Philipson E H, Kalhan S C, Riha M M, Pimentel R
Department of Obstetrics, Case Western Reserve University School of Medicine, Cleveland Metropolitan General Hospital, OH 44109.
Am J Obstet Gynecol. 1987 Oct;157(4 Pt 1):866-73. doi: 10.1016/s0002-9378(87)80075-3.
The maternal and fetal metabolic effects of three commonly used intravenous fluids administered before regional anesthesia were studied in 32 gravid women undergoing elective cesarean section at term. Patients were randomized into one of three groups to receive 1 L of either 5% dextrose (50 gm of glucose) or Ringer's lactate or isotonic saline solution before epidural anesthesia. Acute glucose infusion resulted in maternal hyperglycemia, hyperinsulinemia, and an increase in the blood lactate level. Cord blood glucose, insulin, and lactate levels were also increased in this group. The key finding of this study was the significant lowering of pH in the umbilical cord vein (7.31 +/- 0.04) and artery (7.21 +/- 0.06) in the glucose-infused group when compared with the non-glucose infusion groups (p less than 0.05). Confounding perinatal factors such as maternal position, maternal hypotension, and prolonged time of surgery did not influence the fetal acid-base status. Thus acute maternal glucose infusion in normal patients can cause fetal hyperglycemia, metabolic acidosis, and neonatal hypoglycemia. These findings may be of particular clinical importance when fetal distress or fetal hypoxemia is due to other perinatal events. Under these circumstances, acute maternal glucose infusion may further contribute to fetal metabolic acidosis.
在32名足月行择期剖宫产的孕妇中，研究了区域麻醉前给予三种常用静脉输液对母婴代谢的影响。患者被随机分为三组，在硬膜外麻醉前分别接受1升5%葡萄糖（50克葡萄糖）、乳酸林格氏液或等渗盐溶液。急性输注葡萄糖导致母体血糖升高、胰岛素血症，并使血乳酸水平升高。该组脐带血葡萄糖、胰岛素和乳酸水平也升高。本研究的关键发现是，与非葡萄糖输注组相比，葡萄糖输注组脐带静脉（7.31±0.04）和动脉（7.21±0.06）的pH值显著降低（p<0.05）。诸如母体体位、母体低血压和手术时间延长等围产期混杂因素并未影响胎儿酸碱状态。因此，正常患者急性输注母体葡萄糖可导致胎儿高血糖、代谢性酸中毒和新生儿低血糖。当胎儿窘迫或胎儿低氧血症是由其他围产期事件引起时，这些发现可能具有特别的临床重要性。在这种情况下，急性输注母体葡萄糖可能会进一步导致胎儿代谢性酸中毒。
