延迟结扎脐带对阴道分娩早产儿脑室周围-脑室内出血的影响

Effects of delayed cord damping on periventricular-intraventricular hemorrhage in preterm infant with vaginal delivery

目的探讨延迟结扎脐带对阴道分娩早产儿脑室周围-脑室内出血（PIVH）的影响。方法选择2016年1月-2017年7月在无锡市妇幼保健院阴道分娩早产儿192例，随机分为延迟结扎脐带组（DCC组）94例和即时结扎脐带组（mc组）98例。DCC组至少60s或等待脐带搏动消失后再结扎脐带，不挤压脐带；ICC组10s内结扎脐带。对两组早产儿出生后Apgar评分、新生儿窒息、复苏情况、平均动脉压、血红蛋白、红细胞比容、PIVH发生率进行比较。结果DCC组平均动脉压（40．33±3．21）mmHg，出生后3d血红蛋白（176．84±26．38）g／L，红细胞比容（50．44±6．15）％，均高于ICC组，差异有统计学意义（t值分别为3．570、3．358、3．098；P〈0．05）。DCC组PIVH发生率为18．09％，ICC组PIVH发生率为30．61％，DCC组PIVH发生率低于ICC组，差异有统计学意义（Z=-2．018，P〈0．05）。两组未发生PIVH的早产儿颅内情况比较，DCC组无异常情况59例，ICC组无异常情况37例，两组比较差异有统计学意义（χ2=7．693，P〈0．05）。结论延迟结扎脐带可以降低早产儿脑室周围一脑室内出血发生率，且对早产儿的窒息和复苏没有影响。

Objective To investigate the effect of delayed cord clamping on periventricular- intraventricular hemorrhage （PIVH） in preterm infant with vaginal delivery. Methods A total of 192 cases of preterm infant with vaginal delivery in Wuxi Maternal and Child Health Care Hospital from January 2016 to July 2017 were selected and randomly divided into delayed cord clamping group （DCC Group, 94 cases） and immediate cord clamping group （ICC group, 98 cases）. Umbilical cords were clamped after at least 60 s or until pulses diminished with no extrusion in DCC group, while in ICC group umbilical cords were clamped within 10 s. Apgar score, neonatal asphyxia, recovery situation, average arterial pressure, hemoglobin （Hb）, hematocrit （Hct） and incidence of PIVH were compared between two groups. Results The average arterial pressure, Hb at the 3rd day after the birth, and Hct of preterm infants in DCC group were （40.33 ± 3.21） mmHg, （176.84± 26.38） g/L, and （50.44 ± 6.15）%, which were significantly higher than the ICC group （t=3.570, 3.358, 3.098; P 〈 0.05）. The incidence of PIVH in the DCC group was 18.09%, which was significantly lower than the ICC group （30.61%） （Z=-2.018, P 〈 0.05）. Considering the intracranial situation in preterm infant without PIVH, there were 59 cases in DCC group and 37 cases in ICC group; statistically significant difference was observed between two groups （ χ2=7.693, P 〈0.05）. Conclusions Delayed cord clamping can effectively reduce the incidence of PIVH, and has no effect on neonatal asphyxia and recovery.