Morton K E, Jackson M C, Gillmer M D
Br J Obstet Gynaecol. 1985 May;92(5):473-9. doi: 10.1111/j.1471-0528.1985.tb01351.x.
Forty women in whom ketonuria was detected during the first stage of labour were allocated randomly to intravenous treatment with one litre of either normal saline, Hartmann's solution, 5% dextrose or 10% dextrose. The solutions were administered over 1 h and blood was taken immediately beforehand and thereafter at 30-min intervals for 90 min to assess their effect on intermediary metabolism, plasma osmolality and acid-base status. Although both the 5 and 10% dextrose infusions caused a rapid decline in whole blood D-3-hydroxybutyrate concentrations, they also produced pathological degrees of maternal hyperglycaemia and hyperinsulinaemia and a marked elevation in the mean blood lactate and pyruvate concentrations. Administration of 10% dextrose was also associated with a significant increase in serum osmolality. Hartmann's solution produced significantly higher mean whole blood lactate and pyruvate concentrations than did normal saline. There was a significant increase in the venous base deficit in the group infused with 10% dextrose, indicating that the buffering capacity of the blood had been exceeded. It is concluded that rapid infusions of dextrose or Hartmann's solution should not be administered during labour. Normal saline should be used for rehydration and if dextrose therapy is deemed necessary the dose administered should not exceed physiological requirements.
40名在分娩第一阶段检测出酮尿症的女性被随机分配接受静脉注射治疗，分别输注1升生理盐水、复方氯化钠溶液、5%葡萄糖溶液或10%葡萄糖溶液。这些溶液在1小时内输注完毕，输注前即刻采血，之后每隔30分钟采血一次，共采血90分钟，以评估它们对中间代谢、血浆渗透压和酸碱状态的影响。尽管5%和10%葡萄糖输注均导致全血D-3-羟基丁酸浓度迅速下降，但它们也引起了产妇病理性高血糖和高胰岛素血症，以及平均血乳酸和丙酮酸浓度显著升高。输注10%葡萄糖还与血清渗透压显著升高有关。复方氯化钠溶液产生的平均全血乳酸和丙酮酸浓度显著高于生理盐水。输注10%葡萄糖的组静脉碱缺失显著增加，表明血液的缓冲能力已被超过。结论是，分娩期间不应快速输注葡萄糖或复方氯化钠溶液。应使用生理盐水进行补液，如果认为有必要进行葡萄糖治疗，给药剂量不应超过生理需求量。
