拉贝洛尔治疗妊娠期高血压及其对孕妇、胎儿的影响

EFFECT OF LABETALOL ON PREGNANT WOMEN AND FETUS IN THE TREATMENT OF HYPERTENSION DURING GESTATIONAL PERIOD

[目的]观察静脉用拉贝洛尔治疗妊娠期先兆子痫、子痫及慢性高血压并先兆子痫的降压效果及对孕妇血液动力学的影响。并探索该药在此类病人中应用的剂量、最佳给药方式。[方法]观察52例妊娠期高血压急症病人接受静点拉贝洛尔治疗,0.2mg/min开始输液泵静点,并根据血压调整剂量,0.1～0.2mg/次逐步增加剂量,心电监护仪观察24h动态血压、心率,最初每5min1次,记录达到预期理想血压(140～150/90～100mmHg,即18.7～20/12～14Kpa)的时间及剂量。用我院MP妊高征监测系统通过桡动脉记录患者用药前和用药后4～6h心脏指数(CI)、外周阻力(TPR),了解拉贝洛尔对孕妇血液动力学参数的影响。微量血糖检测仪监测用药前后患者血糖变化。电子胎心监护仪观察用药前用药后2h胎心监护的变化、B超观测用药前及用药后24h脐动脉血流S/D值。[结果]患者静点拉贝洛尔后血压降至预期血压并能保持血压平稳,时间为(18.41±15.99)min。血压下降可伴心率减慢,但不降低心脏指数(CI),而外周阻力(TPR)治疗后较治疗前明显下降,差异有统计学意义(P﹤0.01)。治疗前后患者血糖、胎儿脐血流无明显改变,胎心监护有所改善。[结论]拉贝洛尔用于妊娠期高血压降压治疗是有效的,可平稳维持血压,不增加心率,降低外周阻力,从而降低后负荷,而不影响心脏指数。药物对糖代谢无不良影响。用药过程中未发现有严重不良反应。

[Objective] To evaluate the therapeutic efficacy of labetalol on decreasing blood pressure in preeclampsia, eclampsia and chronic hypertension complicating with PIH and on the hemodynamics among pregnant women. And file dosage and optimal administrated way for these patients were studied. [ Methods] 52 patients with hypertension during gestational period were treated with intravenous labetalol. The dosage of labetalol was increased with the blood pressure, and the automatic cadioelectric monitor observed blood pressure （BP） and heart rate （HR） even 5 minutes in the first 2 hours. We recorded the time and dosage which got the expected BP （140-150/90-100nmtHg or 18.7-20/12-14Kpa）. Cardiac index （C1） and total peripheral resistance （TPR） were observed by MP PIH monitor system before and after treatment to investigate the effect of labetalol to the hemodynamic parameter of pregnant women. Blood glucose was observed by blood glucose meter before and after intervention. Fetal heart rate were observed at the time of 2 hours before and after treatment by electronic fetal monitor as well as umbilical artery flows S/D value at the time of 24 hours before and after treatment were observed by ultrasound. [ Results] The BP of all the patients could be decreased to expected level （140-150/95-100mmHg） after intravenous infusion of nicardipine at the time of 18.41±15.99 minutes. Labetalol therapy resulted in a decrease in maternal pulse and blood pressure without significantly affecting CI and TPR （P 〈 0.01 ）. The BS, FHR and UmAF S/D did not showed significantly different before and after treatment, but the results of fetal monitor revealed to be improved. [ Conclusion ] Labetalol therapy is efficacy in the treatment of hypertension during gestational period, which could stabilize the blood pressure, without increasing the heart rate and reducing peripheral resistance, so it will decrease afterload without influencing the cardiac index. Labetalol will not have adverse effect on the glycometabolism. There is no severe side effects occurred in the process of treatment.