不同脐带结扎方式对早产儿黄疸及血液系统的影响

Influence of different methods of clamping umbilical cord on jaundice and blood system in premature infants

目的探讨不同脐带结扎方式对孕周<34周早产儿的影响。方法选择孕周<34周早产儿388例,按照脐带结扎方式分成常规组、延迟脐带结扎组和挤压脐带组。常规组于分娩后30 s内结扎脐带;延迟脐带结扎组于分娩后120 s结扎脐带;挤压脐带组于近新生儿端20 cm处,从母亲端向新生儿端挤压脐带2~3次后结扎脐带,耗时5~10 s。分别于生后48 h和7 d采集静脉血,检测血红蛋白(hemoglobin,Hb)和血细胞比容(hematocrit,HCT);出生后1~7 d测定经皮胆红素值;记录住院期间光疗、1周贫血、输血及窒息发生率。结果延迟脐带结扎组和挤压脐带组48 h,7 d时Hb、HCT水平明显高于常规组,差异有统计学意义(P<0.05);延迟脐带结扎组和挤压脐带组48 h,7 d时Hb、HCT水平差异无统计学意义(P>0.05)。延迟脐带结扎组和挤压脐带组1周贫血、输血发生率均低于常规组,差异有统计学意义(P<0.05),延迟脐带结扎组和挤压脐带组1周贫血、输血发生率差异无统计学意义(P>0.05);3组光疗和窒息发生率差异无统计学意义(P>0.05)。结论快速挤压脐带与延迟脐带结扎均能提高早产儿机体内Hb和HCT水平,减少1周贫血、输血发生率,且不增加出生后窒息和光疗风险。

Objective To explore the influence of different umbilical cord ligation methods on premature infants with a gestational age of less than 34 weeks.Methods A total of 388 premature infants with a gestational age of less than 34 weeks were selected and divided into routine group,delayed umbilical cord ligation group and umbilical cord milking group according to the umbilical cord ligation method.In the conventional group,the umbilical cord was ligated within 30 s after delivery.In the delayed umbilical cord ligation group,the umbilical cord was ligated 120 s after delivery.In the umbilical cord milking group(UCM),the procedure was to milk approximately 20 cm from the newborn′s end,milk the umbilical cord from the mother′s end to the newborn′s end for 2-3 times and then ligate the umbilical cord,which took 5-10 s.Venous blood was collected at 48 h and 7 d after birth for detection of hemoglobin(Hb)and hematocrit(HCT),and measure percutaneous bilirubin value 1-7 days after birth.The incidence of phototherapy,one-week anemia,blood transfusion and asphyxia during hospitalization were recorded.Results The Hb and HCT level of the delayed umbilical cord ligation group and the umbilical cord milking group at 48 h and 7 d were significantly higher than the routine group,and the differences were statistically significant(P<0.05),while there was no significant difference in the level of Hb and HCT between the delayed umbilical cord ligation group and the umbilical cord milking group at 48 h and 7 d(P>0.05).The incidence of one-week anemia and blood transfusion in the delayed umbilical cord ligation group and the milking umbilical cord group was lower than that in the routine group,and the difference was statistically significant(P<0.05),while there was no significant difference between the delayed umbilical cord ligation group and the umbilical cord milking group(P>0.05).There was no significant difference in the incidence of phototherapy and asphyxia among three groups(P>0.05).Conclusion Both rapid milking of the umbilical cord and delayed umbilical cord ligation can improve the levels of Hb and HCT of premature infants,reduce the incidence of one-week anemia and blood transfusion,and meanwhile not increase the risk of postnatal asphyxia and phototherapy.