕早期超声声像图。图1 示双绒毛膜双羊膜囊双胎妊娠;图2 示单绒毛膜双羊膜囊双胎妊娠
图3 无合并症的双绒毛膜双胎妊娠的超声监测路径示意图
图4 无合并症的单绒毛膜双胎妊娠的超声监测路径示意图
图5~7 单绒毛膜双胎妊娠合并选择性胎儿宫内生长受限的不同分型超声声像图。图5为第Ⅰ型频谱图:脐动脉多普勒波形显示舒张末期正向血流;图6为第Ⅱ型频谱图:脐动脉多普勒波形显示舒张末期血流消失或反向;图7为第Ⅲ型频谱图:脐动脉多普勒波形显示间歇性舒张末期血流消失或反向
表2 指南中Quintero对双胎输血综合征的分期标准
表3 指南中双胎贫血-红细胞增多序列征的产前和产后分期标准
图8~11 合并双胎动脉反向灌注序列征的双胎妊娠超声声像图。图8为供血胎儿正中矢状切面超声声像图;图9~10为无心畸胎矢状切面超声声像图;图11通过宫内激光治疗阻断无心畸胎的血流,超声引导下行穿刺针定位,定位点位于无心畸胎近脐带插入点
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