硫酸镁、硝苯地平联合地西泮方案对子痫前期患者的疗效分析

Effects analysis of magnesium sulfate,nifedipine combined with diazepam on patients with preeclampsia

目的探讨硫酸镁、硝苯地平联合地西泮方案应用对子痫前期患者血压、血清核因子E2相关因子(Nrf2)、胎盘生长因子(PLGF)浓度及妊娠结局的影响。方法选取淮安市第一人民医院于2019年3月至2021年9月收治的105例子痫前期孕产妇为研究对象,采用随机数字表法分为联合治疗组(53例)和对照组(52例)。对照组给予硫酸镁和硝苯地平治疗5天(第1天:20mL硫酸镁快速静脉滴注,60mL硫酸镁持续静脉滴注。第2~5天:60mL硫酸镁持续注射液静脉滴注,口服硝苯地平片10mg/次,3次/天)。联合给药组在对照组的基础上加服地西泮片,5mg/次,睡前服用,连续5天。比较两组患者疗效、血清Nrf2和PLGF浓度及妊娠结局。结果联合给药组产妇的总有效率为92.45%,对照组产妇的总有效率为80.77%,联合给药组总有效率显著高于对照组(χ^(2)=3.969,P<0.05)。治疗后两组舒张压与收缩压均显著低于治疗前(t值分别为4.126、3.675、5.108、4.032,P<0.05),且治疗后联合给药组的舒张压与收缩压均显著低于对照组(t值分别为3.531、3.373,P<0.05)。治疗后两组血清Nrf2均显著低于治疗前(t值分别为4.476、3.908,P<0.05),血清PLGF浓度均显著高于治疗前(t值分别为3.547、3.776,P<0.05),但治疗后联合给药组的血清Nrf2浓度显著低于对照组(t=2.263,P<0.05),治疗后两组孕产妇血清PLGF浓度比较差异无统计意义(P>0.05)。联合给药组的围生儿不良结局和孕产妇不良妊娠结局总发生率均显著低于对照组(χ^(2)值分别为4.107、4.100,P<0.05)。治疗期间两组不良反应发生率比较无显著差异(P>0.05),且停药后症状均自行消失。结论硫酸镁、硝苯地平联合地西泮对子痫前期患者的疗效优于硫酸镁联合硝苯地平,可显著改善患者的氧化应激,降低不良妊娠结局发生率,且安全性良好。

Objective To investigate the effects of magnesium sulfate,nifedipine combined with diazepam on blood pressure,serum nuclear factor E2-related factor-2(Nrf2)and placental growth factor(PLGF)concentration and pregnancy outcomes in patients with preeclampsia.Methods 105pregnant women with preeclampsia received by Huai′an First People′s Hospital from March 2019 to September 2021were selected as the study subject and divided into the combined administration group(53cases)and the control group(52cases)by random number table method.The control group was treated with magnesium sulfate and nifedipine for 5days(on the first day:20mL magnesium sulfate was rapidly injected intravenously,and 60mL magnesium sulfate was continuously injected intravenously.On the second to fifth days:60mL magnesium sulfate was continuously injected intravenously,nifedipine tablets were taken orally,with 10mg per time and 3times per day).In the combined administration group,diazepam tablets were taken on the basis of the control group,with 5mg per time,taken before going to bed,and continuously taken for 5days.The curative effect,serum Nrf2and PLGF concentration and pregnancy outcomes were compared between the two groups.Results The total effective rate was 92.45%in the combined administration group,the total effective rate was 80.77%in the control group,and the total effective rate in the combined administration group was significantly higher than that in the control group(χ^(2)=3.969,P<0.05).After treatment,the diastolic blood pressure and systolic blood pressure in the two groups were significantly lower than those before treatment(t=4.126,3.675,5.108and 4.032,respectively,P<0.05),and after treatment,the diastolic blood pressure and systolic blood pressure in the combined administration group were significantly lower than those in the control group(t=3.531and 3.373,respectively,P<0.05).After treatment,serum Nrf2in the two groups were significantly lower than those before treatment(t=4.476and 3.908,respectively,P<0.05),and serum PLGF concentration was significantly higher than those before treatment(t=3.547and 3.776,respectively,P<0.05).However,after treatment,serum Nrf2concentration in the combined administration group was significantly lower than that in the control group(t=2.263,P<0.05),and there was no statistical significance in serum PLGF concentration between the two groups after treatment(P>0.05).The total incidence of perinatal adverse outcomes and maternal adverse pregnancy outcomes in the combined administration group were significantly lower than those in the control group(χ^(2)=4.107and 4.100,respectively,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05),and the symptoms disappeared spontaneously after drug withdrawal.Conclusion Magnesium sulfate,nifedipine combined with diazepam has better efficacy than magnesium sulfate combined with nifedipine in patients with preeclampsia,which can significantly improve the patients′oxidative stress and reduce the incidence of adverse pregnancy outcomes,and with good safety.