基于全国性问卷调查的延迟脐带结扎影响因素分析  

Influencing factors on delayed cord clamping:based on the national questionnaire survey

作　　者：朱娟娟 古航[2] 王蓓[3] 韩树萍[4] 朱建幸[1] 谢利娟[1] Zhu Juanjuan;Gu Hang;Wang Bei;Han Shuping;Zhu Jianxing;Xie Lijuan(Department of Pediatrics,Xinhua Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200092,China;Department of Gynecology and Obstetrics,Changhai Hospital,Shanghai 200433,China;Department of Obstetrics,Xinhua Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200092,China;Department of Neonatology,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,Jiangsu Province,China)

机构地区：[1]上海交通大学医学院附属新华医院新生儿科,200092 [2]长海医院妇产科,上海200433 [3]上海交通大学医学院附属新华医院产科,200092 [4]南京市妇幼保健院新生儿科,210004

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第1期67-72,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：上海市自然科学基金资助项目(12ZR1419600);上海申康医院发展中心临床科技创新项目(SHDC12016217)。

摘　　要：目的探讨我国新生儿脐带结扎(UCC)现状及实施延迟脐带结扎(DCC)影响因素。方法采用分层随机抽样法,在我国华南、华北、华东、华中、西北、西南和东北7个地区中,以2∶1比例随机抽取2~3个省,共计16个省的126家医院。以这126家医院工作的新生儿科医师、产科医师及助产士/师为调查对象。本研究自行设计《新生儿娩出后脐带结扎方式调查问卷》(以下简称为《调查问卷》)。《调查问卷》主要包括3个方面内容:①被调查对象的一般资料;②被调查对象对DCC的认知程度;③被调查对象认为影响DCC实施因素等。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①最终回收《调查问卷》为5005份,其中,来自综合性医院的符合填写要求《调查问卷》为2280份(45.55%),妇幼保健院为2725份(54.25%)。5005份《调查问卷》中,由助产士/师、产科医师、新生儿科医师填写分别为2253份(45.01%),1541份(30.79%)和1211份(24.20%)。②回收的5005份《调查问卷》中,知晓DCC相关知识者为4325位(86.41%),实施者仅为921位(18.40%)。③被调查者主要从专家讲座(62.87%)、科室规范(53.50%)、文献检索(42.94%)和国际指南(40.00%)等途径获取有关DCC相关知识。④对DCC实施影响因素的多因素非条件logistic回归分析结果显示,医院类型(OR=0.530,95%CI:0.355~0.837,P=0.006),医院等级(OR=0.450,95%CI:0.364~0.556,P<0.001),分娩方式(OR=35.772,95%CI:20.753~61.660,P<0.001),是否早产(OR=3.914,95%CI:2.178~7.033,P<0.001),认为操作是否便捷(OR=2.577,95%CI:0.001~0.014,P<0.001),是否有科室规范(OR=1.187,95%CI:0.767~0.838,P=0.015)和认为能否便于新生儿窒息复苏(OR=0.021,95%CI:0.010~0.142,P<0.001)是DCC实施的影响因素(P<0.05)。结论目前,临床工作者对DCC的知晓率高,但实施率低。临床实施DCC的影响因素较多,在中国建立明确的实施DCC指南或专家共识,对优化产科新生儿分�Objective To explore current status of umbilical cord clamping(UCC)and influencing factors of delayed cord clamping(DCC)in China.Methods Respondents of neonatologists,obstetricians and midwives/teachers worked in 126 hospitals of 16 provinces were randomly selected from 2-3 provinces and municipality directly under Central Government in 7 regions of South,North,East,and Central,Northwest,Southwest,Northeast China at a ratio of 2∶1 by stratified random sampling method.Questionnaire on the Umbilical Cord Method after the Delivery(hereinafter referred to as Questionnaire)was self-designed.It mainly included three aspects:①general information of respondents;②awareness rate of respondents to DCC;③factors that respondents thought to affect on implementation of DCC.The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013.Results①A total of 5005 questionnaires were collected in this survey,including 2280(45.55%)in general hospitals and 2725(54.25%)in maternal and child health hospitals.There were 2253(45.01%),1541(30.79%)and 1211(24.20%)completed by midwives,obstetricians and neonatologists respectively.②Among the 5005 questionnaires,4325(86.41%)respondents knew about DCC,and only 921(18.40%)implemented it.③Respondents obtained DCC-related knowledge through mainly expert lectures(62.87%),departmental standards(53.50%),literature retrieval(42.94%)and international guidelines(40.00%).④The results of multivariate unconditional logistic regression analysis on related influencing factors on implementation of DCC showed that hospital category(OR=0.530,95%CI:0.355-0.837,P=0.006),hospital grade(OR=0.450,95%CI:0.364-0.556,P<0.001)and neonatal delivery mode(OR=35.772,95%CI:20.753-61.660,P<0.001),premature newborns(OR=3.914,95%CI:2.178-7.033,P<0.001),and whether it was easy to operate(OR=2.577,95%CI:0.001-0.014,P<0.001),standardization of clinica department(OR=1.187,95%CI:0.767-0.838,P=0.015),application of neonatal asphyxia resuscitation(OR=0.

关 键 词：脐带 立即脐带结扎 延迟脐带结扎 调查和问卷 影响因素分析 指南 婴儿 新生 

分 类 号：R47[医药卫生—护理学]