Su Tina Y, Reece Mifanwy, Chua Seng C
Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2013 Aug;53(4):375-80. doi: 10.1111/ajo.12081. Epub 2013 Apr 1.
Lactate measurements have become increasingly preferred over pH analysis in the evaluation of fetal acidaemia in labour. In a busy labour ward, often the umbilical cord may be sampled late and as a result yield unreliable lactate values.
To investigate the agreement of hand-held device Lactate Pro with a reference method blood gas analyser and evaluate the stability of umbilical cord lactate values over time.
Prospective study carried out at elective caesarean section. Sixteen umbilical cords were double clamped immediately after delivery with paired arterial and venous blood samples collected by an independent researcher, at varying time intervals, and processed by two Lactate Pro devices and a reference method blood gas analyser.
A significant difference of -0.41 to 0.10 mmol/L was found when different groups of Lactate Pro devices were compared with blood gas analyser at lactate values up to 5.70 mmol/L, with average lactate value of 2.45 mmol/L. Over time, there is progressive rise in lactate samples obtained from the umbilical cord.
Lactate Pro devices have a significant difference, but when used in clinical practice on cord blood after delivery, this is unlikely to be meaningful. In intrapartum fetal surveillance, a systematic overestimation might lead to unnecessary intervention. It is possible to retrospectively predict the likely level of lactate at birth in delayed cord samples.
在评估分娩时胎儿酸血症方面，乳酸测定已越来越比pH分析更受青睐。在繁忙的产房，脐带采样往往较晚，结果导致乳酸值不可靠。
研究手持式乳酸测定仪（Lactate Pro）与参考方法血气分析仪的一致性，并评估脐带乳酸值随时间的稳定性。
在择期剖宫产时进行前瞻性研究。16根脐带在分娩后立即双重钳夹，由一名独立研究人员在不同时间间隔采集配对的动脉血和静脉血样本，并由两台Lactate Pro测定仪和一台参考方法血气分析仪进行检测。
当乳酸值高达5.70 mmol/L（平均乳酸值为2.45 mmol/L）时，将不同组的Lactate Pro测定仪与血气分析仪进行比较，发现存在-0.41至0.10 mmol/L的显著差异。随着时间的推移，从脐带获得的乳酸样本呈逐渐上升趋势。
Lactate Pro测定仪存在显著差异，但在分娩后用于脐带血的临床实践中，这可能并无实际意义。在产时胎儿监测中，系统性的高估可能导致不必要的干预。对于延迟采集的脐带样本，有可能回顾性地预测出生时可能的乳酸水平。
