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目的探讨剖宫产不同断脐时机对母儿结局的影响。方法将2013年9月至2014年2月120例剖宫产新生儿随机分为3组:A组46例(胎盘娩出前脐搏动消失,脐搏动消失时断脐)、B组40例(胎盘娩出前脐搏动未消失,胎盘娩出抬高胎盘30~40 cm并持续1 min断脐)、C组34例(胎儿娩出后即刻断脐)。比较3组产后出血量、胎盘残血量、生后最高1次胆红素值、新生儿血红蛋白(Hb)、Apgar评分及湿肺等母儿结局。结果 3组新生儿出生时Hb水平及1 min、5 min Apgar评分差异均无统计学意义(P均>0.05)。与C组比较,A、B两组产后出血量和胎盘残血量显著降低(P均<0.05),新生儿湿肺发生率显著降低(P均<0.05),产后1周新生儿Hb水平明显升高(P均<0.05),新生儿胆红素水平明显降低(P均<0.05)。A、B两组之间上述指标差异无统计学意义(P均>0.05)。结论 A、B两组延迟断脐方式均可增加胎盘向胎儿的血液灌输,有效预防新生儿贫血和湿肺的发生。抬高胎盘位置可缩短断脐等待时间,便于剖宫产手术的管理。
Objective To investigate the effect of different umbilical cesarean section on maternal and child outcomes. Methods From September 2013 to February 2014, 120 cases of newborn infants with cesarean section were randomly divided into 3 groups: 46 cases in group A (umbilical cord disappeared before placenta delivery and umbilical cord disappeared after umbilical pulsation disappeared), 40 cases in group B Umbilical beat did not disappear before delivery, the placenta was delivered elevated placenta 30 ~ 40 cm and continued 1 min off the umbilical cord), C group 34 cases (the fetus immediately after delivery umbilical). The postpartum hemorrhage volume, placental remnant blood volume, the highest bilirubin value after birth, neonatal hemoglobin (Hb), Apgar score and wet lung were compared between the two groups. Results There was no significant difference in Hb level at birth, Apgar score at 1 min and 5 min between the three groups (all P> 0.05). Compared with group C, the amount of postpartum hemorrhage and placental residual volume in groups A and B were significantly decreased (all P <0.05), the incidence of wet lung in neonates was significantly lower (all P <0.05), and the level of Hb in neonates was significantly higher (All P <0.05), the neonatal bilirubin levels were significantly lower (all P <0.05). A, B between the two groups showed no significant difference between the above indicators (P all> 0.05). Conclusion Delayed umbilicus in group A and group B can increase the blood supply of the fetus to the fetus, effectively preventing the occurrence of neonatal anemia and wet lung. Raise the placenta position can shorten the waiting time of broken umbilical cord to facilitate the management of cesarean section.