目的 探讨不同方式脐带挤压(UCM)对极早产儿血红蛋白水平及并发症发生率的影响,为临床上选择合适的脐带处理方式提供参考。方法 收集2018年5月—2021年5月在厦门大学附属中山医院出生胎龄28～31+6周经阴道分娩的极早产儿共262例作为研究对象,按照不同脐带处理方式分为脐带挤压后断脐(I-UCM)组87例,断脐后脐带挤压(C-UCM)组88例,立即脐带结扎(ICC)组87例。比较各组血红蛋白水平和红细胞压积、血清总胆红素水平和光疗率、脑室周围-脑室内出血、新生儿坏死性小肠结肠炎、早产儿视网膜病变、支气管肺发育不良、新生儿低血糖、新生儿低体温的发生率。结果 I-UCM组和C-UCM组极早产儿生后1小时血红蛋白水平、红细胞压积高于ICC组(F=26.754、29.147,P＜0.001),I-UCM组均高于C-UCM组(P＜0.001);I-UCM组和C-UCM组极早产儿生后第3天和第5天血清总胆红素水平均高于ICC组(F=4.324、7.117,P=0.014);I-UCM组和C-UCM组极早产儿脑室周围-脑室内出血(χ2=10.261)、新生儿坏死性小肠结肠炎(χ2=6.512)、低血糖、低体温(χ2=13.198)的发生率和住院期间输血率(χ2=8.724)均低于ICC组(P<0.05);三组极早产儿视网膜病变、支气管肺发育不良的发生率和住院期间总光疗率比较,差异无统计学意义(P＞0.05)。结论 I-UCM和C-UCM均可有效增加极早产儿血容量。两种脐带挤压方式对于降低脑室周围-脑室内出血、新生儿坏死性小肠结肠炎、新生儿低血糖、新生儿低体温的发生率以及极早产儿输血率的效果相似。
Abstract
Objective To investigate the effect of different ways of umbilical cord milking(UCM) on the hemoglobin level and complication incidences in very preterm infants, so as to provide reference for choosing appropriate way of UCM in clinic. Methods From May 2018 to May 2021,a total of 262 cases of very preterm infants delivered via vagina in Zhongshan Hospital Affiliated to Xiamen University with gestational age of 28 to 31+6 weeks were divided into intact umbilical cord milking(I-UCM) group(n=87), cut-umbilical cord milking(C-UCM) group(n=88), immediate cord milking(ICC) group(n=87) according to different umbilical cord clamping methods. The hemoglobin level, hematocrit, serum total bilirubin level, phototherapy rate and transfusion rate during hospitalization of very preterm infants were compared among three groups. Besides, peri/intraventricular hemorrhage, neonatal necrotizing enterocolitis(NEC), retinopathy of prematurity(ROP), bronchopulmonary dysplasia(BPD), neonatal hypoglycemia and neonatal hypothermia were also compared among three groups. Results The levels of hemoglobin and hematocritin 1 hour after birth in I-UCM group and C-UCM group were significantly higher than those in ICC group(F=26.754, 29.147, P＜0.001), which were even higher in I-UCM group than C-UCM group(P<0.001). Serum total bilirubin level in the third and fifth day after birth in both groups of I-UCM and C-UCM were higher than those in group ICC(F=4.319,7.117, P=0.014). The incidence rates of peri/intraventricular hemorrhage(χ2=10.261), NEC(χ2=6.512), hypoglycemia and hypothermia(χ2=13.198) in both I-UCM group and C-UCM group were significantly lower than those in ICC group(P<0.05). There were no significant differences in the incidence rates of ROP, BPD and the proportion of phototherapyduring hospitalization in very preterm among the three groups(P>0.05). Conclusions Both I-UCM and C-UCM can effectively increase the blood volume of very preterm infants. The two UCM methods have similar effects on reducing the incidence of peri/ventricular hemorrhage, NEC, neonatal hypoglycemia, neonatal hypothermia and blood transfusion rate of very preterm infants.
关键词
脐带挤压 /
血红蛋白 /
极早产儿
Key words
umbilical cord milking /
hemoglobin /
very preterm infants
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