剖宫产术中两种断脐方式对新生儿影响及产后出血的比较

Effect of Two Clamping ways of Umbilical Cord on Newborns in Cesarean Section and Comparison of Postpartum Hemorrhage

目的探讨剖宫产术中宫体应用缩宫素后的断脐方法对母儿结局的影响。方法选取2016年2月至2017年10月在郑州市妇幼保健院产科收治的剖宫产产妇共400例,随机分为两组,每组各200例。对照组进行晚断脐(即等待脐带搏动自然停止后断脐);试验组在胎儿娩出后,宫体立即注射缩宫素,并按摩子宫,等待出现宫缩时,于近胎盘端断脐。比较两组产后出血量、胎盘残余血量、新生儿脐血血红蛋白和红细胞压积、新生儿出生5d后外周静脉血血红蛋白和红细胞压积、新生儿最高1次胆红素值、高胆红素血症发生率及是否需要蓝光治疗、新生儿1、5min Apgar评分、新生儿窒息率以及10min复苏率等指标。结果两组胎盘残余血量、新生儿脐血血红蛋白和红细胞压积、出生后5d足跟血血红蛋白和红细胞压积、生后最高1次胆红素值、新生儿高胆红素血症以及是否需要蓝光治疗、新生儿Apgar评分和新生儿窒息率比较,差异无统计学意义(P>0.05);产后出血量和新生儿10min复苏率比较,差异有统计学意义(P<0.05)。结论试验组较对照组产后出血较少、新生儿窒息复苏成功率高;试验组同样能增加胎盘输血,防治新生儿贫血的发生,并不增加新生儿高胆红素血症的发生率。

Objective To explore the effect of two clamping ways of umbilical cord after oxytocin administration on the outcomes of mothers and newborns in cesarean section.Methods A total of 400 cases with cesarean section treated in Women&Infants Hospital of Zhengzhou from February of 2016 to October of 2017 were selected and divided randomly into the control group and experiment group.The control group was treated with the delayed omphalotomy(i.e.,the umbilical cord was clamped after the natural stop of the umbilical cord pulsation,while the umbilical cord of the experiment group was clamped at the proximal end of placenta with the appearing of uterine contraction after the delivery of newborns,intrauterine injection of oxytocin and massage of uterus.The two groups were compared in the indexes including the volume of postpartum hemorrhage and placental residual blood,the hemoglobin and hematocrit in the neonatal cord blood and the peripheral venous blood of five-day-old newborns,the highest bilirubin values after birth,the incidence of hyperbilirubinemia,the demand for the blue light therapy,the Apgar scores at the 1st and 5th minute after birth,the rate of neonatal asphyxia,and the resuscitation rate after 10 minutes.Results There were no significant differences in the volume of placental residual blood,the hemoglobin and hematocrit in the neonatal cord blood and the peripheral venous blood of five-day-old newborns,the highest bilirubin values after birth,the incidence of neonatal hyperbilirubinemia,the demand for the blue light therapy,the Apgar scores,the rate of neonatal asphyxia between the two groups(P>0.05),while there were significant differences in the volume of postpartum hemorrhage and the resuscitation rate after 10 minutes between the two groups(P<0.05).Conclusion There are less volume of postpartum hemorrhage and higher resuscitation rate after neonatal asphyxia in the experiment group than in the control group.The clamping way of umbilical cord in the experiment group can increase the placental transfusion and prevent the occurrence of neonatal anemia without the increase of the neonatal hyperbilirubinemia incidence.