延迟脐带结扎对胎龄〈32周早产儿影响的meta分析  

Effect of delayed cord clamping on preterm infants with gestational age 〈32 weeks： a meta-analysis

作　　者：余章斌[1] 韩树萍[1] 沙莉[1] 刘凤[1] 陈玉林[1] 邱玉芳[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院儿科,210004

出　　处：《中华围产医学杂志》2013年第11期660-667,共8页Chinese Journal of Perinatal Medicine

基　　金：江苏省医学重点人才基金（RC2011021）;南京市医学科技发展资金（YKK10038）

摘　　要：目的系统评价延迟脐带结扎（delayed cord damping，DCC）对胎龄〈32周早产儿的影响。方法检索Cochrane图书馆、PubMed、EMBASE、万方数据库、中国期刊全文数据库和中国维普数据库，检索时间均从1990年1月1日至2013年4月30日，收集DCC对胎龄〈32周早产儿影响的随机对照试验（randomized controlled trial，RCT）并进行筛选和质量评价。DCC指胎儿娩出后30～90s结扎脐带，对照组选择早期脐带结扎（early cord clamping，ECC）（〈30s）。采用Rev Man 5．1．0软件进行meta分析，计量资料采用加权均数差（mean difference，MD）及其95％CI表示，计数资料采用OR及其95％CJ表示。结果共纳入11篇文献，来自9项研究（373例胎龄〈32周早产儿）。与ECC相比，DCC可以明显提高胎龄〈32周早产儿出生后的红细胞压积（MD=4．19，95％CI：2．97～5．40，Z=6．74，P〈0．00001）、血容量（MD=11．70，95％CJ：6．02～17．38，Z=4．04，P〈0．0001）和平均动脉压（MD=3．11，95％CI：1．30～4．92，Z=3．37，P=0．0008），减少极早产儿低血压时扩容药物的使用（OR=0．32，95％CI：0．11～0．98，Z=2．05，P=0．04）和新生儿坏死性小肠结肠炎的发生（OR=0．48，95％CI：0．25～0．92，Z=2．22，P=0．03）。DCC对极早产儿最高血清胆红素水平、败血症、动脉导管未闭、视网膜病、颅内出血发生率、出院时病死率和7月龄时智力和心理运动发育指数均无影响。结论DCC有可能成为一项安全的、改善胎龄〈32周早产儿预后的临床干预措施；但目前纳入研究样本量偏少，缺乏长期的随访评估研究，因而有必要进一步开展高质量、大样本随机对照试验评价其作用和安全性。Objective To evaluate the effects of delayed cord clamping （DCC） on prmerm infants with gestational age 〈32 weeks. Methods Literatures from January 1, 1990 to April 30, 2013 in Coehrane library, PubMed, EMBASE, China Academic Journal Network Publishing Database, Wanfang Medical Database and VIP Database were searched. Randomized controlled trials （RCT） of DCC in preterm infants with gestational age 〈32 weeks were screened and evaluated. DCC was defined as cord clamping in 30 90 s after delivery, and early cord clamping （ECC） （〈30 s） was as the control. Rev Man 5. 1.0 was used for statistical analysis. Mean difference （MD） and 95%CI were used for continuous data while OR and 95%CI were for categorical data. Results Nine studies （11 articles） involving 373 infants were included. Compared with ECC, DCC improved hematocrit （MD= 4.19, 95%CI： 2.97 5.40,Z=6.74,P〈0.000 01）, blood volume （MD=11.70, 95%CI： 6.02-17.38, Z= 4. 04,P〈0. 0001） and mean arterial pressure of preterm infants with gestational age 〈32 weeks （MD 3. 11, 95% CI： 1.30-4. 92, Z=3.37, P=0. 0008）, decreased the usage of volume expansion for hypotension （OR=0. 32, 95%CI： 0. 11-0. 98,Z=2. 05,P=0. 04） and the incidence of necrotizing enteroeolitis （OR=0. 48, 95%CI：0. 25-0. 92, Z=2.22,P=0. 03）. Meanwhile, DCC had no influence on the peak bilirubin concentration, the incidence of sepsis, patent ductus arteriosus, retinopathy and intracranial hemorrhage,also no influence on neonatal mortality on dcscharge, mental developmental index and psychomotor developmental index at seven-month old. Conclusions DCC might be a safe procedure to improve prognosis of preterm infants less than 32 weeks＇ gestational age. However, due to small sample size and lack of data on follow-up, it is necessary to launch clinical trials with higher quality and larger scale to further evahlate the effect and safetv of DCC.

关 键 词：婴儿 早产 脐带 结扎术 时间 META分析 预后 

分 类 号：R722.6[医药卫生—儿科]