妊娠期高血压病是产科导致母儿严重危害的疾病,尤其是重度子痫前期严重高血压导致的并发症更是孕产妇致病和死亡的主要原因。有效平稳的降压可降低孕妇潜在并发症的风险,如何安全有效、平稳的降压有待进一步探讨。盐酸拉贝洛尔、硝苯地平目前为妊娠期高血压降压药的首要选择,其相应的不良反应需引起重视。
Gestational hypertension remains a leading cause of maternal and fetal morbidity and mortality, primarily caused by complications from severe hypertension. Effective and stable pressure can reduce the potential complications of pregnant women, how to effectively and steadily reduce the pressure to be further discussed. Labetalol and nifedipine are currently the first choice of antihy-pertensive drug during pregnancy; the adverse reaction of the corresponding needs to pay atten-tion to.
重度子痫前期,降压,治疗,盐酸拉贝洛尔,硝苯地平, Severe Preeclampsia Antihypertensive Therapy Labetalol Nifedipine重度子痫前期的降压治疗
盐酸拉贝洛尔:是一种肾上腺素能受体阻滞剂,选择性阻滞α1、β肾上腺受体,相较于传统的β受体阻滞剂,其可将子宫胎盘血流维持在较高水平,目前是广泛用于妊娠期高血压的降压药物,禁用于脑溢血、心动过缓、传导阻滞及支气管哮喘患者。用法:初始时静脉注射用药20 mg,持续2 min,随后每隔10分钟给予20~80 mg的剂量,如先给予20 mg,然后40 mg,随后80 mg,再80 mg,国内每日最大剂量220 mg,国外可达300 mg。持续静脉输注1~2 mg/min可代替间歇给药,血压在给药后5~10 min内开始降低,持续3~6小时。Meta [8] 分析了 363对母体-新生儿结局,从母体及胎儿有效率和安全性对比硝苯地平和盐酸拉贝洛尔。结果如下:硝苯地平Vs盐盐酸拉贝洛尔,母体:严重高血压(6/187 Vs 15/176),母体严重并发症(6/125 Vs 8/131),低血压(1/176 Vs 0/176),母体死亡(0/166 Vs 1/157),副反应(19/106 Vs 32/101),剖宫产(58/151 Vs 56/143);胎儿:胎心率异常(2/166 Vs 8/157),胎死宫内(13/121 Vs 18/157),新生生死亡(3/116 Vs 10/105),5分钟低Apgar(2/45 Vs 4/44),NICU住院(32/166 Vs 39/157)。拉贝洛尔无低血压病例,对持续严重高血压的降压效果低于硝苯地平,致胎心率异常及新生儿死亡的发生率较高,但统计学意义均不明显。对拉贝洛尔长期使用者需在其分娩时需告知用药情况,警惕新生儿并发症的发生。
谌福霞. 重度子痫前期的降压治疗 Antihypertensive Treatment for Sever Preeclampsia[J]. 临床医学进展, 2018, 08(02): 233-237. https://doi.org/10.12677/ACM.2018.82040
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