延迟脐带结扎对极早产儿的临床意义

doi:10.12280/gjfckx.20211089

摘要/Abstract

摘要：

目的：评价延迟脐带结扎（delayed cord clamping,DCC）对极早产儿预后的影响。方法：选取2019年5月—2021年5月郑州大学第三附属医院阴道分娩的极早产儿,随机分为早期脐带结扎（early cord clamping,ECC）组和DCC组。比较2组的血常规、胆红素值、Apgar评分、平均动脉压、血气、体温,以及新生儿低氧血症、急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）、输血、脑室内出血、坏死性小肠炎、败血症、低血糖、新生儿死亡、高胆红素血症及光疗的发生率。比较2组极早产儿平均住院日和平均住院费用,并比较2组产妇的第三产程和产后出血量。结果：DCC组极早产儿出生时血红蛋白、72 h血红蛋白、出生时红细胞压积、72 h红细胞压积、平均动脉压、出生时胆红素、胆红素峰值均高于ECC组,差异有统计学意义（P<0.05）。DCC组的新生儿低氧血症、ARDS、输血、脑室内出血、坏死性小肠炎、新生儿败血症、低血糖的发生率,以及极早产儿平均住院日、平均住院费用均低于ECC组,差异有统计学意义（P<0.05）。2组极早产儿的Apgar评分、体温、酸中毒发生率、高胆红素血症发生率、光疗发生率、红细胞增多症发生率及新生儿死亡率比较,差异无统计学意义（P>0.05）。2组产妇的第三产程及产后出血量比较,差异无统计学意义（P>0.05）。结论：DCC是一项可以有效改善极早产儿分娩结局且不增加其他并发症的临床干预措施。

关键词: 脐带, 结扎术, 胎盘, 婴儿,早产, 并发症, 预后

Abstract:

Objective：To evaluate the effects of delayed umbilical cord clamping methods on the prognosis of very preterm infants. Methods：Very preterm infants delivered vaginally in the Third Affiliated Hospital of Zhengzhou University from May 2019 to May 2021 were randomly divided into early cord clamping (ECC) group of 67 cases and delayed cord clamping (DCC) group of 63 cases. The occurrence rate of blood routine、bilirubin value, Apgar score, mean arterial pressure, blood gas, neonatal hypoxemia, acute respiratory distress syndrome (ARDS), blood transfusion, intraventricular hemorrhage, necrotizing enteritis, sepsis, hypoglycemia, neonatal death, hyperbilirubinemia and phototherapy were compared between the two groups. The average hospitalization days and average hospitalization expenses of very preterm infants in the two groups were compared, and the third stage of labor and postpartum hemorrhage of the two groups were compared. Results：The birth hemoglobin, 72 hour hemoglobin, birth hematocrit, 72 hour hematocrit, birth mean arterial pressure, birth bilirubin value and peak bilirubin of premature infants in DCC group were higher than those in ECC group (P<0.05). The incidence of hypoxemia, ARDS, blood transfusion, intraventricular hemorrhage, necrotizing enteritis, sepsis, hypoglycemia, average hospitalization days and average hospitalization expenses of very preterm infants in DCC group were lower than those in ECC group (P<0.05). There was no significant difference in Apgar score, body temperature, incidence of neonatal acidosis, incidence of hyperbilirubinemia, incidence of phototherapy, incidence of polycythemia and newborn mortality between the two groups (P>0.05). There was no significant difference in the third stage of labor and postpartum hemorrhage between the two groups (P>0.05). Conclusions：Delayed cord clamping is a clinical intervention that can effectively improve the delivery outcome of very preterm infants without increasing other complications.

Key words: Umbilical cord, Ligation, Placenta, Infant, premature, Complications, Prognosis

石巍, 徐一鸣, 王俊耐, 胡孟彩. 延迟脐带结扎对极早产儿的临床意义[J]. 国际妇产科学杂志, 2022, 49(4): 434-438.

SHI Wei, XU Yi-ming, WANG Jun-nai, HU Meng-cai. Clinical Significance of Delayed Cord Clamping in Very Preterm Infants[J]. Journal of International Obstetrics and Gynecology, 2022, 49(4): 434-438.

