探讨我国新生儿脐带结扎(UCC)现状及实施延迟脐带结扎(DCC)影响因素。

采用分层随机抽样法，在我国华南、华北、华东、华中、西北、西南和东北7个地区中，以2∶1比例随机抽取2~3个省，共计16个省的126家医院。以这126家医院工作的新生儿科医师、产科医师及助产士/师为调查对象。本研究自行设计《新生儿娩出后脐带结扎方式调查问卷》(以下简称为《调查问卷》)。《调查问卷》主要包括3个方面内容：①被调查对象的一般资料；②被调查对象对DCC的认知程度；③被调查对象认为影响DCC实施因素等。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①最终回收《调查问卷》为5 005份，其中，来自综合性医院的符合填写要求《调查问卷》为2 280份(45.55%)，妇幼保健院为2 725份(54.25%)。5 005份《调查问卷》中，由助产士/师、产科医师、新生儿科医师填写分别为2 253份(45.01%)，1 541份(30.79%)和1 211份(24.20%)。②回收的5 005份《调查问卷》中，知晓DCC相关知识者为4 325位(86.41%)，实施者仅为921位(18.40%)。③被调查者主要从专家讲座(62.87%)、科室规范(53.50%)、文献检索(42.94%)和国际指南(40.00%)等途径获取有关DCC相关知识。④对DCC实施影响因素的多因素非条件logistic回归分析结果显示，医院类型(OR＝0.530, 95%CI：0.355~0.837，P＝0.006)，医院等级(OR＝0.450，95%CI：0.364~0.556，P<0.001)，分娩方式(OR＝35.772，95%CI：20.753~61.660，P<0.001)，是否早产(OR＝3.914，95%CI：2.178~7.033，P<0.001)，认为操作是否便捷(OR＝2.577，95%CI：0.001~0.014，P<0.001)，是否有科室规范(OR＝1.187，95%CI：0.767~0.838，P＝0.015)和认为能否便于新生儿窒息复苏(OR＝0.021，95%CI：0.010~0.142，P<0.001)是DCC实施的影响因素(P<0.05)。

目前，临床工作者对DCC的知晓率高，但实施率低。临床实施DCC的影响因素较多，在中国建立明确的实施DCC指南或专家共识，对优化产科新生儿分娩的UCC临床实践非常必要。

To explore current status of umbilical cord clamping (UCC) and influencing factors of delayed cord clamping (DCC) in China.

Respondents of neonatologists, obstetricians and midwives/teachers worked in 126 hospitals of 16 provinces were randomly selected from 2-3 provinces and municipality directly under Central Government in 7 regions of South, North, East, and Central, Northwest, Southwest, Northeast China at a ratio of 2∶1 by stratified random sampling method. Questionnaire on the Umbilical Cord Method after the Delivery (hereinafter referred to as Questionnaire) was self-designed. It mainly included three aspects: ①general information of respondents; ②awareness rate of respondents to DCC; ③factors that respondents thought to affect on implementation of DCC. The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013.

① A total of 5 005 questionnaires were collected in this survey, including 2 280 (45.55%) in general hospitals and 2 725 (54.25%) in maternal and child health hospitals. There were 2 253 (45.01%), 1 541 (30.79%) and 1 211 (24.20%) completed by midwives, obstetricians and neonatologists respectively. ②Among the 5 005 questionnaires, 4 325 (86.41%) respondents knew about DCC, and only 921 (18.40%) implemented it. ③Respondents obtained DCC-related knowledge through mainly expert lectures (62.87%), departmental standards (53.50%), literature retrieval (42.94%) and international guidelines (40.00%). ④The results of multivariate unconditional logistic regression analysis on related influencing factors on implementation of DCC showed that hospital category (OR=0.530, 95%CI: 0.355-0.837, P=0.006), hospital grade (OR=0.450, 95%CI: 0.364-0.556, P<0.001) and neonatal delivery mode (OR=35.772, 95%CI: 20.753-61.660, P<0.001), premature newborns (OR=3.914, 95%CI: 2.178-7.033, P<0.001), and whether it was easy to operate (OR=2.577, 95%CI: 0.001-0.014, P<0.001), standardization of clinica department (OR=1.187, 95%CI: 0.767-0.838, P=0.015), application of neonatal asphyxia resuscitation (OR=0.021, 95%CI: 0.010-0.142, P<0.001) were influencing factors of implementation of DCC (P<0.05).

The awareness rate of respondents to DCC after newborns delivered is at a high level, but real implementation rate is low. There are many factors influencing on clinical implementation of DCC. It is necessary to establish clear guidelines or expert consensus to optimize to clinical practice of DCC in China.