脐带采血与外周采血对极低出生体重儿住院期间输血及并发症的影响

Effects of peripheral and umbilical cord blood sampling on transfusion and complications in very low birth weight infants during hospitalization

目的分析生后不同采血方式对极低出生体重儿(very low birth weight infant,VLBWI)住院期间医源性失血、贫血和输血及并发症的影响。方法回顾性分析2014年1月至2018年12月收住长江大学第二临床学院湖北省荆州市中心医院新生儿重症监护病房的VLBWI(出生体重<1500 g)的病例资料。按照首次采血方式分为脐带采血组和外周采血组。比较2组患儿采血、输血情况以及并发症的发生及结局。采用两独立样本t检验、秩和检验或χ^(2)检验(或Fisher精确概率法)进行统计学分析。结果(1)最终入选240例,脐带采血组104例,外周采血组136例。2组一般资料及首次血液检查结果差异均无统计学意义。(2)脐带采血组第1周采血量低于外周采血组[6.5 ml(1~23 ml)与10 ml(1~30 ml),Z=-4.706,P<0.001]。2组第2~9周的采血量差异无统计学意义(P值均>0.05)。脐带采血组患儿生后前4周采血次数均低于外周采血组(Z值分别为-9.124、-2.272、-4.688和-2.017,P值均<0.05),2组第5周及以后的采血次数差异均无统计学意义。脐带采血组第1次红细胞输注(red blood cell transfusion,RBCT)时间迟于外周采血组[4周(1~7周)与3周(1~5周),Z=-2.839,P<0.05]。脐带采血组2次及以上RBCT率低于外周采血组[39.7%(25/63)与56.8%(50/88),χ^(2)=4.312,P<0.05],生后前3周RBCT率低于外周采血组[34.9%(22/63)与59.1%(52/88),χ^(2)=8.583,P<0.05]。2组每次RBCT量、输注后不良反应及首次输注前后的红细胞数、血红蛋白、红细胞压积等差异均无统计学意义。(3)2组新生儿呼吸窘迫综合征、新生儿坏死性小肠结肠炎、支气管肺发育不良、早产儿视网膜病变、Ⅲ~Ⅳ级脑室内出血等并发症的发生率及结局差异均无统计学意义(P值均>0.05)。结论采血方式对VLBWI住院期间贫血发生率和RBCT率无明显影响。脐带采血可推迟VLBWI的第1次RBCT时间,减少前3周RBCT率,但不影响并发症的发生率。

Objective To analyze the effects of different blood sampling methods on the incidence of iatrogenic blood loss,anemia,transfusion,and complications in very low birth weight infants(VLBWI)during hospitalization.Method A retrospective analysis was performed on VLBWIs(birth weight<1500 g)admitted to the neonatal intensive care unit of the Second Hospital of Yangtze University,Jingzhou Central Hospital,Hubei province,from January 2014 to December 2018.According to the first blood sampling method,these infants were subjected to the umbilical cord blood and peripheral blood groups.Blood sampling,transfusion,complications,and outcomes were compared between the two groups.Independent samples t-test,rank-sum test,and Chi-square(or Fisher's exact)test were used for statistical analysis.Results(1)Totally 240 neonates enrolled,including 104 cases in the umbilical cord blood group and 136 in the peripheral blood group.There was no statistical significance in the general information and blood test results for the first time between the two groups.(2)The blood volume collected in the first week in the umbilical cord blood group was lower than that in the peripheral blood group[6.5 ml(1-23 ml)and 10 ml(1-30 ml),Z=-4.706,P<0.01].Differences between the two groups in the blood volume at 2-9 weeks were insignificant(all P>0.05).The number of blood collection procedures in each of the first four weeks after birth in the umbilical cord blood group was less than that in the peripheral blood group(Z value was-9.124,-2.272,-4.688,and-2.017,respectively,all P<0.05),but no statistical difference was found at the fifth week(P>0.05).The time of the first red blood cell transfusion(RBCT)in the umbilical cord blood group was later than that in the peripheral blood group[4 weeks(1-7 weeks)vs 3 weeks(1-5 weeks),Z=-2.839,P<0.05].The proportion of infants who have received RBCT twice or more times in the umbilical cord blood group was lower than that in the peripheral blood group[39.7%(25/63)vs 56.8%(50/88),χ^(2)=4.312,P<0.05].The rate of RBCT during the first three weeks in the umbilical cord blood group was lower than that in the peripheral blood group[34.9%(22/63)vs 59.1%(52/88),χ^(2)=8.583,P<0.05].There were no significant differences in the volume of RBCT per time,adverse reactions after transfusion,and the erythrocyte count,hemoglobin,and hematocrit before and after the first RBCT between the two groups.(3)The incidence of neonatal respiratory distress syndrome,neonatal necrotizing enterocolitis,bronchopulmonary dysplasia,retinopathy of prematurity,and intraventricular hemorrhage(gradeⅢ-Ⅳ)and their outcomes were similar between the two groups(all P>0.05).Conclusion Blood sampling methods show no significant effect on the total incidence of anemia and RBCT in VLBWIs during hospitalization.Umbilical cord blood sampling may delay the first RBCT time of VLBWIs and reduce the rate of RBCT in the first three weeks,but do not affect the incidence of complications.