挤压脐带断脐对胎龄小于32周早产儿贫血和黄疸的影响研究

Effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks

目的探讨挤压断脐对胎龄<32周早产儿贫血和黄疸的影响。方法选择135例胎龄<32周的早产儿作为研究对象,随机分为挤压脐带组、延迟断脐组和常规断脐组各45例。比较3组早产儿娩出后1 h内和出生后1周血红蛋白和红细胞压积、住院期间经皮胆红素峰值、光疗时间和贫血、病理性黄疸、红细胞增多症的发生率。结果挤压脐带断脐组40例、延迟断脐组42例和立即断脐组38例完成研究。挤压脐带断脐组和延迟断脐组出生后1 h内和出生后1周血红蛋白、红细胞压积高于立即断脐组(P<0.05),贫血发生率低于立即断脐组(P<0.05),而挤压脐带断脐组和延迟断脐组血红蛋白、红细胞压积和贫血发生率比较,差异无统计学意义(P>0.05);3组经皮胆红素峰值、光疗时间、病理性黄疸和红细胞增多症发生率比较,差异无统计学意义(P>0.05)。结论与立即断脐相比,挤压脐带断脐和延迟断脐均可降低胎龄<32周早产儿的贫血发生率,且不增加患病理性黄疸的风险。挤压脐带断脐可作为胎龄<32周且出生时有窒息早产儿首选的断脐方法。

Objective To investigate the effects of different umbilical cord ligation methods on anemia and jaun- dice in preterm infants with a gestational age less than 32 weeks. Methods A total of 135 pretenn infants with a gestational age less than 32 weeks were recruited and randomly divided into the umbilical cord milking group,the delayed cord clamping group and the immediate cord clamping group,with 45 cases in each group. Comparisons a- mong three groups were performed on hemoglobin,hematocrit at 1 h and 1 week after birth,and bilirubin peak,total time of phototherapy,the incidence of anemia,pathologic jaundice as well as polycythemia before discharge. Results Finally 40 cases in the umbilical cord milking group,42 cases in the delayed cord clamping group and 38 cases in the immediate cord clamping group were recruited. Compared with the immediate cord clamping group,Hb（g/L） and hematocrit（%） levels were significantly higher in the umbilical cord milking group and the delayed cord clamping group（P〈0.05） ,the anemia rate was significantly lower in umbilical cord milking group and the delayed cord clamping group（P〈0.05）. However,there were no statistical differences in Hb（g/L） and hematocrit（%） levels as well as ane- mia rate between the umbilical cord milking group and the delayed cord clamping group （P〉0.05）. There were no significant differences among three groups in bilirubin peak ,total time of phototherapy and the incidence of patho- logic jaundice as well as polycythemia. Conclusion Umbilical cord milking and delayed cord clamping can both reduce the anemia rate ,but not increase the risk of pathological jaundice. Umbilical cord milking can be preferred method for preterm infants with a gestational age less than 32 weeks and asphyxia.