CAJ | 학술논문

目的系统评价延迟脐带结扎(delayed cord clamping,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30～90 s结扎脐带,对照组选择早期脐带结扎(early cord clamping,ECC) (＜30 s).采用Rev Man5.1.0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％CI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＜0.000 01)、血容量(MD=11.70,95％ CI: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.
목적 계통평개연지제대결찰(delayed cord clamping,DCC)대태령＜32주조산인적영향. 방법 검색Cochrane도서관、PubMed、EMBASE、만방수거고、중국기간전문수거고화중국유보수거고,검색시간균종1990년1월1일지2013년4월30일,수집DCC대태령＜32주조산인영향적수궤대조시험(randomized controlled trial,RCT)병진행사선화질량평개.DCC지태인면출후30～90 s결찰제대,대조조선택조기제대결찰(early cord clamping,ECC) (＜30 s).채용Rev Man5.1.0연건진행meta분석,계량자료채용가권균수차(mean difference,MD)급기95％CI표시,계수자료채용OR급기95％CI표시. 결과 공납입11편문헌,래자9항연구(373례태령＜32주조산인).여ECC상비,DCC가이명현제고태령＜32주조산인출생후적홍세포압적(MD=4.19,95％CI:2.97～5.40,Z=6.74,P＜0.000 01)、혈용량(MD=11.70,95％ CI:6.02～17.38,Z=4.04,P＜0.0001)화평균동맥압(MD=3.11,95％CI:1.30～4.92,Z=3.37,P=0.0008),감소겁조산인저혈압시확용약물적사용(OR=0.32,95％CI:0.11～0.98,Z=2.05,P=0.04)화신생인배사성소장결장염적발생(OR=0.48,95％CI:0.25～0.92,Z=2.22,P=0.03).DCC대겁조산인최고혈청담홍소수평、패혈증、동맥도관미폐、시망막병、로내출혈발생솔、출원시병사솔화7월령시지력화심리운동발육지수균무영향. 결론 DCC유가능성위일항안전적、개선태령＜32주조산인예후적림상간예조시;단목전납입연구양본량편소,결핍장기적수방평고연구,인이유필요진일보개전고질량、대양본수궤대조시험평개기작용화안전성.
Objective To evaluate the effects of delayed cord clamping (DCC) on preterm infants with gestational age ＜32 weeks.Methods Literatures from January 1,1990 to April 30,2013 in Cochrane 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 enterocolitis (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 evaluate the effect and safety of DCC.