邓曦++潘淑媛++曾韶英

[摘要] 目的 探討不同脐带结扎时间对母儿结局的影响。 方法 选择2014年4月～2016年4月在南方医科大学附属新会医院分娩的足月妊娠阴道分娩孕妇160例，按照随机数字表法分为对照组和观察组，每组各80例。对照组分娩时产儿采用早脐带结扎，观察组分娩时产儿采用延迟脐带结扎。比较两组孕妇产后24 h出血量、第三产程时间、产后出血发生率；新生儿脐血和产后3 d足跟血的血红蛋白、血细胞比容，新生儿Apgar评分、胆红素、皮测胆红素峰值及新生儿贫血、高胆红素血症发生率。 结果 两组产后24 h出血量、第三产程时间及产后出血发生率比较，差异无统计学意义（P > 0.05）。观察组脐血和产后3 d足跟血血红蛋白、血细胞比容均高于对照组，差异有统计学意义（P < 0.05）。两组新生儿娩出后1、5 min Apgar评分比较，差异无统计学意义（P > 0.05）。两组新生儿胆红素、高胆红素血症发生率比较，差异无统计学意义（P > 0.05）。观察组胆红素峰值高于对照组，差异有统计学意义（P < 0.05）。观察组新生儿贫血发生率低于对照组，差异有统计学意义（P < 0.05）。 结论 延迟脐带结扎能够显著提高新生儿血红蛋白、血细胞比容水平，减少贫血的发生，皮测胆红素峰值呈上升趋势，不增加新生儿高胆红素血症和新生儿窒息发生率。

[关键词] 早脐带结扎；延迟脐带结扎；时机；母儿结局

[中图分类号] R714.3 [文献标识码] A [文章编号] 1673-7210（2017）01（b）-0089-04

Influence of different umbilical cord ligation time on maternal and child outcomes

DENG Xi PAN Shuyuan ZENG Shaoyin

Department of Obstetrics， Xinhui Hospital Affiliated to Southern Medical University， Guangdong Province， Jiangmen 529100， China

[Abstract] Objective To explore the influence of different umbilical cord ligation time on maternal and child outcomes. Methods 160 pregnant women with the full-term pregnancy and the vaginal delivery were selected in Xinhui Hospital Affiliated to Southern Medical University from April 2014 to April 2016. They were divided into control group and observation group according to random number table， 80 cases in each group. The early cord clamping was used in neonatal of control group， and delayed cord clamping was applied in neonatal of observation group. Postpartum 24 h hemorrhage， the third labor time， incidence rate of postpartum hemorrhage， hemoglobin and hematocrit in umbilical cord blood and postpartum 3 d heel blood， neonatal Apgar score， bilirubin and transcutaneous bilirubin peak and incidence rate of neonatal anemia， hyperbilirubinemia between two groups were compared. Results Postpartum 24 h hemorrhage， the third labor time， incidence rate of postpartum hemorrhage between two groups were compared， with no statistical difference （P > 0.05）. Hemoglobin and hematocrit in umbilical cord blood and postpartum 3 d heel blood in observation group were higher than those in control group， with statistical differences （P < 0.05）. Neonatal Apgar score after delivery of 1 and 5 min two groups were compared， with no statistical difference （P > 0.05）. The neonatal bilirubin and incidence rate of hyperbilirubinemia between two groups were compared， with no statistical difference （P > 0.05）. The peak value of bilirubin in observation group was higher than that in control group， with statistical difference （P < 0.05）. The incidence rate of anemia in observation group was lower than that in control group， with statistical difference （P < 0.05）. Conclusion Delayed umbilical cord ligation can significantly improve neonatal hemoglobin， hematocrit levels， and reduce anemia. Skin test bilirubin peak is rising， but it dose not increase neonatal hyperbilirubinemia and neonatal asphyxia.

[Key words] Early cord clamping； Delayed cord clamping； Opportunity； Maternal and child outcomes

早脐带结扎是指胎儿娩出后即刻（30 s内）进行结扎脐带，与预防性应用缩宫素及可控性脐带牵拉一起作为积极管理第三产程的一部分，是产科常规操作。近几年来，脐带结扎的最佳时机提出了异议，认为早脐带结扎使出生时新生儿应得到的红细胞数减少超过50%，是引起婴幼儿贫血的主要原因之一[1]。延迟结扎脐带即在胎儿娩出30～60 s后，或等待脐带搏动停止后再结扎。有研究认为，结扎过晚，可能导致红细胞增多或胆红素过多，诱发新生儿高胆红素血症[2-3]。目前……