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脐带延迟结扎和脐带挤压输血对早产儿脑血流动力学的影响：一项随机双盲对照试验
Effect of delayed cord clamping and umbilical cord milking on cerebral hemodynamics in preterm infants: a randomized double-blind controlled trial
目的 比较脐带延迟结扎（DCC）和脐带挤压（UCM）输血对早产儿脑血流的影响。方法 该试验是一项单中心、前瞻性、双盲、随机对照临床试验。纳入2018年11月2日至2019年11月15日遂宁市中心医院出生、胎龄30~33+6周早产儿46名，随机分为DCC组（23例）和UCM组（23例）。主要结局指标包括生后0.5~1 h、（24±1）h、（48±1）h、（72±1）h超声多普勒测得的脑血流动力学参数：收缩期峰值流速（PSV）、舒张期峰值流速（EDV）和阻力指数（RI）。次要结局指标包括生后第1天检测的红细胞压积、血红蛋白、红细胞计数和血清总胆红素水平及住院期间颅内出血的发生率。结果 DCC组和UCM组实际进入统计分析的早产儿分别为21例和23例。DCC组和UCM组两组患儿生后各观察时间点PSV、EDV、RI差异无统计学意义（P > 0.05）；两组生后第1天红细胞压积、血红蛋白、红细胞计数和总胆红素水平及住院期间颅内出血发生率的比较差异无统计学意义（P > 0.05）。结论 DCC和UCM对30~33+6周早产儿脑血流动力学的影响无明显不同。
Objective To compare the effect of delayed cord clamping (DCC) versus umbilical cord milking (UCM) on cerebral blood flow in preterm infants. Methods This was a single-center, prospective, double-blind, randomized controlled trial. A total of 46 preterm infants, with a gestational age of 30-33+6 weeks, who were born in Suining Central Hospital from November 2, 2018 to November 15, 2019 were enrolled and randomly divided into DCC group and UCM group, with 23 infants in each group. The primary outcome indexes included cerebral hemodynamic parameters[peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI)] measured by ultrasound within 0.5-1 hour, (24±1) hours, (48±1) hours, and (72±1) hours after birth. Secondary outcome indexes included hematocrit, hemoglobin, red blood cell count, and serum total bilirubin levels on the first day after birth and the incidence rate of intraventricular hemorrhage during hospitalization. Results A total of 21 preterm infants in the DCC group and 23 in the UCM group were included in the statistical analysis. There was no significant difference in PSV, EDV, and RI between the two groups at all time points after birth (P > 0.05). There was also no significant difference between the two groups in the hematocrit, hemoglobin, red blood cell count and total bilirubin levels on the first day after birth, and the incidence rate of intraventricular hemorrhage during hospitalization (P > 0.05). Conclusions DCC and UCM have a similar effect on cerebral hemodynamics in preterm infants with a gestational age of 30-33+6 weeks.
Delayed cord clamping / Umbilical cord milking / Cerebral blood flow / Preterm infant
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2020年四川省卫生健康委员会资助课题（20PJ282）；遂宁市中心医院资助课题（2019y25）。
