硝苯地平联合硫酸镁治疗妊娠高血压综合征患者对肾功能损伤的影响

Effect of nifedipine combined with magnesium sulfate on serum CysC,urea nitrogen,creatinine and uric acid in patients with pregnancy induced hypertension

目的观察硝苯地平联合硫酸镁对妊娠高血压综合征(PIH)患者肾功能损伤的影响。方法分析2013年4月—2016年6月湖北省枣阳市第一人民医院产科诊治的PIH患者138例的临床资料,采用抽签法均分为观察组和对照组各69例。2组患者均给予解痉常规治疗,25%硫酸镁冲击剂量20 ml+5%葡萄糖注射液10 ml于10min内静脉推注,然后给予25%硫酸镁注射液60 ml+5%葡萄糖注射液500 ml静脉滴注,在此基础上观察组患者加用硝苯地平释片30 mg舌下含服,3次/d。对比不程度PIH患者的血清胱抑素C(CysC)、尿素氮(BUN)、肌酐(SCr)与尿酸(UA)水平,观察2组PIH患者治疗前后的CysC、BUN、SCr与UA的水平变化、临床疗效和并发症。结果治疗前PIH重度患者的CysC、BUN、SCr与UA水平明显高于轻、中度患者。观察组总有效率为94.20%高于对照组的82.61%(χ~2=4.524,P=0.033)。与治疗前比较,2组患者治疗后的CysC、BUN、SCr与UA水平均明显下降(观察组t=8.183、13.475、30.870、6.048;对照组t=5.734、2.250、16.052、2.803,P均<0.01);与对照组比较,观察组治疗后CysC、BUN、SCr与UA水平下降更明显(t=2.086、10.207、12.240、3.298,P均<0.01)。观察组发生宫缩乏力、胎儿窘迫、新生儿室息、新生儿感染及产后出血并发症发生率明显低于对照组(χ~2=6.059、4.944、7.787、6.740、21.068,P均<0.05)。结论硝苯地平联合硫酸镁治疗妊娠高血压综合征可明显降低患者的血清胱抑素C、尿素氮、肌酐与尿酸水平,改善患者肾功能,减少并发症的发生率,临床疗效显著,值得临床推广使用。

Objective To investigate the effect of nifedipine combined with magnesium sulfate on renal dysfunction in patients with pregnancy induced hypertension（PIH）. Methods Forty three patients with PIH were enrolled in this study from April 2013 to June 2016 ,and they were divided into observation group and control group（ 69 cases in each group）by lottery method. Two groups of patients were given antispasmodic conventional treatment,25 % magnesium sulfate impact dose 20 ml ＋ 5% glucose injection 10 ml intravenous injection within 10 min, and then given 25% magnesium sulfate injection 60 ml ＋ 5% glucose injection 500 ml intravenous drip Note treatment, on this basis, the observation group of patients with nifedipine release tablets 30 mg sublingual,3 times / d. The Level changes of CysC, BUN, SCr and UA were observed before and after treatment in PIH patients, clinical efficacy and complications after treatment were compared. Results The total effective rate was 94.20% in the observation group,which was 82.61% higher than that in the control group（x2 = 4. 524,P = 0. 033）. The levels of CysC, BUN, SCr and UA in patients with severe PIH before treatment were significantly higher than those in mild to moderate patients, the ievels of CysC, BUN, SCr and UA in the two groups were significantly lower than those before treatment （ obser ration group ： t = 8.183,13. 475,30. 870,6.048, control group ： t = 5. 734,2. 250,16. 052,2. 803, all P = 0.000）, com- pared with the control group,the levels of CysC, BUN, SCr and UA in the observation group were significantly lower than those in the control group（t =2. 086, P =0. 039,t = 10.207, P =0. 000 ,t = 12. 240, P =0.000,t =3. 298, P =0. 001 ）. The inci- dence of eomplieations such as uterine inertia, fetal distress, neonatal ventricle, neonatal infection and postpartum hemorrhage were significantly lower in the observation group than in the control group（ X2 = 6. 059,4. 944,7. 787,6. 740,21. 068, P =0. 014, P = 0. 026,P = 0. 005, P = 0. 009, P = 0. 000 ）. Conclusion Nifedipine combined with magnesium sulfate in the treatment of pregnancy induced hypertension can significantly reduce serum levels of CysC, urea nitrogen, creatinine and uric acld,improve renal function and reduce the incidence of complications, clinical efficacy is significant. Worthy of clinical use.