彩色多普勒评价脐带挤压对早产儿肠系膜上动脉血流的影响

The influence of the superior mesenteric artery blood flow on umbilical cord milking of premature infants assessed by Doppler ultrasound

目的探讨经脐带挤压(UCM)后早产儿肠系膜上动脉(SMA)血流参数变化及其与喂养耐受性的关系。方法本研究为前瞻性研究,采用随机对照研究方法收集2018年6月至2020年2月在上海市嘉定区妇幼保健院出生并符合纳入标准的早产儿共88例,分别纳入UCM组45例及早结扎脐带(ECC)组43例,于第1次喂养前15 min(餐前)和喂养后60 min(餐后),采用GE Voluson 730彩色多普勒超声诊断仪检测SMA血流参数:如收缩期峰值流速(PSV)、时间平均流速(TAMV)、搏动指数(PI)、阻力指数(RI),分别比较2组早产儿的出生胎龄、出生体质量、出院体质量、SMA血流参数变化、达到全肠内营养时间、住院时间及相关并发症的发病率等情况,采用t检验、χ^(2)检验、Fisher′s确切概率法和秩和检验对数据进行分析。结果1.UCM组和ECC组早产儿的出生胎龄、出生体质量、母亲产前血红蛋白水平及相关并发症的发生率差异均无统计学意义(均P>0.05)。2.在SMA各血流参数中,除RI外其余各参数均为UCM组高于ECC组,但仅餐前TAMV[(24.74±11.47)cm/s比(20.24±7.71)cm/s]、餐后TAMV[(42.11±15.74)cm/s比(28.31±9.99)cm/s]及TAMV的增加幅度[(13.89~20.86)cm/s比(5.31~10.82)cm/s],2组比较差异均有统计学意义(均P<0.05),其余各参数差异均无统计学意义(均P>0.05)。3.多元线性回归显示出生胎龄、出生体质量、PSV的升高及PI的下降与达足量喂养天数呈负相关(均P<0.05)。4.UCM组早产儿达到全肠内营养时间[(11.75±7.36)d比(13.38±8.12)d]及喂养不耐受发病率[13.3%(6/45例)比20.9%(9/43例)]均低于ECC组,但差异均无统计学意义(均P>0.05)。结论UCM能在一定程度上提高血红蛋白,改善SMA血流,可能对早产儿的喂养耐受性有益。

Objective To investigate the correlation between the dynamic changes of the superior mesenteric artery(SMA)blood flow after umbilical cord milking(UCM)detected and feeding tolerance in premature infants.Methods This was a prospective study a total of 88 premature infants delivered in Shanghai Jiading Maternal and Child Health Care Hospital from June 2018 to February 2020 were randomly divided into UCM group(45 cases)and early cord clamping group(ECC group,43 cases).SMA blood flow indexes 15 min before the first feeding(prefeed)and 60 min after the first feeding(post-feed)were detected using the GE Voluson 730 Ultrasound Machine,including the peak systolic velocity(PSV),time-averaged mean velocity(TAMV),pulsatility index(PI)and resistance index(RI).The gestational age,birth weight,the weight at discharge,SMA blood flow indexes,time to achieve enteral nutrition,length of stay and incidence of complications between the two groups were analyzed using t test,Chi-square test or Fisher′s exact test.Results(1)There were no significant differences in the gestational age,birth weight,the mother′s hemoglobin before deliver,and the incidence of complications between UCM group and ECC group(all P>0.05).(2)Except for RI,all SMA blood flow indexes were higher in UCM group than those of ECC group.However,only prefeed TAMV[(24.74±11.47)cm/s vs.(20.24±7.71)cm/s],post-feed TAMV[(42.11±15.74)cm/s vs.(28.31±9.99)cm/s]and TAMV change before and after feeding[(13.89-20.86)cm/s vs.(5.31-10.82)cm/s]were detected to be significantly higher in UCM group than those of ECC group(all P<0.05).(3)Multivariable linear regression analysis showed that the gestational age,birth weight,PSV elevation and PI reduction were negatively correlated with the length of adequate feeding(all P<0.05).(4)The time to achieve enteral nutrition[(11.75±7.36)d vs.(13.38±8.12)d]and the incidence of feeding intolerance[13.3%(6/45 cases)vs.20.9%(9/43 cases)]were lower in UCM group than those of ECC group,although no significant differences were detected(all P>0.05).Conclusions UCM increases the hemoglobin level in premature infants,which is beneficial to feeding tolerance of premature infants by improving SMA blood flow.