目的 观察盐酸利托君对孕中期先兆流产孕妇子宫血流、孕激素和血清D-二聚体(D-D)及左心室射血分数(EF)、每搏输出量(SV)的影响.方法 纳入孕中期先兆流产孕妇为研究对象.对照组静脉滴注25％硫酸镁15 g,qd,连续治疗3 d;试验组静脉滴注盐酸利托君100 mg,待宫缩停止继续进行12～18 h静脉滴注,之后服用利托君片,前24 h剂量为10 mg/2 h,随后控制剂量为10 mg/4～6 h,每天最高不超过120 mg,连续治疗3 d.比较2组治疗前后子宫血流动力学[阻力指数(RI)、搏动指数(PI)、收缩期/舒张期比值(S/D)]、孕激素[孕酮(P)、人绒毛膜促性腺激素(HCG)、雌二醇(E2)]、血清D-D、EF、SV、症状消失时间、保胎成功率、新生儿不良结局及药物不良反应.结果 治疗后,试验组与对照组RI分别为0.74±0.13和0.81±0.17,PI分别为2.08±0.39和2.63±0.42,S/D 分别为 3.14±0.57 和 3.65±0.62,D-D 分别为(0.60±0.12)和(0.58±0.13)mg·L-1,P 分别为(44.83±7.62)和(41.35±7.96)μg·L-1,HCG 分别为(20 958.63±2 143.72)和(20 043.82±2 125.64)mU·mL-1,E2 分别为(538.72±83.16)和(503.69±87.42)ng·L-1,EF 分别为(61.34±8.05)％和(72.52±8.37)％,SV 分别为(75.06±7.92)和(80.29±8.34)mL,出血消失时间分别为(2.65±0.43)和(2.87±0.39)d,腹痛消失时间分别为(2.57±0.38)和(2.80±0.42)d,腰酸消失时间分别为(2.36±0.35)和(2.74±0.38)d,保胎成功率分别为98.04％和77.55％,早产率分别为12.00％和18.42％,新生儿不良结局发生率分别为6.00％和10.53％.试验组上述指标与对照组比较,除D-D、早产率、新生儿不良结局发生率外,在统计学上差异均有统计学意义(均P＜0.05).试验组和对照组药物不良反应总发生率分别为7.84％和6.12％,在统计学上差异无统计学意义(P＞0.05).结论 盐酸利托君可有效改善孕中期先兆流产孕妇子宫血流动力学,提高孕激素水平,获得良好的保胎效果.
Objective To observe the effect of ritodrine hydrochloride on uterine blood flow,progesterone,serum D-dimer(D-D),left ventricular ejection fraction(EF)and stroke volume(SV)in pregnant women with threatened abortion in the second trimester of pregnancy.Methods Pregnant women with threatened abortion in the second trimester were included in the study.The control group was treated with intravenous drip of 25％magnesium sulfate 15 g,qd,for 3 d.The treatment group was treated with intravenous drip of ritodrine hydrochloride 100 mg and the intravenous drip lasted for 12-18 h after uterine contraction stopped.Then,patients in the group were treated with ritodrine tablets(10 mg/2 h in the former 24 h and then 10 mg/4-6 h)no more than 120 mg every day,for 3 d.Uterine hemodynamics[resistance index(RI),pulsatility index(PI)and systolic/diastolic ratio(S/D)],progesterone[progesterone(P),human chorionic gonadotropin(HCG)and estradiol(E2)],serum D-D,EF,SV,disappearance time of symptoms,success rate of fetal protection,adverse neonatal outcomes,and adverse drug reactions were compared between two groups.Results After treatment,RI in the treatment group and the control group were 0.74±0.13 and 0.81±0.17;PI were 2.08±0.39 and 2.63±0.42;S/D were 3.14±0.57 and 3.65±0.62;D-D levels were(0.60±0.12)and(0.58±0.13)mg·L-1;P levels were(44.83±7.62)and(41.35±7.96)μg·L-1;HCG levels were(20 958.63±2 143.72)and(20 043.82±2 125.64)mU·mL-1;E2 levels were(538.72±83.16)and(503.69±87.42)ng·L1;EF were(61.34±8.05)％and(72.52±8.37)％;SV were(75.06±7.92)and(80.29±8.34)mL;the disappearance time of bleeding were(2.65±0.43)and(2.87±0.39)d;the disappearance time of abdominal pain were(2.57±0.38)and(2.80±0.42)d;the disappearance time of soreness of waist were(2.36±0.35)and(2.74±0.38)d;the success rates of fetal protection were 98.04％and 77.55％;the premature delivery rates were 12.00％and 18.42％;the incidence rates of adverse neonatal outcomes were 6.00％and 10.53％;there were statistically significant differences between the treatment group and the control group except for D-D,preterm delivery rate,and the incidence of neonatal adverse outcomes(all P＜0.05).The total incidence of adverse drug reactions in the treatment group and the control group were 7.84％and 6.12％,respectively,and the difference were not statistically significant(P＞0.05).Conclusion Ritodrine hydrochloride can effectively improve uterine hemodynamics,increase progesterone levels,and achieve good fetal protection effect in pregnant women with threatened abortion in the second trimester of pregnancy.
胡春;王萍
永康市妇幼保健院产科,浙江永康 321300
药学
盐酸利托君;先兆流产;子宫血流;孕激素;心功能
ritodrine hydrochloride;threatened abortion;uterine blood flow;progesterone;cardiac function
《中国临床药理学杂志》 2024 (001)
12-16 / 5
10.13699/j.cnki.1001-6821.2024.01.003
评论