尼卡地平治疗重度妊娠期高血压疾病的疗效及安全性

Curative effect and safety of nicardipine in treatment of severe hypertensive disorder complicating pregnancy

目的探讨尼卡地平治疗重度妊娠期高血压疾病(HDCP)的疗效及安全性,为临床治疗HDCP提供参考依据。方法选择2014年1月-2016年12月上海市虹口区江湾医院产科住院重度HDCP患者为研究对象。随机分为尼卡地平组(27例)和拉贝洛尔组(33例),两组静脉滴注尼卡地平或拉贝洛尔注射液,并根据血压随时调节药量直至目标血压(140~150/90~100)mm Hg,比较药物起效时间、血压达标时间、药物不良反应、孕妇血流动力学改变及对胎儿、围生结局的影响。结果两组在药物起效时间[(4.58±1.26)min vs(5.83±2.25)min]、血压达标时间[(11.67±7.23)min vs(16.38±5.17)min]及有效率(92.59%vs 90.91%)比较,差异无统计学意义(均P>0.05)。尼卡地平组用药后心率增快,拉贝洛尔组用药后心率减缓,无须特殊处理,未出现严重低血压、皮疹、发热等不良反应。心脏超声检测用药前及用药后24 h心脏指数及外周阻力,与治疗前比较均得到明显改善,差异有统计学意义(P<0.05或P<0.01),但两组间比较差异无统计学意义(均P>0.05)。两组胎儿在用药前、后脐动脉收缩末期峰值(S)/舒张末期峰值(D)(S/D值)略下降,但组内及两组间比较差异无统计学意义(均P>0.05),出现胎心监护异常(3 vs 4)经干预后均恢复正常,两组比较差异无统计学意义(P>0.05)。两组各发生产后出血2例,无心衰、子痫及孕产妇死亡发生,两组比较差异无统计学意义(P>0.05)。两组分娩孕周<34周与≥34周中,新生儿Apgar评分≤3分(4 vs 6;1 vs 2)、围生儿死亡(2 vs 1;0 vs 0)比较差异无统计学意义(均P>0.05)。结论尼卡地平用于重度HDCP的紧急降压效果好,不良反应少,有良好的母胎耐受性,安全性好。

Objective To explore the curative effect and safety of nicardipine in treatment of severe hypertensive disorder complicating pregnancy（ HDCP）,provide a reference basis for clinical treatment of HDCP. Methods From January 2014 to December 2016,severe HDCP patients were selected from Department of Obstetrics in Jiangwan Hospital of Hongkou District as study object,then the patients were randomly divided into nicardipine group（ 27 patients） and labetalol group（ 33 patients）. The patients in the two groups were treated by intravenous injection of nicardipine or labetalol,respectively. Drug doses were adjusted according to blood pressure till target blood pressure140-150/90-100 mm Hg. The onset time of drug,the time for blood pressure return to the criterion,drug adverse reactions,maternal hemodynamic changes,the effect on fetal and perinatal outcomes in the two groups were compared. Results There was no statistically significant difference in the onset time of drug,the time for blood pressure return to the criterion,effective rate between the two groups [（ 4. 58±1. 26）minutes vs（ 5. 83±2. 25） minutes,（ 11. 67±7. 23） minutes vs（ 16. 38±5. 17） minutes,92. 59% vs 90. 91%） ]（ P〉0. 05）. After treatment,heart rate of patients in nicardipine group increased,while heart rate of patients in labetalol group decreased,no special treatment was provided,no adverse reaction occurred,such as severe hypotension,erythra,and fever. Compared with before treatment,cardiac index and peripheral vessel resistance at 24 hours after treatment were improved significantly（ P〈0. 05 or P〈0. 01）,but there was no statistically significant difference between the two groups（ P〉0. 05）. Compared with before treatment,the ratio of peak systolic velocity to end diastolic velocity（ S/D） after treatment decreased slightly,but there was no statistically significant difference,and there was no statistically significant difference between the two groups（ P〉0. 05）. The numbers of cases with abnormal fetal monitoring before and after treatment were 3 and 4,respectively,there was no statistically significant difference between the two groups（ P〉0. 05）. Postpartum hemorrhage occurred in two patients in nicardipine group and two patients in labetalol group,no heart failure,eclampsia,and maternal death occurred,there was no statistically significant difference between the two groups（ P〉0. 05）. There was no statistically significant difference in the numbers of cases with neonatal Apgar score≤3 and perintal death between 〈34 gestational week group and ≥34 gestational week group（ 4 vs 6,1 vs 2; 2 vs1,0 vs 0）（ P〉0. 05）. Conclusion The emergent antihypertensive efficacy of nicardipine for severe HDCP is good,the adverse reactions are less,maternal and fetal tolerance is good,and safety is high.