延迟脐带结扎质量改进项目在极/超早产儿中的应用研究  

Study on the application and promotion of the delayed umbilical cord clamping quality improvement project in very preterm and extremely preterm infants

作　　者：段顺艳 高薇薇[1] 陈佳[1] 严隆丽 刘颖[1] 杜岚岚[1] 王柱[1] Duan Shunyan;Gao Weiwei;Chen Jia;Yan Longli;Liu Ying;Du Lanlan;Wang Zhu(National Key Clinical Specialty Construction Project/Department of Neonatology,Guangdong Women and Children's Hospital,Guangdong Neonatal Intensive Care Unit Medical Quality Control Center,Guangzhou 511400,China)

机构地区：[1]国家临床重点专科/广东省妇幼保健院新生儿科,广东省新生儿重症医学专业质量控制中心,广州511400

出　　处：《中华新生儿科杂志（中英文）》2023年第10期598-602,共5页Chinese Journal of Neonatology

基　　金：广东省医学科研基金(A2022065);广东省卫生健康适宜技术推广项目(20220628163649)。

摘　　要：目的:探讨延迟脐带结扎(delayed umbilical cord clamping,DCC)在极早产儿和超早产儿中应用的安全性及可行性。方法:选择广东省妇幼保健院2020年7~12月脐带结扎质量改进项目实施前生后立即脐带结扎(immediate umbilical cord clamping,ICC)的患儿为ICC组,2021年1~6月项目实施后进行DCC的极/超早产儿为DCC组进行前瞻性研究。比较两组患儿窒息、低体温发生率、生后24 h内和72 h内气管插管率、机械通气时间、总用氧时间、支气管肺发育不良等早产儿并发症发生率。结果:ICC组45例,DCC组54例,两组胎龄分别为(29.3±1.7)周和(29.6±1.4)周,出生体重分别为(1250±332)g和(1257±306)g,差异均无统计学意义(P>0.05)。两组窒息发生率、收入新生儿重症监护病房时体温、低体温发生率、生后24 h内气管插管率、生后72 h内气管插管率及其他早产儿并发症发生率比较,差异均无统计学意义(P>0.05)。结论:DCC不增加极/超早产儿窒息、低体温、有创呼吸支持等风险。Objective To study the safety and feasibility of application of delayed umbilical cord clamping(DCC)in very preterm and extremely preterm infants.Methods Based on the previous improvement projects of temperature management and respiratory support,we conducted a prospective study on the effect of umbilical cord clamping quality improvement project using the clinical data of very preterm and extremely preterm infants admitted to Guangdong Maternal and Child Health Hospital.The infants admitted from July to December 2020 who underwent immediate umbilical cord clamping(ICC)were included in the ICC group,and the infants admitted from January to June 2021 who underwent DCC were involved in the DCC group.The incidence of asphyxia,hypothermia,endotracheal intubation within 24 h after birth,endotracheal intubation within 72 h after birth,bronchopulmonary dysplasia and other complications,mechanical ventilation duration and total oxygen therapy duration were compared between the two groups.Results A total of 45 cases were included in ICC group and 54 cases in DCC group.The gestational age of the two groups was(29.3±1.7)weeks and(29.6±1.4)weeks,and the birth weight was(1250±332)g and(1257±306)g.The differences were not statistically significant(P>0.05).There were no significant differences between the two groups in the incidence of asphyxia,hypothermia,bronchopulmonary dysplasia and other complications related to preterm infants,tracheal intubation rates within 24 and 72 h,and the neonatal temperature at admission to NICU(P>0.05).Conclusions Delayed umbilical cord clamping does not increase the risks of asphyxia,hypothermia or invasive respiratory support in very preterm and extremely preterm infants.

关 键 词：极早产儿 超早产儿 延迟脐带结扎 低体温 气管插管 

分 类 号：R722.6[医药卫生—儿科]