脐带挤压对早产儿出生后相关指标影响的Meta分析

doi:10.3761/j.issn.0254-1769.2019.11.007

摘要/Abstract

摘要：

目的分析脐带挤压对早产儿出生后相关指标的影响。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和中国生物医学文献服务系统中从建库至2019年2月发表的早产儿脐带挤压的随机对照试验。由2名经过培训的研究员独立筛选文献、评价质量和提取资料,并采用Review Manager 5.3进行Meta分析。结果最终纳入9篇文献,英文文献7篇,中文文献2篇,共774例早产儿,其中脐带挤压组388例,立即断脐组386例。Meta分析结果显示：①与立即断脐相比,脐带挤压能提高早产儿血红蛋白水平[SMD=0.75,95%CI（0.51,0.98）,Z=6.22,P<0.01]、收缩压[MD=3.85,95%CI（0.75,6.95）,Z=2.44,P=0.01]、舒张压[MD=3.75,95%CI（1.20,6.31）,Z=2.88,P<0.01]及上腔静脉血流量;②与立即断脐相比,脐带挤压减少了早产儿输血人数[RR=0.72,95%CI（0.54,0.95）,Z=2.28,P=0.02]、机械通气时间[SMD=-0.31,95%CI（-0.57,-0.05）,Z=2.38,P=0.02]及脓毒症发生率[RR=0.73,95%CI（0.57,0.94）,Z=2.49,P=0.01];③两组早产儿胆红素峰值、光疗人数、红细胞增多症发生率及脑室内出血发生率的比较,差异均无统计学意义（P>0.05）。结论脐带挤压能改善早产儿出生后相关指标,降低早产儿输血需求、减少早产儿机械通气时间及脓毒症的发生率,且未增加早产儿近期不良结局。

关键词: 脐带挤压, 早产儿护理, 适应, 并发症, Meta分析

Abstract:

Objective To explore the effect of umbilical cord milking on related indexes of premature infants.Methods PubMed,Embase,The Cochrane Library,Web of Science,CNKI,WanFang Data,VIP,Sinomed were searched for randomized controlled trials about preterm infants’ umbilical cord milking published from inception to February 2019. Two trained evaluators screened literatures,evaluated quality and extracted data independently,and Meta-analysis was implemented with Review Manager 5.3 software.Results Nine articles（7 in English,2 in Chinese） were included in the analysis,which involved 388 cases of umbilical cord milking（UCM） and 386 cases of immediate cord clamping（ICC）.The results of Meta-analysis showed that：①Compared with ICC,UCM could increase initial hemoglobin[SMD=0.75,95%CI（0.51,0.98）,Z=6.22,P<0.01],systolic blood pressure[MD=3.85,95%CI（0.75,6.95）,Z=2.44,P=0.01],diastolic blood pressure[MD=3.75,95%CI（1.20,6.31）,Z=2.88,P<0.01] and blood flows in superior vena cava;②Compared with ICC,UCM could decrease the number of blood transfusions[RR=0.72,95%CI（0.54,0.95）,Z=2.28,P=0.02],mechanical ventilation time[SMD=-0.31,95%CI（-0.57,-0.05）,Z=2.38,P=0.02] and sepsis[RR=0.73,95%CI（0.57,0.94）,Z=2.49,P=0.01];③There were no statistical differences in peak levels of bilirubin,numbers of preterm infants for phototherapy,incidences of polycythemia and intraventricular hemorrhage between two groups.Conclusion UCM improves the related indexes of preterm infants,reduces the need for blood transfusion,shortens the mechanical ventilation time,decreases the incidence of sepsis,and does not increase the risk of short-term adverse outcomes.

Key words: Umbilical Cord Milking, Premature Birth Nursing, Adaptability, Complication, Meta-Analysis

张燕艳, 罗公印, 徐元锂, 杨润瑜, 王翠, 胡议尹, 蒋明娇, 陶明. 脐带挤压对早产儿出生后相关指标影响的Meta分析[J]. 中华护理杂志, 2019, 54(11): 1634-1639.

ZHANG Yanyan, LUO Gongyin, XU Yuanli, YANG Runyu, WANG Cui, HU Yiyin, JIANG Mingjiao, TAO Ming. Effect of umbilical cord milking on related indexes of preterm infants：a Meta-analysis[J]. Chinese Journal of Nursing, 2019, 54(11): 1634-1639.

图/表 6

图1 文献筛选流程

表1 文献的基本特征

表2 文献质量评价结果

图2 脐带挤压和立即断脐对早产儿出生后血红蛋白水平的影响

图3 脐带挤压和立即断脐对早产儿收缩压的影响

图4 脐带挤压和立即断脐对早产儿舒张压的影响

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