挤压脐带及延迟脐带结扎对早产儿平均血压、脑血流及新生儿神经行为测定评分的影响

Effect of umbilical cord milking and delayed cord clamping on mean blood pressure,cerebral blood flow and neurological assessment score in preterm infants

目的:观察挤压脐带及延迟脐带结扎对早产儿平均血压、脑血流及新生儿神经行为测定评分的影响。方法:选择120例胎龄为34-35周的早产儿,随机分为生后立即结扎脐带(ICC)组、挤压脐带(UCM)组及延迟脐带结扎(DCC)组,每组各40例。新生儿于出生后2 h及24 h行平均血压(MBP)及脑血流测定,早产儿于纠正胎龄至预产期时行新生儿神经行为测定(NBNA)测定。脑血流参数分别为收缩期峰值流速(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)和阻力指数(RI)。结果:DCC组与UCM组早产儿生后2 h及24 h MBP均高于ICC组早产儿,差异有统计学意义(P<0.01),而DCC组与UCM组早产儿MBP比较,差异无统计学意义(P>0.05)。ICC组、DCC组及UCM组间早产儿脑血流参数比较,差异无统计学意义(P>0.05)。ICC组、DCC组及UCM组间早产儿NBNA评分比较,差异无统计学意义(P>0.05)。结论:DCC与UCM可以增加早产儿MBP,对脑血流及NBNA评分无明显影响。

Objective To investigate the effect of umbilical cord milking and delayed cord clamping on mean blood pressure, cerebral blood flow and neurological assessment score in preterm infants. Method 120 preterm infants deliveried between 34 and 35 weeks gestation were enxolled in study. They were randomly divided into immediate cord clamping （ICC） group, umbilical cord milking（UCM） group and delayed cord clamping （DCC） group. 40 cases in each group. Cerebral blood flow and mean blood pressure （MBP）were evaluated in 2 hours and 24 hours after birth. Neonatal Behavioral Neurological Assessment （NBNA） was e- valuated on expected date of delivery. The cerebral blood flow of middle cerebral artery （MCA） of all research objects monitored by transcranial Doppler. The parameters were peak systolic velocity （Vs）, end diastolic velocity （Va ）, mean flow velocity （Vm） and resistance index （RI）. NBNA scores were recorded. Results MBP of preterm infants in DCC group and UCM group were sig- nificantly higher than those in ICC group （ P 〈 0. 0l ） , while there was no significant difference between DCC group and UCM group （ P 〉 0. 05 ）. There was no significant statistical significance in the cerebral blood flow parameters between ICC group, DCC group and UCM group（ P 〉 0. Q5 ）. There was no significant statistical significance in NBNA between [CC group ,DCC group and UCM group （ P 〉 0. 05 ）. Conclusion DCC and UCM could increase the MBP of preterm infants, and had no significant effect on the cerebral blood flow and NBNA score.