延遲結扎臍帶對早產兒母嬰結局的影響

陳慧娟等

[摘要] 目的 探討延遲結扎對產婦及早產兒結局的影響。 方法 選取2013年9月～2014年10月在南京醫科大學附屬無錫婦幼保健院（以下簡稱“我院”）正常分娩的產婦50例為常規斷臍組，2013年10月～2014年9月在我院延遲斷臍的50例產婦為延遲斷臍組。比較兩組產后出血量、新生兒Apgar評分、臍血血紅蛋白、新生兒出生后6 d血紅蛋白、血細胞比容、膽紅素水平。 結果 新生兒生后6 d，延遲斷臍組血紅蛋白[（171.16±20.82）g/L]、血細胞比容[（50.44±6.15）%]均顯著高于常規斷臍組[（153.29±27.81）g/L，（45.95±7.83）%]，差異均有統計學意義（P < 0.05）；延遲斷臍組產婦第三產程時間[（9.90±2.75）s]短于常規斷臍組[（14.44±2.67）s]，差異有統計學意義（P < 0.05）；而兩組產婦產后出血量、新生兒Apgar評分、新生兒臍血血紅蛋白、生后3 d膽紅素水平比較，差異無統計學意義（P > 0.05）。 結論 延遲夾斷臍帶能有效預防早產兒貧血的發生，對產婦第三產程有積極影響，對早產兒膽紅素水平、Apgar評分未發現有不良影響。

[關鍵詞] 延遲結扎；早產兒；母嬰結局

[中圖分類號] R722 [文獻標識碼] A [文章編號] 1673-7210（2015）05（c）-0097-04

[Abstract] Objective To explore the influence of delayed umbilical cord clamping on premature infant and maternal outcomes Methods 50 puerperas with normal delivery from September 2013 to Octomber 2014 in Wuxi Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University （“our hospital” for short） were selected as conventional fault umbilical group， and 50 puerperas received delayed umbilical cord clamping additionally after birth from Octomber 2013 to September 2014 in our hospital were selected as delayed umbilical cord clamping group. The amount of postpartum hemorrhage， neonate Apgar score， Hb of umbilical cord blood， Hb of newborn 6 days after birth， HCT and bilirubin level were compared between the two groups. Results 6 days after birth， the Hb [（171.16±20.82）g/L] and HCT [（50.44±6.15）%] of newborn in the delayed umbilical cord clamping group were higher than those of the control group [（153.29±27.81）g/L， （45.95±7.83）%]， the differences were statistically significant （P < 0.05）； the third stage of labor time [（9.90±2.75）s] was shorter than that of the control group [（14.44±2.67）s]， the difference was statistically significant. There were no significant difference on postpartum hemorrhage， Apgar score， Hb of umbilical cord blood and bilirubin level 3 days after birth between two groups （P > 0.05）. Conclusion Delayed umbilical cord clamping is beneficial for premature infants to defense anemia and it brought some positive effect on the third labor for delivery women. There is no adverse effect on premature bilirubin and neonate Apgar scoring.

[Key words] Delayed umbilical cord clamping； Premature infants； Neonate and maternal outcome

關于結扎臍帶時間的早晚，一直是產科醫學存在爭議的問題。延遲結扎的提出是產科醫學發展革新后，進行了大量臨床實踐后的觀察結果。有學者認為傳統的快速斷臍法，可能剝奪了新生兒的血鐵儲備，對其造成不良影響[1]。通過近十年的臨床實踐，越來越多的醫療工作者及相關人員認識到了延遲斷臍（delayed cord clamping，DCC）對新生兒的益處，如減少新生兒時期貧血的發生率，對其產后良好的心肺適應性等。與此同時，延遲斷臍使得新生兒從胎盤獲得更多的液體灌輸以及血細胞的同時，也可能導致紅細胞的增多癥。隨著產后紅細胞破壞得增加，膽紅素也會增多，血液黏度也會隨之增高[2-3]。鑒于以上不同的觀點，考慮到延遲結扎的利與弊，目前國內各醫院還是以傳統的快速斷臍為主.也陸續嘗試開展了延遲斷臍在足月兒中臨床實踐[4-7]，而關于早產兒的研究較少，因此，現將南京醫科大學附屬無錫婦幼保健院（以下簡稱“我院”）進行的針對早產兒的延遲結扎臨床實踐做一報道，為今后延遲結扎在早產兒人群的推廣應用提供科學依據。