延迟脐带结扎对极早产儿临床结局影响的研究

Effect of delayed cord clamping on clinical outcome in extremely premature infants

摘要:

目的： 探讨出生延迟脐带结扎（delayed cord clamping，DCC）（娩出后60 s及以上结扎脐带）对极早产儿（孕周<32周）疾病的影响分析。方法： 回顾性分析2017至2019年100例极早产儿的病例临床资料，试验组为50例延迟脐带结扎的极早产儿，对照组为50例按照临床立即脐带结扎（immediate cord clamping，ICC）（娩出后15 s内结扎脐带）的极早产儿。比较2组极早产儿生后24 h及2周的血红蛋白（hemoglobin，HB）及红细胞压积（hematocrit，HCT）水平，比较生后2周2组极早产儿的贫血发生率及在住院期间需要输血治疗的情况，2组在新生儿坏死性小肠结肠炎（neonatal necrotizing enterocolitis，NEC）、新生儿高胆红素血症、脑室周围-脑室内出血（periventricular-intraventricular hemorrhage，PVH-IVH）、新生儿红细胞增多症的发生率。结果： 生后24 h及2周，试验组HB高于对照组，差异有统计学意义（P<0.05）。生后24 h HCT比较无统计学差异。但生后2周HCT比较，DCC组高于ICC组，且有统计学差异（P<0.05）。2组的贫血发生率、输血率及PVH-IVH发生率比较均有统计学差异（P<0.05），但2组在新生儿红细胞增多症、NEC、新生儿高胆红素血症发生率上均无统计学差异。结论： DCC可以在住院期间降低早产儿贫血发生率、输血概率及新生儿颅内出血发生率。

Abstract:

Objective: To investigate the effect of delayed cord clamping (DCC, clamping the cord after 60 s of delivery) on the clinical outcome in extremely preterm infants (gestational week<32 weeks). Methods: The clinical data of 100 cases of extremely premature infants from 2017 to 2019 were retrospectively analyzed and were divided into the experiment group (50 extremely premature infants with DCC) and the control group[50 extremely premature infants with immediate cord clamping (ICC, clamping within 15s after delivery)]. The level of hemoglobin (HB) and hematocrit (HCT) were compared after 24 hours and 2 weeks of birth between two groups, and the incidence of anemia and the amount of blood transfusion during hospitalization were also compared between two groups. The incidence of neonatal necrotizing enterocolitis, neonatal hyperbilirubinemia, periventricular intraventricular hemorrhage (PVH-IVH) and neonatal polycythemia was compared between the two groups. Results: After 24 hours and 2 weeks of birth, the hemoglobin in the experimental group was higher than that in the control group, with statistically significant difference (P<0.05). The hematocrit between two groups after 24 hours of birth had no statistical difference, but it in the experimental group was higher than that in the control group at 2 weeks after birth (P<0.05). There were significant differences in the incidence of anemia, transfusion and periventricular-intraventricular hemorrhage between two groups (P<0.05), but there was no significant difference in the incidence of hyperbilirubinemia, neonatal necrotizing enterocolitis and neonatal polycythemia between two groups. Conclusion: DCC can reduce the incidence of anemia, transfusion and PVH-IVH in extermely premature infants during hospitalization.