延迟脐带结扎对胎龄<32周早产儿的影响

Influence of delayed cord clamping on preterm infants with a gestational age of <32 weeks

摘要:

目的 评价延迟脐带结扎 （DCC）对胎龄<32周早产儿的影响。方法 将2015年1~12月自然分娩的90例胎龄<32周早产儿随机分为DCC组 （46例）和早期结扎 （ICC）组 （44例），对比两组的血常规、红细胞输注总量、血气、平均动脉压、胆红素峰值、光疗总时间，以及坏死性小肠结肠炎、晚发性败血症、颅内出血和视网膜病、支气管肺发育不良的发生几率。结果 DCC组的血红蛋白、红细胞压积、平均动脉压、标准碱剩余 （sBE）高于ICC组，而接受扩容及多巴胺升压治疗的早产儿比例以及红细胞输注量低于ICC组，差异有统计学意义 （P<0.05）。两组间体温、pH值、HCO₃^-浓度、血清胆红素峰值、总光疗时间以及晚发型败血症、视网膜病、Ⅱ级以上颅内出血及Ⅱ级以上新生儿坏死性小肠结肠炎的发生率差异无统计学意义 （P>0.05）。结论 DCC是一项安全的、可以改善胎龄<32周早产儿预后的临床干预措施

Abstract:

Objective To investigate the influence of delayed cord clamping (DCC) on preterm infants with a gestational age of <32 weeks. Methods Ninety preterm infants with a gestational age of <32 weeks delivered naturally from January to December, 2015 were enrolled and randomly divided into DCC group (46 infants) and immediate cord clamping (ICC) group (44 infants). The routine blood test results, total amount of red blood cell transfusion, blood gas parameters, mean arterial pressure, bilirubin peak, total time of phototherapy, and incidence rates of necrotizing enterocolitis, late-onset sepsis, intracranial hemorrhage, retinopathy, and bronchopulmonary dysplasia were compared between the two groups. Results Compared with the ICC group, the DCC group had significantly higher levels of hemoglobin, hematocrit, mean arterial pressure, and standard base excess (P<0.05), as well as a significantly lower percentage of preterm infants who underwent volume expansion and dopamine treatment and a significantly lower amount of red blood cell transfusion (P<0.05). The body temperature, pH value, HCO₃^- concentration, serum bilirubin peak, total time of phototherapy, and incidence rates of late-onset sepsis, retinopathy, grade ≥2 intracranial hemorrhage, and grade ≥2 neonatal necrotizing enterocolitis showed no significant differences between the two groups (P>0.05). Conclusions DCC is a safe clinical intervention and can improve the prognosis of preterm infants with a gestational age of <32 weeks.