中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
Chinese Journal of Perinatal Medicine
2015年
10期
747-754
,共8页
婴儿,极低出生体重%输血%胎盘血液循环%脐带%结扎术%收缩%Meta分析
嬰兒,極低齣生體重%輸血%胎盤血液循環%臍帶%結扎術%收縮%Meta分析
영인,겁저출생체중%수혈%태반혈액순배%제대%결찰술%수축%Meta분석
Infant,very low birth weight%Blood transfusion%Placental circulation%Umbilical cord%Ligation%Constriction%Meta-analysis
目的 探讨极低出生体重儿(very low birth weight infant,VLBWI)出生时采用延迟脐带结扎或挤压脐带等胎盘输血措施的益处和风险. 方法 检索1965年1月至2014年7月期间PubMed、EMBASE、ClinicalTrials.gov、中国学术期刊网络出版总库和万方数据库中,关于VLBWI延迟脐带结扎和脐带挤压的随机对照试验.采用Cochrane评价手册5.1.0推荐的标准对纳入文献进行质量评价.Meta分析采用Revman 5.3软件,根据文献的异质性采用固定效应模型或随机效应模型分析. 结果 纳入14篇英文文献进行meta分析.8项研究采用延迟脐带结扎,6项研究采用脐带挤压.胎盘输血组任何级别脑室内出血(intraventricular hemorrhage,IVH)发生率低于对照组(9项研究,OR=0.49,95％CI:0.32～0.77,P＜0.01);生后4h内的平均动脉压高于对照组(8项研究,MD=4.42, 95％CI: 3.85～4.98,P＜ 0.01);入院后首次血红蛋白值高于对照组(6项研究,MD=3.52,95％CI: 1.67～5.37,P＜ 0.01);住院期间脓毒血症的发生率低于对照组(5项研究,OR=0.46,95％CI: 0.26～0.83,P=0.01),差异均有统计学意义.比较胎盘输血组与对照组5 min Apagr评分(MD=0.0l,95％CI:-0.21～0.22)、入院时体温(MD=0.13,95％CI:-0.15～0.41)、胆红素峰值(MD=0.59,95％CI:-0.13～1.31)、入院后首次红细胞压积(MD=3.48,95％CI:-0.46～7.43)、住院期间病死率(OR=0.63,95％CI:0.31～1.25)、Bell分期2期以上的坏死性小肠结肠炎发生率(OR=0.62,95％CI: 0.29～1.33)、因贫血需要输血的比例(OR=0.63,95％CI: 0.35～1.15)、纠正胎龄36周需要用氧的比例(OR=0.79,95％CI:0.46～1.34),差异均无统计学意义(P值均＞0.05). 结论 VLBWI 出生时采用延迟脐带结扎或挤压脐带等胎盘输血措施可改善结局,与早期结扎脐带比较可明显降低任何级别IVH及住院期间脓毒血症的风险,但最佳的操作方法及其对远期神经发育结局的影响还需要进一步研究.
目的 探討極低齣生體重兒(very low birth weight infant,VLBWI)齣生時採用延遲臍帶結扎或擠壓臍帶等胎盤輸血措施的益處和風險. 方法 檢索1965年1月至2014年7月期間PubMed、EMBASE、ClinicalTrials.gov、中國學術期刊網絡齣版總庫和萬方數據庫中,關于VLBWI延遲臍帶結扎和臍帶擠壓的隨機對照試驗.採用Cochrane評價手冊5.1.0推薦的標準對納入文獻進行質量評價.Meta分析採用Revman 5.3軟件,根據文獻的異質性採用固定效應模型或隨機效應模型分析. 結果 納入14篇英文文獻進行meta分析.8項研究採用延遲臍帶結扎,6項研究採用臍帶擠壓.胎盤輸血組任何級彆腦室內齣血(intraventricular hemorrhage,IVH)髮生率低于對照組(9項研究,OR=0.49,95％CI:0.32～0.77,P＜0.01);生後4h內的平均動脈壓高于對照組(8項研究,MD=4.42, 95％CI: 3.85～4.98,P＜ 0.01);入院後首次血紅蛋白值高于對照組(6項研究,MD=3.52,95％CI: 1.67～5.37,P＜ 0.01);住院期間膿毒血癥的髮生率低于對照組(5項研究,OR=0.46,95％CI: 0.26～0.83,P=0.01),差異均有統計學意義.比較胎盤輸血組與對照組5 min Apagr評分(MD=0.0l,95％CI:-0.21～0.22)、入院時體溫(MD=0.13,95％CI:-0.15～0.41)、膽紅素峰值(MD=0.59,95％CI:-0.13～1.31)、入院後首次紅細胞壓積(MD=3.48,95％CI:-0.46～7.43)、住院期間病死率(OR=0.63,95％CI:0.31～1.25)、Bell分期2期以上的壞死性小腸結腸炎髮生率(OR=0.62,95％CI: 0.29～1.33)、因貧血需要輸血的比例(OR=0.63,95％CI: 0.35～1.15)、糾正胎齡36週需要用氧的比例(OR=0.79,95％CI:0.46～1.34),差異均無統計學意義(P值均＞0.05). 結論 VLBWI 齣生時採用延遲臍帶結扎或擠壓臍帶等胎盤輸血措施可改善結跼,與早期結扎臍帶比較可明顯降低任何級彆IVH及住院期間膿毒血癥的風險,但最佳的操作方法及其對遠期神經髮育結跼的影響還需要進一步研究.
