新生儿出生后脐带自然搏动的生理特征与意义.docVIP

新生儿出生后脐带自然搏动的生理特征与意义 　　作者：张宏玉1,华少萍2,郑思华2,凌奕2　　　作者单位：海南医学院1.国际护理学院， 2. 附属医院，海南 海口　571001 　　【摘要】目的：分析新生儿出生后脐带搏动的生理特征，和对母儿结局的影响。方法：采用回顾性病例对照研究。收集生后等待脐带搏动自然停止后断脐的新生儿129例为样本，按不同的脐带搏动时间进行分组，并区分早产儿与足月儿两个亚层进行病例对照研究，比较不同组之间母儿结局指标。结果：脐带生后自然搏动时间18～540 s，平均(113.938±85.930)s。在足月新生儿，脐带搏动时间2 min或更长组，与短于1 min组比较，有更少的产后出血(t=14.524，P0.05)，胎盘端残血量增多(t=14.181，P0.05)，新生儿生后最高胆红素值降低(t=27.735 ， P0.05)，且有更少的入NICU的病率(Χ2 = 14.366 ，P0.05);在早产儿未显示各组指标差异有统计学意义;也未显示有不利的结果;相关性分析提示，产后出血量与脐带搏动时间呈负相关，与新生儿最高胆红素值亦呈正相关，与胎盘端残血量呈负相关，提示搏动时间延长，可能有更好的母儿结局。结论：脐带产后自然的搏动时间越长，显示了更好的母儿结局，或更健康的新生儿，有更长的产后脐带搏动时间，应等待脐带自然搏动停止后断脐。 　　【关键词】 新生儿生后脐带搏动;母儿结局;新生儿贫血 　　[ABSTRACT] Objective： To analyze physical character and effect of umbilical cord pulse after neonatal birth on maternal and neonatal outcomes. Methods： A total of 129 newborns with omphalotomy after arrest of umbilical cord pulse were divided based on the pulse time， and on premature and term infants. Indexes of maternal and neonatal outcomes were compared. Results： The time of natural pulse was 18-540 s， averaged as (113.938±85.930)s. For term infants， the time was more than 2 min. The incidence of postpartum hemorrhage was lower (t=14.524，P=0.000)， the volume of residue blood in placenta(t=14.181，P=0.000)， the highest level of bilirubin (t=27.735，P=0.000)and the incidence of NIUC (Χ2 = 14.366 ，P= 0.001)were decreased. For premature infants， there was no significant difference in those indexes. Correlation analysis showed the volume of postpartum hemorrhage was negatively correlated with pulse time. The pulse time had positive correlation with highest level of bilirubin， and negative correlation with the volume of residue blood. The prolonging pulse time is associated with better outcomes. Conclusions： The longer the pulse time， the better the maternal and neonatal outcomes. The omphalotomy should be performed after natural arrest of pulse. 　　[KEY WORDS] Pulse of umbilical cord; Newborn; Maternal and neonatal outcomes; Anemia of newborns 　　人