脐带挤压和延迟脐带结扎对早产儿及产妇的影响

Effect of umbilical cord milking and delayed cord clamping in preterm infants and maternal

目的 通过分析脐带挤压(UCM)与延迟脐带结扎(DCC)对于早产儿及产妇围生期各项指标的影响,探索脐带挤压及延迟脐带结扎对早产儿和产妇的意义。方法 以本院产科孕周28~37周经阴道分娩且符合早产儿诊断标准的240例新生儿及产妇作为研究对象,其中分为脐带挤压组(UCM组)80例、延迟脐带结扎组(DCC组)80例及立即脐带结扎组(ICC组)80例,比较各组早产儿血红蛋白(Hb)水平和红细胞比容(HCT)、血清总胆红素的水平及光疗率、新生儿坏死性小肠结肠炎(NEC)及脑室周围-脑室内出血(PIVH)的发病率、早产儿体温的情况及低血糖的发病率、产妇产后出血(PHH)发病率及分娩前后血红蛋白(Hb)水平。结果 UCM组和DCC组新生儿血红蛋白及红细胞比容均高于ICC组(P<0.05),其中UCM组与DCC组相比,差异无统计学意义(P>0.05);生后第3天及第5天UCM组和DCC组新生儿血清总胆红素水平均高于ICC组(P<0.05),其中UCM组与DCC组相比,差异无统计学意义(P>0.05),UCM组、DCC组、ICC组光疗率比较,差异无统计学意义(P>0.05);UCM组和DCC组新生儿生后30 min体温均高于ICC组(P<0.05),UCM组、DCC组生后低血糖发病率均低于ICC组(P<0.05);UCM组和DCC组发生脑室周围-脑室内出血的比例较ICC组减少(P<0.05),UCM组、DCC组、ICC组早产儿坏死性小肠结肠炎发病率相比,差异无统计学意义(P>0.05);UCM组、DCC组、ICC组产妇产后出血发病率及分娩前、分娩后血红蛋白水平相比,差异无统计学意义(P>0.05)。结论 脐带挤压和脐带延迟结扎在提高早产儿血容量、防止低体温、降低新生儿低血糖及脑室周围-脑室内出血的发病率方面均有效果,且二者差异无统计学意义,对早产儿光疗率及产妇分娩出血量无显著影响。

Objective To analyzing the effects of umbilical cord milking(UCM) and delayed cord clamping(DCC)on perinatal indexes of preterm infants and parturients,explore the significance of umbilical cord milking and delayed cord clamping on preterm infants and parturients.Methods 240 premature infants born in the obstetrics department of our hospital were selected as the research objects,there were 80 cases in the umbilical cord milking group(UCM group),80 cases in the delayed cord clamping group(DCC group) and 80 cases in the immediate cord clamping group(ICC group).The changes of hemoglobin concentration(Hb),hematocrit(HCT),bilirubin and phototherapy rate of preterm infants,the incidence of neonatal necrotizing enteritis(NEC) and peri/intraventricular hemorrhage(PIVH),the change of body temperature and hypoglycemia of preterm infants,the incidence of postpartum hemorrhage(PHH) and hemoglobin concentration(Hb) before and after delivery were compared among the three groups.Results Neonatal hemoglobin and hematocrit in UCM group and DCC group were higher than those in ICC group(P<0.05).There was no significant difference between UCM group and DCC group(P>0.05).On the third day and five day after birth,the bilirubin levels of newborns in UCM group and DCC group were higher than those in ICC group(P<0.05),and there was no difference between UCM group and DCC group(P>0.05).There was no significant difference in phototherapy rate among UCM group,DCC group and ICC group(P>0.05).The temperature of newborns in UCM group and DCC group was higher than that in ICC group(P<0.05),and the incidence of postnatal hypoglycemia in UCM group and DCC group was lower than that in ICC group(P>0.05).The incidence rate of peri/intraventricular hemorrhage in group UCM and group DCC was lower than that in group ICC(P<0.05).There was no significant difference in incidence of necrotizing enterocolitis among premature infants in UCM group,DCC group and ICC group(P>0.05).Conclusions Umbilical cord milking and delayed cord clamping have no significant difference in improving blood volume,preventing hypothermia,reducing incidence rate of neonatal hypoglycemia and peri/intraventricular hemorrhage,and have no significant effect on the rate of phototherapy and delivery volume of premature infants.