延迟脐带结扎对新生儿复苏的影响

Effect of delayed cord clamping on neonatal resuscitation

目的探讨延迟脐带结扎对新生儿复苏的影响。方法将2013年1月至2015年1月在吉林省妇幼保健院出生的7 429例足月新生儿随机分为观察组（n=3 727）和对照组（n=3 702）。观察组新生儿娩出后延迟脐带结扎2 min，对照组娩出后10 s内结扎脐带。比较2组窒息发生率、复苏成功率，窒息新生儿生后1及5 min Apgar评分，生后1 h血pH、碱剩余、血糖及肌钙蛋白I水平。采用t检验或χ2检验进行统计学分析。结果观察组新生儿窒息发生率低于对照组[0.75%（28/3 727）与1.21%（45/3 702），χ^2=4.115，P〈0.05]。观察组轻度、重度窒息发生率分别为0.62%（23/3 727）和0.13%（5/3 727），与对照组[分别为0.89%（33/3 702）和0.32%（12/3 702）]比较差异均无统计学意义（P值均〉0.05）。重度窒息新生儿生后1及5 min Apgar评分分别为（2.80±0.45）和（8.00±1.00）分，均高于对照组[分别为（2.08±0.67）和（6.25±1.66）分，t值分别为2.181和2.176，P值均〈0.05]。观察组窒息新生儿生后1 h血pH值高于对照组（7.16±0.41与7.13±0.72），血糖低于对照组[（5.91±1.19）与（6.60±1.56）mmol/L]，差异均有统计学意义（t值分别为2.068和2.046，P值均〈0.05）；2组碱剩余和血肌钙蛋白I差异均无统计学意义（P值均〉0.05）。观察组重度窒息新生儿生后血pH、碱剩余、血糖及肌钙蛋白I分别为7.08±0.29、（－16.82±0.60）mmol/L、（7.93±0.78）mmol/L和（0.203±0.041）ng/ml，与对照组[分别为7.02±0.56、（－17.43±0.35）mmol/L、（8.02±0.53）mmol/L和（0.249±0.035） ng/ml]比较差异均有统计学意义（t值分别为2.270、2.387、－2.371和－2.341，P值均〈0.05）。结论延迟结扎脐带2 min有助于降低窒息发生率，改善重度窒息的复苏效果。

Objective To investigate the effect of delayed cord clamping on outcomes of neonatal resuscitation. Methods Totally, 7 429 full term infants born in the Maternal and Child Health Care Hospital of Jilin from January 2013 to January 2015 were randomly divided into two groups, the observation group （n= 3 727） and the control （n=3 702）. The cords were clamped 2 rain delayed in the former group, while those in the latter group were clamped within 10 s after birth. The rate of asphyxia and successful resuscitation, Apgar score at 1 and 5 min after birth, and pH value, base excess （BE）, blood glucose, cardiac troponin （cTn） I at 1 h after birth were compared with t-test or Chi-square test. Results The incidence of neonatal asphyxia in the observation group was lower than in the control [0.75%（28/3 727） vs 1.2 1%（45/3 702）, χ^2=4. 115, P〈0.05], but no significant difference was found in the rate of mild or severe asphyxia between the two groups [0.62% （23/3 727） vs 0.89% （33/3702）, 0.13% （5/3 727） vs 0.32% （12/3 702）, all P〉0.05]. In observation group, those newborns who suffered from severe asphyxia had higher Apgar score at 1 and 5 rain than control （1 min： 2.80±0.45 vs 2.08 ±0.67, t=2.181 ; 5min： 8.00 ± 1.00 vs 6.25 ±1,66, t=2.176; both P〈0.05）. Higher blood pH value and lower glucose level were shown in the observation group than in the control group [7.16±0.41 vs 7.13±0.72, （5.91 ±1.19） vs （6.60±1.56） mmol/L, t=2.068 and 2.046, both P〈0.05]. However, no difference was found in BE and cTnl levels between the two groups （both P〉0.05）. For those babies with severe asphyxia, the blood pH, BE, blood glucose and cTnl levels in the observation group were significantly different from the control group [7.08±0.29 vs 7.02±0.56, （ - 16.82±0.60） vs （ - 17.43±0.35） retool/L, （7.93±0.78） vs （8.02±0.53） mmol/L and （0.203±0.041） vs （0.249±0.035） ng/ml, t-=2.270, 2.387, - 2.371 and - 2.341, all P〈0.05]. Conclusion Two minutes delayed in cord clamping could help to reduce the incidence of asphyxia and improve the effect of resuscitation in severe asphyxia.