陈慧娟等

[摘要] 目的 探讨延迟结扎对产妇及早产儿结局的影响。 方法 选取2013年9月～2014年10月在南京医科大学附属无锡妇幼保健院（以下简称“我院”）正常分娩的产妇50例为常规断脐组，2013年10月～2014年9月在我院延迟断脐的50例产妇为延迟断脐组。比较两组产后出血量、新生儿Apgar评分、脐血血红蛋白、新生儿出生后6 d血红蛋白、血细胞比容、胆红素水平。 结果 新生儿生后6 d，延迟断脐组血红蛋白[（171.16±20.82）g/L]、血细胞比容[（50.44±6.15）%]均显著高于常规断脐组[（153.29±27.81）g/L，（45.95±7.83）%]，差异均有统计学意义（P < 0.05）；延迟断脐组产妇第三产程时间[（9.90±2.75）s]短于常规断脐组[（14.44±2.67）s]，差异有统计学意义（P < 0.05）；而两组产妇产后出血量、新生儿Apgar评分、新生儿脐血血红蛋白、生后3 d胆红素水平比较，差异无统计学意义（P > 0.05）。 结论 延迟夹断脐带能有效预防早产儿贫血的发生，对产妇第三产程有积极影响，对早产儿胆红素水平、Apgar评分未发现有不良影响。

[关键词] 延迟结扎；早产儿；母婴结局

[中图分类号] R722 [文献标识码] A [文章编号] 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

关于结扎脐带时间的早晚，一直是产科医学存在争议的问题。延迟结扎的提出是产科医学发展革新后，进行了大量临床实践后的观察结果。有学者认为传统的快速断脐法，可能剥夺了新生儿的血铁储备，对其造成不良影响[1]。通过近十年的临床实践，越来越多的医疗工作者及相关人员认识到了延迟断脐（delayed cord clamping，DCC）对新生儿的益处，如减少新生儿时期贫血的发生率，对其产后良好的心肺适应性等。与此同时，延迟断脐使得新生儿从胎盘获得更多的液体灌输以及血细胞的同时，也可能导致红细胞的增多症。随着产后红细胞破坏得增加，胆红素也会增多，血液黏度也会随之增高[2-3]。鉴于以上不同的观点，考虑到延迟结扎的……