孕期氯沙坦暴露致羊水过少

Oligohydramnios caused by exposure to losartan during pregnancy

1例32岁女性肾病综合征患者在服用氯沙坦钾片(50 mg、1次/d)、甲泼尼龙片(12 mg、1次/隔日)和双嘧达莫片(50 mg、1次/d)治疗期间怀孕。孕期继续上述药物治疗。孕24^+2周行超声检查提示羊水过少,持续至孕32^+2周,羊水最大暗区垂直深度1.1~3.4 cm,羊水指数1.9~6.9 cm。停用氯沙坦钾片和甲泼尼龙片,换用硝苯地平控释片(30 mg、1次/d)降压,羊水量逐渐增加至正常水平。孕34^+4周血压升高至177/113 mmHg(1 mmHg=0.133 kPa),考虑子痫前期。给予硫酸镁(以1 g/h的速度静脉滴注)、硝苯地平控释片(加量至60 mg口服、1次/d)和拉贝洛尔片(200 mg口服、2次/d)治疗,血压143/82mmHg,尿蛋白(++)。于孕35+3周行剖宫产分娩1男婴,身长43 cm,体重2200 g,出生1 min和5 min Apgar评分均为10分,无出生缺陷。随访至24月龄,生长发育情况良好,智力发育及运动均正常。

A 32-year-old female patient with nephrotic syndrome got pregnant during treatments with losartan potassium tablets(50 mg once daily),methylprednisolone tablets(12 mg every other day),and dipyridamole tablets(50 mg once daily).She continued these drugs during pregnancy.Ultrasonographic examination at 24^+2 weeks of gestation indicated oligohydramnios,which lasted until 32^+2 weeks of gestation.The amniotic fluid volume ranged 1.1-3.4 cm,and the amniotic fluid indexes were 1.9-6.9 cm.Losartan and methylprednisolone were discontinued,and nifedipine controlled released tablets(30 mg once daily)were given to reduce blood pressure.Amniotic fluid volume gradually increased to normal.At 34^+4 weeks of gestation,her blood pressure rose to 177/113 mmHg.Preeclampsia was diagnosed.She was treated with magnesium sulfate(IV infusion at a speed of 1 g/h),oral nifedipine controlled released tablets(60 mg once daily)and labetalol(200 mg twice daily).Then her blood pressure was 143/82 mmHg and urinary protein detection was positive(++).At 35+3 weeks of gestation,a baby boy was delivered by cesarean section,with a body length of 43 cm and a weight of 2200 g.Neonatal Apgar scores at 1 min and 5 min were both 10,and no birth defects were found.During the follow-up to 24 months of age,his growth and development were good,and intellectual development and physical exercise were normal.