Nicolini U, Hubinont C, Santolaya J, Fisk N M, Rodeck C H
Royal Postgraduate Medical School, Institute of Obstetrics and Gynaecology, Queen Charlotte's Maternity Hospital, London, United Kingdom.
Horm Metab Res. 1990 Aug;22(8):426-30. doi: 10.1055/s-2007-1004939.
Fetal intravenous glucose challenge test (0.75 g/kg of estimated fetal weight) was performed at 26-33 weeks gestation in 9 patients undergoing fetal blood sampling (FBS) by ultrasound guided needling from the umbilical vein. The indication for FBS was rapid karyotyping for fetal malformations in 5 (control group) and severe intrauterine growth retardation in the remaining 4 (IUGR group). Fetal blood samples were taken before the glucose infusion and after 1, 3, 5, 10 and 15 min; glucose and insulin were assayed on each occasion and acid-base balance at 0 and 5 min. Basal fetal pO2, pH, glucose and insulin were lower in the IUGR group than in controls. Following the glucose challenge, fetal glucose levels were similar in the two groups, but in the IUGR group the latter part of the glucose curve was characterized by a slower and delayed return to basal levels. In control fetuses the insulin response following the glucose challenge peaked at 3 min while in IUGR no change in insulin concentration was detected. Fetal pO2 did not change in either group; the median change in fetal pH was significantly different between the two groups (controls: +0.01; IUGR: -0.04; P less than 0.05) and there was a significant correlation between basal pO2 and the change in fetal pH (r = 0.79) (P less than 0.02). These results support the concept of a low energy state in IUGR. Fetal glucose supplementation in IUGR is unlikely to be of benefit and may even exacerbate underlying acidosis.
对9例接受超声引导下经脐静脉穿刺采集胎儿血样（FBS）的孕妇，在妊娠26 - 33周时进行了胎儿静脉葡萄糖耐量试验（按估计胎儿体重0.75 g/kg）。进行FBS的指征是，5例用于胎儿畸形的快速核型分析（对照组），其余4例用于严重宫内生长受限（IUGR组）。在输注葡萄糖前以及输注后1、3、5、10和15分钟采集胎儿血样；每次均检测葡萄糖和胰岛素，并在0和5分钟时检测酸碱平衡。IUGR组胎儿的基础pO2、pH、葡萄糖和胰岛素水平低于对照组。葡萄糖激发试验后，两组胎儿的葡萄糖水平相似，但在IUGR组，葡萄糖曲线的后半部分表现为恢复到基础水平的速度较慢且延迟。在对照胎儿中，葡萄糖激发试验后的胰岛素反应在3分钟时达到峰值，而在IUGR组中未检测到胰岛素浓度的变化。两组胎儿的pO2均未改变；两组胎儿pH的中位数变化有显著差异（对照组：+0.01；IUGR组：-0.04；P<0.05），并且基础pO2与胎儿pH变化之间存在显著相关性（r = 0.79）（P<0.02）。这些结果支持IUGR存在低能量状态的概念。IUGR胎儿补充葡萄糖不太可能有益，甚至可能加重潜在的酸中毒。
