延迟脐带结扎与脐带挤压对早产儿血容量、血红蛋白和胆红素水平的影响

Effects of delayed umbilical cord ligation and umbilical cord compression on blood volume,hemoglobin and bilirubin levels in premature infants

目的探讨延迟脐带结扎(DCC)与脐带挤压(UCM)方法处理脐带对早产儿血容量、血红蛋白、胆红素水平的影响,并分析不同脐带结扎方式对新生儿并发症的影响。方法纳入分娩的早产儿146例,按照随机数字表法分为常规钳夹脐带组(n=51),延迟脐带结扎组(n=48)和脐带挤压组(n=47),分别采取不同的方式进行脐带处理;收集所有新生儿及产妇的临床资料,早产儿不同时间点血红蛋白水平(入NICU时、3~5 d时、出院时、出生后3个月),经皮胆红素水平(出生后24、48、72 h);记录所有早产儿住院期间新生儿贫血发生率、脑室内出血及新生儿坏死性小肠结肠炎发生率。结果延迟脐带结扎组和脐带挤压组在入NICU时、3~5 d时、出院时血红蛋白水平、红细胞比容明显高于常规结扎组,差异有统计学意义(P<0.05),延迟脐带结扎组和脐带挤压组在不同时间点血红蛋白水平、出院时红细胞比容比较无统计学差异(P>0.05);延迟脐带结扎组和脐带挤压组在早产儿出生48、72 h经皮胆红素水平高于常规结扎组(P<0.05);延迟脐带结扎组和脐带挤压组新生儿贫血发生率明显低于常规结扎组,差异具有统计学意义(P<0.05);延迟脐带结扎组和脐带挤压组早产儿脑室内出血、新生儿坏死性肠炎、晚发型败血症总发生率明显低于常规结扎组,差异具有统计学意义(P<0.05)。结论与常规脐带结扎相比,延迟脐带结扎和脐带挤压均能够达到增加早产儿血容量、减少新生儿贫血的目的,并不会增加新生儿高胆红素血症、脑室内出血的风险,且对于改善早产儿不良预后具有积极意义。

Objective To investigate the effect of delayed umbilical cord ligation and umbilical cord compression on the blood volume,hemoglobin and bilirubin levels of premature infants,and analyze the effects of different umbilical cord ligation methods on neonatal complications.Methods 146 premature infants admitted in the department of obstetrics were divided into the conventional clamp umbilical cord group(n=51),the delayed umbilical cord ligation group(n=48)and the umbilical cord extrusion group(n=47).Hemoglobin levels were detected at admission to NICU,3~5 days,before discharge and three months after birth in premature infants,and percutaneous bilirubin levels were detected at 24h,48h and 72h after birth;The number of neonatal anemia,intraventricular hemorrhage and neonatal necrotizing enterocolitis were recorded during hospitalization of all preterm infants.Results The delayed umbilical cord ligation group and umbilical cord squeeze group had significantly higher hemoglobin levels and hematocrit at the time of admission to the NICU,3~5 days,and discharge from the hospital.The difference was statistically significant(P<0.05).The level of percutaneous bilirubin in the delayed umbilical cord ligation group and the umbilical cord compression group was higher than that in the conventional ligation group at 48 h and 72 h of premature infants(P<0.05),and the percutaneous bilirubin in the delayed umbilical cord ligation group and the umbilical cord compression group.The incidence of neonatal anemia in the delayed umbilical cord ligation group and the umbilical cord compression group was significantly lower than that in the conventional ligation group(P<0.05);Intra-ventricular hemorrhage,neonatal in premature infants in the delayed umbilical cord ligation group and the umbilical cord compression group.The total incidence of necrotizing enteritis and late-onset sepsis in children was significantly lower than that in the conventional ligation group,and the difference was statistically significant(P<0.05).Conclusion Compared with conventional umbilical cord ligation,delayed umbilical cord ligation and umbilical cord squeezing can achieve the purpose of increasing blood volume of preterm infants and reducing anemia in neonates,and not increase the risks of neonatal hyperbilirubinemia,and for improving the poor prognosis of preterm infants has a positive significance.