图/表 5

参考文献 20

[1]	Perretta LJ, Spaight M, Yap V, et al. Randomized Study of Delayed Cord Clamping of 30 to 60 Seconds in the Larger Infant Born Preterm[J]. J Pediatr, 2020, 224:153-157. doi: 10.1016/j.jpeds.2020.04.058. doi: 10.1016/j.jpeds.2020.04.058
[2]	孔祥永, 张珊, 封志纯, 等. 中国14家医院超/极早产儿早期预后的多中心调查[J]. 中国医刊, 2018, 53(12):1356-1362. doi: 10.3969/j.issn.1008-1070.2018.12.015. doi: 10.3969/j.issn.1008-1070.2018.12.015
[3]	徐韬. 世界卫生组织延迟脐带结扎指南解读[J]. 中国妇幼卫生杂志, 2018, 9(4):1-4. doi: 10.19757/j.cnki.issn1674-7763.2018.04.001. doi: 10.19757/j.cnki.issn1674-7763.2018.04.001
[4]	张惠欣, 张月琴, 张晓丽. 晚断脐对早产儿的影响[J]. 中国妇幼保健, 2017, 32(1):198-200. doi: 10.7620/zgfybj.j.issn.1001-4411.2017.01.68. doi: 10.7620/zgfybj.j.issn.1001-4411.2017.01.68
[5]	赵晓谈, 温晓红, 黄金华. 延迟结扎脐带对新生儿的影响[J]. 中国妇幼临床医学杂志, 2020, 16(4):381-385. doi: 10.3877/cma.j.issn.1673-5250.2020.04.002. doi: 10.3877/cma.j.issn.1673-5250.2020.04.002
[6]	中华医学会围产医学分会, 中华医学会妇产科学分会产科学组, 中华护理学会产科护理专业委员会, 等. 中国新生儿早期基本保健技术专家共识(2020)[J]. 中华围产医学杂志, 2020, 23(7):433-440. doi: 10.3760/cma.j.cn113903-20200416-00354. doi: 10.3760/cma.j.cn113903-20200416-00354
[7]	Knol R, Brouwer E, van den Akker T, et al. Physiological-based cord clamping in very preterm infants - Randomised controlled trial on effectiveness of stabilisation[J]. Resuscitation, 2020, 147:26-33. doi: 10.1016/j.resuscitation.2019.12.007. doi: 10.1016/j.resuscitation.2019.12.007
[8]	季小红, 苗治晶, 吕燕, 等. 极早期和早期早产儿预后评估[J]. 南京医科大学学报(自然科学版), 2018, 38(4):546-549. doi: 10.7655/NYDXBNS20180427. doi: 10.7655/NYDXBNS20180427
[9]	Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterem infants: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2018, 218(1):1-18. doi: 10.1016/j.ajog.2017.10.231. doi: 10.1016/j.ajog.2017.10.231
[10]	刘晶, 彭燕, 吕海荣. 不同断脐时间对阴道分娩早产儿的影响[J]. 中国计划生育和妇产科, 2018, 10(3):73-76. doi: 10.3969/j.issn.1674-4020.2018.03.20. doi: 10.3969/j.issn.1674-4020.2018.03.20
[11]	张谦慎, 贺红云. 极早产儿延迟脐带结扎时的床边复苏意义及其实施策略[J]. 中华围产医学杂志, 2017, 20(8):564-567. doi: 10.3760/cma.j.issn.1007-9408.2017.08.004. doi: 10.3760/cma.j.issn.1007-9408.2017.08.004
[12]	Zhao Y, Hou R, Zhu X, et al. Effects of delayed cord clamping on infants after neonatal period: A systematic review and meta-analysis[J]. Int J Nurs Stud, 2019, 92:97-108. doi: 10.1016/j.ijnurstu.2019.01.012. doi: 10.1016/j.ijnurstu.2019.01.012
[13]	郑增鑫, 张建华, 张荣华, 等. 脐带结扎时间对早产儿脑室内出血的影响[J]. 中国当代医药, 2019, 26(14):124-127. doi: 10.3969/j.issn.1674-4721.2019.14.037. doi: 10.3969/j.issn.1674-4721.2019.14.037
[14]	Brown BE, Shah PS, Afifi JK, et al. Delayed cord clamping in small for gestational age preterm infants[J]. Am J Obstet Gynecol, 2022, 226(2):247.e1-247.e10. doi: 10.1016/j.ajog.2021.08.003. doi: 10.1016/j.ajog.2021.08.003
[15]	Hemmati F, Sharma D, Namavar Jahromi B, et al. Delayed cord clamping for prevention of intraventricular hemorrhage in preterm neonates: a randomized control trial[J]. J Matern Fetal Neonatal Med, 2020 Oct 22: 1-7. doi: 10.1080/14767058.2020.1836148. Epub ahead of print. doi: 10.1080/14767058.2020.1836148
[16]	万丽, 顾水琴, 徐建平. 脐带挤压断脐对剖宫产早产儿体温和血糖的影响研究[J]. 护理与康复, 2019, 18(10):47-49. doi: 10.3969/j.issn.1671-9875.2019.10.011. doi: 10.3969/j.issn.1671-9875.2019.10.011
[17]	李丽霞, 陈华萍, 蒋叶均, 等. 延迟脐带结扎对早产儿并发症的影响[J]. 浙江医学, 2020, 42(7):720-722. doi: CNKI:SUN:ZJYE.0.2020-07-022. doi: CNKI:SUN:ZJYE.0.2020-07-022
[18]	黄少励, 吕峻峰, 陆镜明, 等. 延迟脐带结扎对早产儿的影响[J]. 中国医学创新, 2018, 15(25):120-122. doi: 10.3969/j.issn.1674-4985.2018.25.032. doi: 10.3969/j.issn.1674-4985.2018.25.032
[19]	Popat H, Galea C, Evans N, et al. Effect of Delayed Cord Clamping on Cerebral Oxygenation in Very Preterm Infants[J]. Neonatology, 2019, 115(1):13-20. doi: 10.1159/000492712. doi: 10.1159/000492712
[20]	刘誉, 杨慧霞. 2020年美国妇产科医师协会分娩后延迟脐带结扎的专家共识解读[J]. 中华妇产科杂志, 2021, 56(7):516-518. doi: 10.3760/cma.j.cn112141-20201223-00909. doi: 10.3760/cma.j.cn112141-20201223-00909

