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目的系统评价挤压脐带(UCM)对新生儿的影响。方法检索Cochrane图书馆、Pub Med、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月起至2013年4月,对同质资料进行Meta分析。结果共纳入5项研究(372例)。UCM与过早脐带结扎(ECC)/立即脐带结扎(ICC)相比,新生儿出生时血红蛋白水平(MD=2.08,95%CI:1.65~2.52)和6周时血红蛋白水平(MD=1.10,95%CI:0.73~1.47)升高,出生时红细胞比积(MD=4.69,95%CI:2.87~6.51)和平均动脉压(MD=5.81,95%CI:4.17~7.45)升高,低血压的发生风险(OR=0.22,95%CI:0.06~0.86)、扩容药物的使用(OR=0.17,95%CI:0.06~0.47)、颅内出血发生率(OR=0.41,95%CI:0.18~0.94)均降低,差异均有统计学意义(P<0.05);UCM与延迟脐带结扎(DCC)相比,新生儿出生时红细胞比积差异无统计学意义(P>0.05)。UCM对新生儿出生后最高血清总胆红素水平、红细胞增多症、坏死性小肠结肠炎、早产儿视网膜病变、脑白质软化发生率和新生儿死亡率的影响均无统计学意义(P>0.05)。结论 UCM可以提高新生儿出生后的血红蛋白水平,减少新生儿出生后低血压和颅内出血的发生,有可能成为一项安全的改善新生儿预后的临床方法;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。
Objective To systematically evaluate the effect of umbilical cord compression (UCM) on newborns. Methods The Cochrane Library, Pub Med, EMBASE, Wanfang Database, Chinese Journal Full-text Database and China Wipu Database were searched from January 1990 to April 2013. Meta-analysis was performed on homogeneous data. Results A total of five studies (372 cases) were included. Neonatal hemoglobin levels at birth (MD = 2.08, 95% CI: 1.65-2.52) and hemoglobin levels at 6 weeks (MD = 1.10, 95) compared with premature umbilical cord ligation (ECC) / immediate cord ligation % CI: 0.73-1.47). The hematocrit at birth (MD = 4.69, 95% CI: 2.87-6.51) and mean arterial pressure (MD = 5.81, 95% CI: 4.17-7.45) (OR = 0.17, 95% CI: 0.06-0.47), and the incidence of intracranial hemorrhage (OR = 0.41, 95% CI: 0.18-0.86) 0.94), the differences were statistically significant (P <0.05). There was no significant difference in the hematocrit at birth between UCM and delayed cords (DCC) (P> 0.05). UCM had no significant effect on the highest serum total bilirubin levels, polycythemia vera, necrotizing enterocolitis, retinopathy of prematurity, the rate of white matter softening and neonatal mortality after birth (P> 0.05 ). Conclusions UCM can increase the hemoglobin level after birth and reduce the incidence of post-natal hypotension and intracranial hemorrhage. It may be a safe clinical method to improve the prognosis of neonates. However, the current study population is too small and lacking Long-term follow-up evaluation study, therefore, it is necessary to further carry out high-quality, large sample randomized controlled trials to evaluate its role and safety.