目的 分析胎龄＜34周早产儿不同断脐方式下血红蛋白、胆红素及相关并发症差异,为早产分娩行挤压脐带断脐法(UCM)提供临床依据。方法 回顾性分析115例经阴道分娩的胎龄＜34周的早产儿,根据断脐方式分为UCM组(n=59)和立即断脐(ICC)组(n=56),比较两组早产儿娩出后血红蛋白变化趋势和输血量、住院期间经皮胆红素值及光疗时间以及颅内出血、早产儿视网膜病变、支气管肺发育不良和坏死性小肠结肠炎的发生率。结果 UCM组出生后1 h内、出生后1周左右和出院前血红蛋白显著高于ICC组(t=2.246、2.123、1.886,P＜0.05),住院期间ICC组早产儿输血次数及每人次输血量显著多于UCM组(χ2=2.145,t=2.160,P＜0.05)。两组经皮胆红素达峰时间均为3～6 d,UCM组经皮胆红素值显著高于ICC组(t=2.231、2.654、2.686、2.038,P＜0.05),两组光疗时长差异无统计学意义(P＞0.05)。早产儿住院期间发生颅内出血、视网膜病变、支气管肺发育不良及坏死性小肠结肠炎等并发症两组间差异无统计学意义(P＞0.05)。结论 与正常断脐相比,挤压脐带可增加胎龄＜34周早产儿的血容量和血红蛋白量,减少住院期间输血次数及输血量,且不增加患儿病理性黄疸和并发症的风险,可作为胎龄＜34周早产儿首选的断脐方法。
Abstract
Objective To analyze the differences of hemoglobin, bilirubin and related complications between umbilical cord milking (ICM) and immediate cord clamp (ICC), in order to provide clinical evidence for cord-cutting in premature infants born at less than 34 weeks of gestation.Methods The clinical data of 115 cases of premature infants born at less than 34 weeks of gestation and delivered via vaginal were analyzed retrospectively. The infants were divided into UCM group (n=59) and ICC group (n=56) according to cord milking method. Hemoglobin change trend, blood transfusion volume, percutaneous bilirubin value and phototherapy time during hospitalization were compared between infants in UCM group and ICC group. Besides, the prevalence rates of intracranial hemorrhage, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were also compared.Results The hemoglobin level of infants in the UCM group were higher than that in the ICC group within 1 h after birth, about 1 week after birth and before discharge (t=2.246, 2.123, 1.886, P＜0.05). The frequency and volume of blood transfusions for premature infants in the ICC group were higher than those in the UCM group during hospitalization (χ2=2.145, t=2.160, P＜0.05). The peak time of transcutaneous bilirubin in the two groups both ranged from 3 to 6 days. During this period, the value of transcutaneous bilirubin of infants in the UCM group was significantly higher than that in the ICC group(t=2.231, 2.654, 2.686, 2.038, P＜0.05), but there was no significant difference in the duration of phototherapy between the two groups (P＞0.05). The occurrence of complications such as intracranial hemorrhage, ROP, BPD and NEC during the hospitalization was all no significantly different between the two groups (P＞0.05).Conclusions Compared with conventional umbilical cord amputation, umbilical cord milking can increase the blood volume and hemoglobin content, reduce the frequency and volume of blood transfusions during hospitalization, and do not increase pathological jaundice and complications in preterm infants with gestational age ＜34 weeks. Therefore, umbilical cord milking can be used as the first choice for premature infants with gestational age ＜34 weeks.
关键词
挤压脐带 /
早产儿 /
血红蛋白 /
黄疸
Key words
umbilical cord milking /
premature infants /
hemoglobin /
jaundice
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