Low J A, Froese A F, Galbraith R S, Sauerbrei E E, McKinven J P, Karchmar E J
Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada.
Am J Obstet Gynecol. 1990 Apr;162(4):977-81; discussion 981-2. doi: 10.1016/0002-9378(90)91299-r.
One hundred twenty preterm newborns less than 34 weeks' gestational age have been studied prospectively to determine the frequency of fetal and newborn metabolic acidosis and to examine the relationship of metabolic acidosis to periventricular leukomalacia as demonstrated by serial newborn ultrasonographic examinations. Fetal metabolic acidosis, based on an umbilical artery buffer base less than 34 mmol/L at delivery, occurred in three cases (2%), one of which had evidence of periventricular leukomalacia. Newborn metabolic acidosis that is based on a buffer base less than 34 mmol/L during the 4 days after delivery occurred in 12 cases (10%), five of which had evidence of periventricular leukomalacia. There is a significant relationship between the degree and duration of newborn metabolic acidosis and the occurrence of periventricular leukomalacia. This study indicates that systemic metabolic acidosis is an important pathophysiologic marker of periventricular leukomalacia. Intrapartum fetal asphyxia with metabolic acidosis, although an infrequent occurrence in the preterm newborn, may account for a few cases of periventricular leukomalacia, while the more common newborn metabolic acidosis, when of sufficient degree and duration, carries a high risk of periventricular leukomalacia.
对120例胎龄小于34周的早产新生儿进行了前瞻性研究，以确定胎儿和新生儿代谢性酸中毒的发生率，并通过系列新生儿超声检查来探讨代谢性酸中毒与脑室周围白质软化症之间的关系。基于分娩时脐动脉缓冲碱小于34 mmol/L的胎儿代谢性酸中毒发生在3例（2%）中，其中1例有脑室周围白质软化症的证据。基于出生后4天内缓冲碱小于34 mmol/L的新生儿代谢性酸中毒发生在12例（10%）中，其中5例有脑室周围白质软化症的证据。新生儿代谢性酸中毒的程度和持续时间与脑室周围白质软化症的发生之间存在显著关系。这项研究表明，全身性代谢性酸中毒是脑室周围白质软化症的一个重要病理生理标志物。产时伴有代谢性酸中毒的胎儿窒息，虽然在早产新生儿中不常发生，但可能是少数脑室周围白质软化症病例的原因，而更常见的新生儿代谢性酸中毒，当程度和持续时间足够时，发生脑室周围白质软化症的风险很高。
