延迟断脐对妊娠期糖尿病新生儿脐动脉血气及黄疸的影响

目的：研究延迟断脐对足月妊娠期糖尿病母亲新生儿脐动脉血气及黄疸的影响。方法：选择2020年1月至8月在温州医科大学附属第二医院育英儿童医院分娩的161例足月单胎妊娠期糖尿病孕妇为研究人群，随机分为立即断脐组（＜15 s）和延迟断脐组（≥30 s），根据纳入和排除标准，最终立即断脐组66例，延迟断脐组66例。比较2组新生儿脐动脉血气分析的结果及出生后1～4 d的经皮胆红素值。结果：延迟断脐组新生儿脐动脉血碱剩余浓度明显低于立即断脐组，乳酸浓度明显高于立即断脐组碱剩余：-3.72 （-5.58，-2.41） vs. -3.06（-4.79，-1.62）mmol/L，乳酸：3.0（2.4，4.3） vs. 2.1（1.6，4.0）mmol/L，P ＜0.05]。2组脐动脉血pH和碳酸氢根离子浓度的差异无统计学意义pH：7.29（7.24，7.33） vs. 7.31（7.25，7.33），碳酸氢根离子：24.0（22.5，25.0） vs. 24.3（22.6，25.5）mmol/L，P ＞0.05]。2组新生儿脐动脉血二氧化碳分压和血氧分压的差异无统计学意义（P ＞0.05）。2组新生儿血红蛋白、红细胞压积水平的差异无统计学意义（P ＞0.05）。出生后1～4 d，2组新生儿经皮胆红素值的差异无统计学意义（P ＞0.05），但延迟断脐组新生儿高胆红素血症患病率明显高于立即断脐组（17.0% vs .6.1% （）P＜0.05）。结论：延迟断脐增强足月妊娠期糖尿病母亲新生儿的无氧代谢，增加了代谢酸浓度及新生儿高胆红素血症的发病率，但不影响血pH值。

The effect of delayed cord clamping on umbilical artery blood gas and jaundice in term infants of diabetic mothers

Objective: To investigate the effect of delayed cord clamping on umbilical artery blood gas and jaundice in term infants of diabetic mothers. Methods: Totally 161 full-term pregnant women with gestational diabetes mellitus who delivered in the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to August 2020 were enrolled in this study. They were randomly allocated into the early cord clamping group (<15 seconds, ECC) and the delayed cord clamping group (≥30 seconds, DCC). According to the inclusion and exclusion criteria, 132 cases remained, with 66 cases in the ECC group and 66 cases in the DCC group. The results of umbilical artery blood gas analysis and neonatal transcutaneous bilirubin levels at 1-4 days after birth were compared between the two groups. Results: Arterial cord blood base excess (BE) in the DCC group was significantly lower than that in the ECC group, and lactate was significantly higher BE: -3.72(-5.58, -2.41) vs.-3.06 (-4.79, -1.62)mmol/L, lactate: 3.0 (2.4, 4.3) vs. 2.1 (1.6, 4.0)mmol/L, P<0.05]. There was no significant difference in pH and bicarbonate (HCO3-) between the two groups pH: 7.29 (7.24, 7.33) vs. 7.31 (7.25, 7.33),HCO3-: 24.0 (22.5, 25.0) vs. 24.3 (24.3, 25.5)mmol/L, P>0.05]. There were no significant differences in the partial pressure of carbon dioxide (PCO2) and partial pressure of oxygen (PO2) between the two groups (P>0.05). Also, DCC did not improve hemoglobin and hematocrit levels (P>0.05). There was no difference in transcutaneous bilirubin levels at 1-4 days after birth between the two groups (P>0.05), but and the incidence of hyperbilirubinemiain the DCC group was markedly higher than that in the ECC group (17.0% vs. 6.1%) (P<0.05). Conclusion:Delayed cord clamping enhanced anaerobic metabolism, increased metabolic acid in term infants of diabetic mothers, and increased the incidence of neonatal hyperbilirubinemia but did not affect pH value.