重度子痫前期产妇产后早期血压调控的临床观察

Observation on the Blood pressure of the Postpartum with Severe Eclampsism were Treated by Nitroprusside

目的探讨并总结重度子痫前期产妇产后早期血压调控的经验。方法回顾性分析34例重度子痫前期产妇产后早期血压调控的情况。按给药不同分为硝普钠组、硝酸甘油组、盐酸乌拉地尔组等3组,各组给药途径均为经静脉微泵。同时各组予静脉滴注人血白蛋白10g后静脉推注速尿10mg,每日3～4次。比较3组病人用药前、后1h的血压变化,同时比较脱水治疗后前3天血压控制的有效率。结果治疗后好转32例,自动出院1例,死亡1例。重症医学科住留(71.2±22.4)h(46～98h)。硝普钠组、硝酸甘油组、乌拉地尔组治疗的有效率分别为62.5%、52.4%和12.5%;脱水量第1d(1 420±680)mL,第2d(2 150±815)mL,第3d(1 635±540)mL;脱水治疗后迅速停用了硝普钠、硝酸甘油和乌拉地尔等药物,患者血压基本恢复正常水平。结论重度子痫前期产妇产后早期单纯使用降压药物降压效果不理想;经补充白蛋白并选择速尿注射快速脱水治疗调节血压安全有效。

Objective Exploring and summarize the experience on the blood pressure of the postpartum with severe eclampsism were treated by nitroprusside.Methods Thirty-four puerperas with severe eclampsism after parturition were analyzed.Sodium nitroprusside,nitroglycerin and urapidil were used with minipump.Furosemide 10 mg were used every 6 to 8 hours after albumin 10 g.Results Three groups patients were transferred out of ICU with a stable condition,but there is one patient discharged from hospital and one patient died.The average time in ICU was（71.2±22.4）h.The result of the blood pressure were rated with nitroprusside 62.5%,nitroglycerin 52.4% and urapidil 12.5%.Fluid loss in the first day were（1 420±680）mL,in the second day were（2 150±815）mL,in the third day were（1 635±540）mL.Conclusions The effects of sodium nitroprusside and nitroglycerin as well as urapidil in severe preeclampsia patients in prophase of postpartum were dissatisfactory.The method of dehydration therapy using furosemide after album was safety and effective for severe preeclampsia patients.