口服硝苯地平与静脉注射拉贝洛尔治疗妊娠期急性高血压的疗效比较

Comparison of the efficacy of oral nifedipine and intravenous labetalolin the management of acute hypertensive emergencies in pregnancy

目的 比较口服硝苯地平与静脉注射拉贝洛尔治疗妊娠期急性高血压患者的临床疗效。方法 回顾性将2018年1月—2020年12月于南京同仁医院妇产科就诊根据纳入标准和排除标准筛选后的186名妊娠期急性高血压患者。根据用药差异分为硝苯地平组和拉贝洛尔组两组,硝苯地平组患者通过口服硝苯地平来控制血压,拉贝洛尔组患者通过静脉推注拉贝洛尔来控制血压。收集并比较患者入院时的一般资料、使用硝苯地平或拉贝洛尔治疗后的情况、孕产妇和新生儿结局以及两组患者用药后的疗效评价。结果 通过统计分析,硝苯地平组和拉贝洛尔组具有可比性。硝苯地平组和拉贝洛尔组患者组在使用降压药物治疗后的血压均发生明显下降,但两组间比较差异无统计学意义。硝苯地平组患者达到目标血压时间明显少于拉贝洛尔组患者[35(26~55)min vs. 59(44~122)min](P<0.05),药物使用次数也明显少于拉贝洛尔组[2(1~3)次vs. 3(2~4)次](P<0.05)。在用药后24h内患者排尿量方面硝苯地平组患者24 h内排出(2169.58±104.47)mL,显著高于拉贝洛尔组患者(1482.01±160.23)mL(P<0.05)。硝苯地平组和拉贝洛尔组患者在妊娠方式、新生儿体重、新生儿不良结局方面比较差异均无统计学意义。硝苯地平组患者中有79例(84.95%)患者在用药2h内达到了目标血压,拉贝洛尔组患者中有69例(74.19%)患者。在用药2 h内达到了目标血压方面,两组间比较差异无统计学意义(P>0.05)。结论 静脉注射拉贝洛尔和口服硝苯地平都能有效控制妊娠期突发急性高血压。硝苯地平能更快地降低血压,并对尿量有有利的影响。口服硝苯地平只需要较小的剂量就能在短时间内发挥作用,可能是静脉推注拉贝洛尔的理想替代方案。

Objective To compare the efficacy of oral nifedipine with intravenous labetalol in achieving target blood pressure in patients with severe hypertension in pregnancy.Methods One hundred and eighty-six patients with acute hypertension in pregnancy who attended the obstetrics and gynaecology department of Nanjing Tongren Hospital from January 2018 to December 2020 were screened according to the inclusion and exclusion criteria.Patients in the nifedipine group were randomly divided equally into two groups,with patients in the nifedipine group receiving oral nifedipine to control blood pressure and patients in the labetalol group receiving intravenous push labetalol to control blood pressure.General information on patients at admission,after treatment with nifedipine or labetalol,maternal and neonatal outcomes and evaluation of the efficacy of the medication in both groups were collected and compared.Results By statistical analysis,the nifedipine and labetalol groups were comparable.A significant reduction in blood pressure occurred in both the nifedipine and labetalol groups after treatment with antihypertensive drugs,but there was no significant difference in the comparison between the two groups.The time to achieve target blood pressure was significantly less in the nifedipine group than in the labetalol group[35(26-55)min vs.59(44-122)min](P<0.05)and the number of doses was significantly less in the labetalol group[2(1-3)doses vs.3(2-4)doses](P<0.05).Patients in the nifedipine group excreted(2169.58±104.47)mL of urine in 24 hours after dosing,which was significantly higher than that in the labetalol group(1482.01±160.23)mL(P<0.05).There were no significant differences between patients in the nifedipine and labetalol groups in terms of mode of pregnancy,neonatal weight,or adverse neonatal outcomes.Target blood pressure was achieved within 2 hours of dosing in 79(84.95%)patients in the nifedipine group and 69(74.19%)patients in the labetalol group.There was no significant difference between the two groups in terms of achieving the target blood pressure within 2 hours of dosing(P>0.05).Conclusion Both intravenous labetalol and oral nifedipine were effective in controlling blood pressure. Nifedipine lowered blood pressure more rapidly and had afavourable effect on urine output. Oral nifedipine requires only a smaller dose to be effective in a short period of time andmay be an ideal alternative to intravenous push labetalol.