Issel E P
J Perinat Med. 1983;11(5):232-42. doi: 10.1515/jpme.1983.11.5.232.
Several authors have recommended [1, 3, 8, 12] that the fetus be mechanically stimulated if the abdominal pregnancy CTG shows no accelerations. One expects the fetus to show a motor response to mechanical stimulation. Fetal movements expressed as accelerations in the abdominal CTG are considered to reflect "arousal" of the previously asleep fetus and are thought to be normal. An absence of such a response in considered by some as a sign of pathological fetal changes [3, 8, 12]. Others, however, have found that the normal non-stressed fetus need not change its sleep-arousal state after mechanical stimulation [5, 14]. An attempt was made to clarify this in the present work. We studied the CTG recordings and the ultrasound pictures in 63 pregnancies in a total of 83 cases for an average of 56 minutes. Fetal movements were marked by pressing a lever on the labor pressure chart. The fetus was mechanically stimulated by shaking its head manually for 5 seconds. Control recordings were also made, when the fetus was not so stimulated. The following results were obtained: With a normal CTG (reactive nonstress test, FISCHER score 8-10 points) Mechanical stimulation led to no changes in 87% of NREM sleep and in 93.9% of REM sleep. A change to a more active state (REM sleep + arousal) due to stimulation was found in 13% of NREM sleep, which is significantly more frequent than the 2.9% found when no stimulation occurred. A change from REM sleep to arousal was found in 6.1%, not significantly different from 1.8% found without stimulation. Short-lasting reactions to mechanical stimulation included movements, acceleration of fetal heart rate and dip 0. These reactions were equally frequent in REM and NREM sleep, i.e. 75% and 68.5% respectively. These reactions occurred by chance less frequently, in 14.5% of cases in REM and in 3% of cases in NREM sleep (Tab. II). The occurrence is significantly higher in REM than in NREM sleep. In a pathological CTG (Fischer score 7 points or less) our technique does not permit us to distinguish the different sleep-arousal states. Only the short-lasting response to mechanical stimulation of the fetus was hence evaluated. Mechanical stimulation resulted in a fetal response in 19% with decelerations of variable expression (Figs. 1a, 1b, 2, 3) similar to the variable decelerations observed during labor. These decelerations occurred only together with other signs of fetal distress in the CTG.(ABSTRACT TRUNCATED AT 400 WORDS)
几位作者[1, 3, 8, 12]建议，如果腹部妊娠CTG未显示加速情况，应对胎儿进行机械刺激。人们期望胎儿对机械刺激表现出运动反应。在腹部CTG中表现为加速的胎儿运动被认为反映了先前处于睡眠状态的胎儿的“觉醒”，并被认为是正常的。一些人认为缺乏这种反应是胎儿病理变化的迹象[3, 8, 12]。然而，其他人发现正常的无应激胎儿在机械刺激后不一定会改变其睡眠-觉醒状态[5, 14]。本研究试图对此进行阐明。我们研究了总共83例中的63例妊娠的CTG记录和超声图像，平均时长为56分钟。通过按压产程压力图上的杠杆来标记胎儿运动。通过手动摇晃胎儿头部5秒钟对其进行机械刺激。当胎儿未受到这种刺激时，也进行对照记录。得到了以下结果：在正常CTG（反应性无应激试验，菲舍尔评分8 - 10分）的情况下，机械刺激导致87%的非快速眼动睡眠和93.9%的快速眼动睡眠无变化。在13%的非快速眼动睡眠中，刺激导致转变为更活跃的状态（快速眼动睡眠 + 觉醒），这比未进行刺激时发现的2.9%明显更频繁。在6.1%的快速眼动睡眠中发现从快速眼动睡眠转变为觉醒，与未刺激时发现的1.8%无显著差异。对机械刺激的短暂反应包括运动、胎儿心率加速和下降0。这些反应在快速眼动睡眠和非快速眼动睡眠中同样频繁，分别为75%和68.5%。这些反应偶然发生的频率较低，在快速眼动睡眠中为14.5%的病例，在非快速眼动睡眠中为3%的病例（表二）。其发生率在快速眼动睡眠中显著高于非快速眼动睡眠。在病理性CTG（菲舍尔评分7分或更低）的情况下，我们的技术不允许我们区分不同的睡眠-觉醒状态。因此，仅评估了胎儿对机械刺激的短暂反应。机械刺激导致19%的胎儿出现反应，伴有不同表现的减速（图1a、1b、2、3），类似于分娩期间观察到的可变减速。这些减速仅与CTG中其他胎儿窘迫迹象同时出现。（摘要截断于400字）
