Krüger K, Kublickas M, Westgren M
Department of Obstetrics and Gynecology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
Obstet Gynecol. 1998 Dec;92(6):918-22. doi: 10.1016/s0029-7844(98)00347-0.
We investigated lactate concentrations in fetal scalp and cord blood to determine the sources of fetal lactacidosis in fetuses with ominous heart rate patterns.
Cord blood was collected from newly delivered infants who had been monitored by fetal scalp blood sampling during labor. In 250 cases umbilical arterial and venous cord blood lactate levels were measured. We assessed the umbilical arterial lactate concentrations in relation to the venous lactate levels, the arterial pH level, base excess, and arteriovenous lactate differences in cord blood. In 103 cases the levels of lactate in fetal scalp blood, sampled within 60 minutes of delivery, were compared with those in the umbilical artery and vein and the pH level and base excess immediately after birth.
Lactate level in the umbilical artery showed a significant correlation to that in umbilical venous blood (r = .84, P < .001), to arteriovenous lactate differences (r = .52, P < .001), as well as to pH (r = -.55, P < .001) and base excess (r = -.63, P < .001) in arterial cord blood. Lactate concentrations in fetal scalp blood shortly before delivery showed a significant correlation to lactate levels in the umbilical arterial (r = .65, P < .001) and venous blood (r = .62, P < .001).
The study indicates a close correlation between lactate levels in arterial and venous cord blood, as well as between the lactate levels and pH and base excess in cord arterial blood in patients with ominous fetal heart rate patterns. We also found an increased fetal contribution with increasing lactacidemia. Lactate concentrations in fetal scalp blood correlated well with those in cord arterial and venous blood.
我们研究了胎儿头皮血和脐血中的乳酸浓度，以确定心率异常胎儿发生胎儿乳酸性酸中毒的来源。
从分娩过程中接受胎儿头皮血采样监测的新生儿采集脐血。对250例病例测量脐动脉和脐静脉血中的乳酸水平。我们评估了脐动脉乳酸浓度与静脉乳酸水平、动脉pH值、碱剩余以及脐血动静脉乳酸差值之间的关系。对103例病例，比较了分娩后60分钟内采集的胎儿头皮血中的乳酸水平与脐动脉和脐静脉血中的乳酸水平，以及出生后即刻的pH值和碱剩余。
脐动脉中的乳酸水平与脐静脉血中的乳酸水平显著相关（r = 0.84，P < 0.001），与动静脉乳酸差值显著相关（r = 0.52，P < 0.001），也与脐动脉血中的pH值（r = -0.55，P < 0.001）和碱剩余（r = -0.63，P < 0.001）显著相关。分娩前不久胎儿头皮血中的乳酸浓度与脐动脉（r = 0.65，P < 0.001）和脐静脉血中的乳酸水平显著相关（r = 0.62，P < 0.001）。
该研究表明，在胎儿心率异常的患者中，脐动脉血和脐静脉血中的乳酸水平之间，以及乳酸水平与脐动脉血中的pH值和碱剩余之间存在密切相关性。我们还发现随着乳酸性血症的增加，胎儿的贡献也增加。胎儿头皮血中的乳酸浓度与脐动脉和脐静脉血中的乳酸浓度密切相关。