组别	n	孕妇年龄（岁）	胎龄（周）	新生儿体质量（g）
DCC组	63	29.59±4.60	29.97±0.98	1 817.30±466.48
ECC组	67	29.04±3.61	30.29±0.96	1 856.72±412.35
t		0.751	-1.907	-0.511
P		0.454	0.059	0.610

组别	n	孕妇年龄（岁）	胎龄（周）	新生儿体质量（g）
DCC组	63	29.59±4.60	29.97±0.98	1 817.30±466.48
ECC组	67	29.04±3.61	30.29±0.96	1 856.72±412.35
t		0.751	-1.907	-0.511
P		0.454	0.059	0.610

组别	n	1 min Apgar 评分	5 min Apgar 评分	平均动脉压（mmHg）	体温（℃）
DCC组	63	9.00±1.49	9.63±0.70	49.18±3.84	36.57±0.15
ECC组	67	8.66±1.21	9.40±0.70	44.00±2.46	36.53±0.16
t		1.443	1.888	9.095	1.812
P		0.151	0.061	<0.001	0.072

组别	n	1 min Apgar 评分	5 min Apgar 评分	平均动脉压（mmHg）	体温（℃）
DCC组	63	9.00±1.49	9.63±0.70	49.18±3.84	36.57±0.15
ECC组	67	8.66±1.21	9.40±0.70	44.00±2.46	36.53±0.16
t		1.443	1.888	9.095	1.812
P		0.151	0.061	<0.001	0.072

组别	n	产妇第三产程（min）	产妇产后出血量（mL）	极早产儿平均住院日（d）	极早产儿平均住院费用（元）
DCC组	63	7.00（6.00,9.00）	180.00（170.00,230.00）	12.00（9.00,21.50）	21 654.00（12 790.00,45 290.50）
ECC组	67	8.00（5.50,11.00）	190.00（180.00,230.00）	21.00（13.50,39.50）	47 470.00（27 114.00,86 436.50）
Z		-1.217	-0.786	-3.785	-4.353
P		0.224	0.432	<0.001	<0.001