多胞胎早产儿出生后立即与延迟脐带结扎的比较

Comparison of immediate and delayed cord clamping in preterm infants with multiple births

目的探讨多胞胎早产儿出生后延迟脐带结扎(DCC)的可行性。方法本研究为前瞻性病例对照研究。选取2018年1月至2020年1月在扬州大学附属盐城市妇幼保健院分娩的孕28;~36;周的多胞胎产妇及其早产儿。根据生后脐带结扎的时间分为立即结扎(ICC)组(即出生后立即夹紧并切断脐带时间<3~5s)与DCC组(即出生与断脐间隔30~60s),比较两组多胞胎产妇及其早产儿的临床资料及相关预后指标。结果共纳入多胞胎产妇53例(早产儿113例),其中ICC组26例(早产儿56例),DCC组27例(早产儿57例)。两组产妇及其早产儿一般情况比较差异无统计学意义(P>0.05);两组早产儿在复苏情况、入院时生命体征、入院时血糖、出生后72h内需扩容、峰值胆红素水平、光疗持续时间、住院时间,主要并发症及病死率方面比较差异均无统计学意义(P>0.05)。DCC组多胞胎早产儿入院时红细胞压积(Hct)高于ICC组,差异有统计学意义(t=6.030,P<0.05);DCC组早产儿上腔静脉(SVC)的速度时间积分、直径、流量高于ICC组,差异有统计学意义(t值分别为2.476、4.808、2.383,P<0.05);出生后8周的Hct和网织红细胞计数比较,DCC组早产儿高于ICC组,差异均有统计学意义(t值分别为3.224、2.361,P<0.05)。两组产妇产时失血量比较差异无统计学意义(P>0.05),但DCC组产妇产后出血发生率高于ICC组,差异有统计学意义(χ^(2)=3.902,P<0.05)。结论多胞胎早产儿出生后延迟30~60s进行脐带结扎可显著改善胎盘输血,并降低其生理性贫血的程度。但DCC组产妇产后出血发生率增高。

Objective To investigate the feasibility of delayed cord clamping(DCC)in preterm infants with multiple births.Methods This was a prospective case-control study.The pregnant women with multiple births of 28;to 36;weeks′gestation,who delivered in Yancheng Maternity and Child Health Care Hospital,Affiliated of Yangzhou University from January 2018 to January 2020 and their preterm infants were selected.According to the time of cord clamping after birth,they were divided into the immediate cord clamping(ICC)group(cord was clamped and cut immediately after birth<3-5 seconds)and DCC group(the interval between birth and cord clamping was 30-60 seconds).The clinical data and related prognostic indicators of the pregnant women with multiple births and their preterm infants were compared between the two groups.Results A total of 53 pregnant women with multiple births(113 cases of preterm infants)were included,including 26 cases in the ICC group(56 cases of preterm infants)and 27 cases in the DCC group(57 cases of preterm infants).There were no significant differences in the baseline characteristics of the pregnant women and their preterm infants between the two groups(P>0.05).There were no significant differences in resuscitation requirement,vital signs at admission,blood glucose at admission,fluid bolus within 72 hours after birth,peak bilirubin,duration of phototherapy,length of stay,major complications and mortality of preterm infants between the two groups(P>0.05).The hematocrit(Hct)of preterm infants with multiple births at admission in the DCC group was significantly higher than that in the ICC group,and the difference was statistically significant(t=6.030,P<0.05).The velocity time integral,diameter and flow of superior vena cava(SVC)of preterm infants in the DCC group were significantly higher than those in the ICC group,and the differences were statistically significant(t=2.476,4.808 and 2.383,respectively,P<0.05).The Hct(t=3.224,P=0.002)and the reticulocyte count(t=2.361,P=0.020)of preterm infants at 8 weeks after birth in the DCC group were higher than those in the ICC group,and the difference were statistically significant(P<0.05).There was no significant difference in blood loss during delivery of pregnant women between the two groups(P>0.05),but the incidence of postpartum hemorrhage(PPH)of pregnant women in the DCC group was significantly higher than that in the ICC group,and the difference was statistically significant(χ^(2)=3.902,P<0.05).Conclusion Delayed cord clamping at 30-60 seconds after birth of preterm infants with multiple births can significantly improve placental transfusion and reduce the degree of physiological anemia.However,the incidence of postpartum hemorrhage of pregnant women with multiple births is higher in the DCC group.