两种宫缩抑制剂盐酸利托君与阿托西班治疗先兆早产的临床分析

Clinical Analysis of Tocolysis with Ritodrine Hydrochloride or Atosibanin Treatment of Threatened Preterm Labour

目的:探讨盐酸利托君与阿托西班两种宫缩抑制剂治疗先兆早产的临床效果。方法:对2018年12月至2020年12月于浙江大学医学院附属妇产科医院诊断为先兆早产,住院并分娩的患者的临床资料进行回顾性分析,根据宫缩抑制剂的使用情况分为盐酸利托君组、阿托西班组以及交替用药组,通过组间比较筛选有统计学意义的结局指标,进行Logistic回归控制混杂因素,分析对比3组患者和其新生儿的临床结局,并用校正OR值进行量化评价。结果:(1)阿托西班组(OR 7.932,95%CI 1.722~36.526)和交替用药组(OR 4.054,95%CI 1.649~9.965)<28孕周早产的风险显著高于盐酸利托君组,差异有统计学意义(P<0.01);(2)与盐酸利托君组比较,阿托西班组(HR 5.942,95%CI 1.736~20.335)及交替用药组(HR 3.030,95%CI 1.565~5.865)的妊娠延长天数明显减少,但阿托西班组药物不良反应发生率低于盐酸利托君组和交替用药组(P<0.01);(3)盐酸利托君组和阿托西班组以及交替用药组在新生儿活产率上比较,差异均无统计学意义(P>0.05);(4)盐酸利托君组和阿托西班组在新生儿入住新生儿重症监护室(NICU)、新生儿呼吸窘迫综合征(NRDS)、呼吸暂停、机械通气的风险上差异无统计学意义,而交替用药组发生上述的风险均高于盐酸利托君组(P<0.05),OR值分别为2.302(95%CI 1.149~4.612),5.569(95%CI 2.380~13.033),6.487(95%CI 2.564~16.409),6.839(95%CI 2.896~16.152)。结论:盐酸利托君单独用药治疗先兆早产,其延长妊娠效果优于阿托西班单用和两种药物交替使用,而阿托西班导致的药物不良反应较盐酸利托君更少。临床上如何选择用药还需通过随机对照研究进一步探究。

Objective:To assess the eficacy of two tocolytic agents,ritodrine hydrochloride and atosiban,for inhibiting preterm labour.Methods:The clinical data of 284 patients diagnosed with preterm labour,hospitalised and delivered in Women's Hospital School of Medicine Zhejiang University from December 2018 to December 2020 were retrospectively reviewed.They were divided into three groups which are the intravenous ritodrine hydrochloride group,the atosiban group,and the alternative group according to the use of tocolysis.Screening for statistically significant outcome indicators by group comparison and controlling the confounding factors by Logistic regression,the maternal and neonatal outcomes were compared among three groups and quantitatively assess-mented by corrected OR.Results:①Atosiban(OR 7.932,95%CI 1.722-36.526)group and altermative(OR 4.054,95%CI 1.649-9.965)group showed higher risks of giving birth before 28 weeks than ritodrine hydrochlo-ride group(P<0.01).②Compared to ritodrine hydrochloride group,atosiban(HR 5.942,95%CI 1.736-20.335)group and altermative(HR 3.030,95%CI 1.565-5.865)group had less increase in the mean gestation-al age at delivery;the adverse drug reactions in atosiban group were less than those in ritodrine hydrochloride group and alternative group(P<0.01).③No apparent differences were showed between ritodrine hydrochloride and other two groups in live birth rate(P>0.05).④There were also no significant differences between ritodrine hydrochloride group and atosiban group in infant admission to neonatal intensive care unit(NICU),neonatal re-spiratory distress syndrome(NRDS),apnea,or need for mechanical ventilation.While there were higher event rates for these risks in alternative group compared with ritodrine hydrochloride group(P<0.05),OR=2.302(95%CI 1.149-4.612),5.569(95%CI 2.380-13.033),6.487(95%CI 2.564-16.409),6.839(95%CI 2.896-16.152).Conclusions:Monotherapy with ritodrine hydrochloride was more effective than monotherapy with atosiban and alternative therapy with these two medications for inhibiting preterm labour and prolonging the duration of pregnancy.However,atosiban had less adverse drug reactions compared with ritodrine hydrochloride.Suitable use of medications should be explored by further randomized controlled studies.