上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (10): 1197-.doi: 10.3969/j.issn.1674-8115.2018.10.011

• 论著·临床研究 • 上一篇    下一篇

脐带挤压对早产儿血红蛋白量、胆红素及心功能的早期影响

张莉 1, 2，黄绮薇 1，龚小慧 1，李嫔 1   

  1. 1. 上海市儿童医院，上海交通大学附属儿童医院内分泌科，上海 200040；2. 上海市嘉定区妇幼保健院新生儿科，上海 201821
  • 出版日期:2018-10-28 发布日期:2018-11-18
  • 通讯作者: 李嫔，电子信箱：lipin21@126.com。
  • 作者简介:张莉（1976—），女，主治医师，硕士生；电子信箱： chouchou1225@163.com。
  • 基金资助:
    上海市科学技术委员会重大项目（ 12411952402）；上海市嘉定区科学技术委员会项目（ JDKW-2017-W25）

Early effects of umbilical cord milking on hemoglobin, bilirubin and cardiac function in premature infants

ZHANG Li1, 2, HUANG Qi-wei1, GONG Xiao-hui1, LI Pin1   

  1. 1. Department of Endocrinology, Shanghai Childrens Hospital, Shanghai Jiao Tong University, Shanghai 200040, China; 2. Department of Neonatology, Jiading District Maternal and Children Health Care Hospital, Shanghai 201821, China
  • Online:2018-10-28 Published:2018-11-18
  • Supported by:
    Foundation of Science and Technology Committee of Shanghai Municipality, 12411952402; Foundation of Science and Technology Committee of Jiading District, Shanghai, JDKW-2017-W25

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摘要： 目的 ·探讨脐带挤压对早产儿的血红蛋白量、胆红素及心功能的早期影响，以及对预防贫血的意义。方法 ·选择 2017年 7月 — 11月在上海市嘉定区妇幼保健院出生的孕周 < 37周的早产儿，按随机原则分为脐带挤压组（ n41）与正常断脐组（ n37）。比较 2组早产儿经皮血氧饱和度、不同时间段血红蛋白值、生后 72 h内左心功能指标、头颅超声、经皮胆红素水平、光疗总时间等。结果 ·脐带挤压组入院血红蛋白质量浓度较正常断脐组明显升高，差异有统计学意义（ P0.008）；生后 3～ 5 d、8～ 11 d、14～ 18 d脐带挤压组血红蛋白质量浓度均明显高于正常断脐组（ P<0.05）；随访至出生后 4个月时，脐带挤压组血红蛋白质量浓度仍高于正常断脐组，但差异无统计学意义（ P0.075）。2组早产儿光疗总时间比较，差异无统计学意义（ P0.849）。2组早产儿在生后 72 h左心室射血分数及左心室短轴缩短分数比较，差异均无统计学意义（ P>0.05）。结论 ·脐带挤压可提高早产儿生后早期体内血红蛋白水平，可降低出院时贫血的发生率，且未加重其左心负担，也未升高需要光疗的高胆红素血症的发病率，对于早产儿是一项简单、安全而又能有效提升其血红蛋白浓度的方法。

关键词: 脐带挤压, 早产儿, 血红蛋白, 左心功能, 高胆红素血症

Abstract:

Objective · To investigate the impact of umbilical cord milking on hemoglobin, bilirubin and cardiac function in premature newborns, and the significance of prevention of anemia. Methods · A randomized controlled trial was performed in Maternal and Child Health Hospital of Shanghai Jiading July to November 2017 on neonates born<37 weeks. Preterm newborns were randomly assigned to umbilical cord compression group (experiment group, n41) and control group (cord clamping within 15 s without compression, n37). Clinical measures of the outcomes were measuredtranscutaneous oxygen saturation (TcSO2), hemoglobin at different periods, left heart function within 72 h, cranial ultrasound, transcutaneous bilirubin, the total time of phototherapy. Results · Hemoglobin values were significantly higher in the experiment group than those in the control group in vein at the first time (P0.008). Hemoglobin values were significantly higher in the experiment group than those in the control group 3-5 d, 8-11 d, and 14-18 d after birth (P<0.05). Four months after birth, hemoglobin in the experiment group was higher than that in the control group, but there was no significant difference (P0.075). There was no significant difference in the total time of phototherapy between the two groups (P0.849). There were no significant differences between the two groups on left ventricular ejection fraction and left ventricular short axis shortening score 72 h after birth (P>0.05). Conclusion · Umbilical cord milking can increase the hemoglobin level to premature infants and reduce the incidence of anemia at discharge, and it does not increase the risk of cardiac insufficiency and hyperbilirubinemia. This practice has been shown to be simple and safe.

Key words: umbilical cord milking, premature infant, hemoglobin, cardiac function, hyperbilirubinemia

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