| Objective:Compare the results of umbilical arterial blood gas analysis(p H,Pa CO2,BEecf,HCO3~-,Pa O2),Apgar scores at 0,5,and 10 minutes of birth,and menstrual cycle of 4-10 minutes of birth in cesarean infants.Skin oxygen saturation,change in mean arterial pressure at 0,2,6,12,18,and 24 hours after birth,transcutaneous bilirubin value within 4 days after birth,peak during hospitalization,time to peak,and jaundice requiring phototherapy The number of people,the red blood cell count,hematocrit,hemoglobin,and the ratio of neonatal polycythemia at 72 hours after birth;at the same time,observe the maternal blood loss during cesarean section,the operation time,the time of placental dissection,and the residual blood volume of the placenta,The use rate of second-line uterine contraction drugs,blood transfusion rate,and changes in the difference between Hb and Hct before and after surgery.The purpose is to provide a theoretical basis for the safe application and reliability of delayed umbilical cord clamping in cesarean section,seek the best time for umbilical cord ligation during cesarean section,and contribute little to our hospital(and even our city)maternal and infant health care power.Methods:260 cases of parturients and their newborns who were delivered by cesarean section in the Affiliated Hospital of Yan’an University from August 2020 to January 2021 were selected.Based on the time to clamp the umbilical cord after birth,there are 5 groups in total:Early cord rupture[<30 seconds]group,1-minute umbilical cord rupture group,2-minute umbilical cord rupture group,3-minute umbilical cord rupture group,and umbilical artery pulsation disappeared group.After birth,when the time to ligate the umbilical cord is reached,the surgeon will collect the cord blood,and the professional physician will perform blood gas analysi;Apgar score and Sp O2 will be monitored within 10 minutes of birth(4-10 minutes after birth);professional obstetric nurses will conduct blood gas analysis after birth.2,6,12,18,and 24 hours to monitor and record blood pressure;during the hospitalization,the neonatal transcutaneous bilirubin value was measured,2times/day(take the average of the forehead,abdomen,and back),and record the menstrual period during the hospitalization.The peak value and peak time of skin bilirubin;the scalp venous blood sampling performed by the pediatric professional nurse at 72 hours after birth;the calculation of neonatal polycythemia during the neonatal hospitalization and the incidence of jaundice requiring blue light irradiation treatment;adopt The hemoglobin difference method is used to estimate the 24-hour blood loss of the parturient;the time of placental dissection,the operation time,whether second-line uterine contractions are used,and whether blood transfusion is required are recorded;the resident uses the weighing method to count the residual blood volume of the placenta.Results:1.With the extension of the umbilical cord ligation time,there was no significant difference in the hematocrit value,hemoglobin difference,operation time,intraoperative blood loss and hand placenta removal rate of the cesarean parturient women before and after the operation(P>0.05);3min umbilical cord was broken The residual blood volume of the placenta in the umbilical cord group was less than that in the other umbilical cord groups.The placental dissection time of the 3-min cord umbilical cord group was shorter than that in the other umbilical cord groups(P<0.05);the use rate of intraoperative second-line uterine contraction drugs and the effect of blood transfusion between each group The demand rate was not statistically significant(P>0.05).2.There was no statistically significant difference in Apgar scores at 1,5,and 10minutes after birth among the groups(P>0.05).3.The Hb,Hct,and RBC of the newborns in the 3 min umbilical cord rupture group increased slightly compared with other groups,but the incidence of neonatal polycythemia in the 5 groups of newborns was not statistically significant(P>0.05).4.With the prolonging of the umbilical cord ligation time,the difference between the groups of cord blood Pa O2 and BEecf was statistically significant(P<0.05);the cord blood p H,HCO3~-,PCO2 were not statistically significant between the groups(P>0.05).5.With the extension of the umbilical cord ligation time,the transcutaneous bilirubin values of 4 days after birth were not statistically significant(P>0.05)).The peak time of transcutaneous bilirubin value was not statistically significant(P>0.05),but there was a statistically significant difference between the 3 min umbilical cord rupture group and the immediate umbilical cord rupture group(P<0.05).There was no significant difference in the peak value of transcutaneous bilirubin(P>0.05),but the difference between the 2min umbilical cord rupture group and the 1 min umbilical cord rupture group was statistically significant(P<0.05).There was no significant difference in the number of jaundice requiring blue light treatment among the groups(P>0.05).6.With the extension of the umbilical cord ligation time,Sp O2 gradually increased;and the difference between 4-9 minutes was statistically significant(P<0.05),and the difference at the 10th minute of birth was not statistically significant(P>0.05).7.The MAP value of newborns at 24h was significantly different among the groups(P<0.05);the MAP at 24h of newborns was volatile,and the MAP at 2h of birth was low;the stability of MAP at 24h of newborns was time dependent,That is,as the umbilical cord ligation time increases,the stability becomes higher.Conclusion:1.DCC increases its blood volume without increasing the risk of NP;as the umbilical cord ligation time increases,the neonatal bilirubin value increases slightly,but does not increase its peak time,peak value,and the incidence of jaundice requiring blue light treatment The MAP value of newborns at 2h is slightly lower than other time periods,but DCC can increase the stability of MAP;DCC can also increase blood oxygen saturation,which is beneficial to reduce the risk of asphyxia and cerebral palsy.2.DCC does not increase the blood loss of the parturient during cesarean section and shortens the time of placental dissection;as the umbilical cord ligation time increases,the residual blood volume of the placenta decreases,that is,the amount of placenta-fetal blood transfusion increases;in addition,DCC does not increase the second-line The use rate of uterine contraction drugs and the maternal demand for blood transfusion.3.After analyzing and comparing the indicators of newborns and women with cesarean section,it is recommended that the best time to ligate the umbilical cord during cesarean section is 3 minutes. |
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