목적 탐토겁저출생체중인(very low birth weight infant,VLBWI)출생시채용연지제대결찰혹제압제대등태반수혈조시적익처화풍험. 방법 검색1965년1월지2014년7월기간PubMed、EMBASE、ClinicalTrials.gov、중국학술기간망락출판총고화만방수거고중,관우VLBWI연지제대결찰화제대제압적수궤대조시험.채용Cochrane평개수책5.1.0추천적표준대납입문헌진행질량평개.Meta분석채용Revman 5.3연건,근거문헌적이질성채용고정효응모형혹수궤효응모형분석. 결과 납입14편영문문헌진행meta분석.8항연구채용연지제대결찰,6항연구채용제대제압.태반수혈조임하급별뇌실내출혈(intraventricular hemorrhage,IVH)발생솔저우대조조(9항연구,OR=0.49,95％CI:0.32～0.77,P＜0.01);생후4h내적평균동맥압고우대조조(8항연구,MD=4.42, 95％CI: 3.85～4.98,P＜ 0.01);입원후수차혈홍단백치고우대조조(6항연구,MD=3.52,95％CI: 1.67～5.37,P＜ 0.01);주원기간농독혈증적발생솔저우대조조(5항연구,OR=0.46,95％CI: 0.26～0.83,P=0.01),차이균유통계학의의.비교태반수혈조여대조조5 min Apagr평분(MD=0.0l,95％CI:-0.21～0.22)、입원시체온(MD=0.13,95％CI:-0.15～0.41)、담홍소봉치(MD=0.59,95％CI:-0.13～1.31)、입원후수차홍세포압적(MD=3.48,95％CI:-0.46～7.43)、주원기간병사솔(OR=0.63,95％CI:0.31～1.25)、Bell분기2기이상적배사성소장결장염발생솔(OR=0.62,95％CI: 0.29～1.33)、인빈혈수요수혈적비례(OR=0.63,95％CI: 0.35～1.15)、규정태령36주수요용양적비례(OR=0.79,95％CI:0.46～1.34),차이균무통계학의의(P치균＞0.05). 결론 VLBWI 출생시채용연지제대결찰혹제압제대등태반수혈조시가개선결국,여조기결찰제대비교가명현강저임하급별IVH급주원기간농독혈증적풍험,단최가적조작방법급기대원기신경발육결국적영향환수요진일보연구.
Objective To investigate the risks and benefits of interventions promoting placental transfusion (PT) at delivery [delayed cord clamping (DCC) or umbilical cord milking (UCM)] compared with early cord clamping (ECC) on outcomes among very low birth weight infants (VLBWI).Methods A systematic search was conducted of PubMed, EMBASE, ClinicalTrials.gov, China Academic Journal Network Publishing Database and Wanfang Medical Databases (January 1965 to July 2014) for randomized controlled trial (RCT) articles relating to PT strategies (DCC and UCM) in VLBWI.The Cochrane Handbook 5.1.0 was used to evaluate the methodological quality and RevMan 5.3 software from Cochrane Collaboration was used for metaanalysis.The fixed effect or random effect model was adopted according to the result of heterogeneity, Results We identified 14 eligible studies describing a total of 659 neonates with an average birth weight ＜ 1 500 g.There were eight studies for DCC and six studies for UCM.Compared with the control, benefits of greater PT decreased any grade intraventricular hemorrhage (IVH) (nine studies, OR=0.49, 95％CI: 0.32-0.77, P ＜ 0.01), increased the blood pressure at four hours of life (eight studies, MD=4.42, 95％CI: 3.85-4.98, P ＜ 0.01), and also showed higher initial hemoglobin (Hb) level (six studies, MD=3.52, 95％CI: 1.67-5.37, P ＜ 0.01) and lower incidence of sepsis during the hospital stay (five studies, OR=0.46, 95％CI: 0.26-0.83, P=0.01).No differences were observed between the groups about the fllowing indicators (all P ＞ 0.05): 5-minute Apgar scores (MD=0.01,95％CI:-0.21-0.22), admission temperature (MD=0.13, 95％CI:-0.15 to 0.41), peak serum bilirubin levels (MD=0.59, 95％CI:-0.13 to 1.31), initial reported hematocrit (MD=3.48, 95％CI:-0.46 to 7.43), mortality before discharge (OR=0.63, 95％CI:0.31-1.25), Bell's stage 2 or greater necrotizing enterocolitis (OR=0.62 ,95％CI: 0.29-1.33), rates of transfusion due to anemia (OR=0.63, 95％CI: 0.35-1.15) and oxygen therapy at 36 weeks of corrected age (OR=0.79, 95％CI: 0.46-1.34).Conclusions It is suggested that enhanced PT (both DCC and UCM) at birth is safe and provide better neonatal outcomes than ECC for those VLBWI, most notably reduces the overall IVH occurrence and lower the incidence of sepsis.The optimal umbilical cord clamping practice and UCM among VLBWI infants remains uncertain and long-term neurodevelopmental outcomes are warranted.
