硝苯地平联合拉贝洛尔治疗对子痫前期患者sFlt–1及PLGF浓度的影响

目的：探讨硝苯地平联合拉贝洛尔治疗对子痫前期患者可溶性Fms样酪氨酸激酶–1(sFlt–1)及胎盘生长因子（PLGF）浓度的影响。方法：选择2021年4月至2022年4月于郑州大学第一附属医院诊治的380例子痫前期患者,根据简单随机法分成观察组、对照组,各190例。对照组患者给予硫酸镁联合硝苯地平治疗,观察组患者在对照组基础上联合拉贝洛尔治疗,比较两组患者治疗前、治疗14 d后血液/尿液指标[尿肌酐（UCr）、24 h尿蛋白定量（24h UPQ）、血清脑利尿钠肽（BNP）、sFlt–1、PLGF]、血压[收缩压（SBP）、舒张压（DBP）]、超声检查指标[血流阻力指数（RI）、脐动脉血流速度峰谷比（S/D）与搏动指数（PI）]以及妊娠结局。结果：观察组患者治疗后UCr、24h UPQ、血清BNP、s Flt–1水平、SBP、DBP、RI、PI、S/D均低于对照组,血清PLGF水平高于对照组,差异具有统计学意义（P <0.05）;观察组不良妊娠结局总发生率为13.16%,低于对照组的25.26%,差异具有统计学意义（P <0.05）。结论：子痫前期患者联合应用硝苯地平与拉贝洛...     

Labetalol,a cross-over double blind controlled trial

Summary 20 patients (12 female) with moderately severe essential hypertension [blood pressure during placebo treatment 181±6 (systolic), 107±3 (diastolic)] completed a double-blind, cross-over dosetitrated comparison of labetalol and methyldopa. Both drugs reduced lying and standing arterial blood pressure to a similar extent, although only labetalol reduced heart rate. Compliance was high (>95%) with both drugs, and the incidence of subjective adverse effects was similar.     

Effects of Labetalol on the Releas of Prostacyclin and Endothelin-1 by Cultured Human Umbilical Vein Endothelial Cells and on the Excretion of Prostacyclin and Thromboxane Metabolites in Preeclamptic Patients

Objective: Labetalol reduces blood pressure primarily by blocking alpha-and beta-receptors, but other mechanisms of action may also be possible. We studied the effects of labetalol on the synthesis of vasodilatory prostacyclin (PGI₂) and vasoconstrictory endothelin-1 (ET-1) by cultured human umbilical vein endothelial cells (HUVECs). We also studied the effect of oral labetalol treatment on PGI, and thromboxane A₂ (TxA.₂) production in preeclamptic patients.

Methods: HUVECs were incubated in the absence (control) and presence of labetalol (10^?8-10-⁵ mol/L) and the release of PGI-, as measured by its metabolite 6-keto-PGF_1α, and that of ET-1, were assessed by radioimmuno- assays. Because the presence of serum strongly affects endothelial cell function, we studied the effect of labetalol in HUVECs incubated with or without serum. In the in vivo part of the study, urine samples collected before and during oral labetalol intake were assessed for 2,3-dinor-6-keto-PGF, a metab-olite of PGI.1_α and for 2,3-dinor-thromboxane-B., a metabolite of TxA,₂ with high-pressure liquid chromatography and radioimmunoassay.

Results: HUVECs incubated in the presence of serum (10%) produced 8 times more 6-keto-PGF_loi and 5 times more ET-1 than HUVECs incubated without serum. Labetalol (10^?8-10^?5 mol/L) did not affect the production of PGL, although the highest labetalol level (not achievable in vivo, 10^?5 mol/L) was accompanied by a drop in PG1-, release in both serum-free (– 21%) and serum conditions (- 14%); this was probably a sign of toxic effect. Labetalol caused no consistent change in the release of ET-1 in HUVECs. Oral labetalol treatment did not affect urinary excretion of PGI, and TxA., metabolites.

Conclusions: No clinically relevant effects of labetalol were found on endothelial cell PG1-, or ET-1 production. Labetalol at therapeutic doses and concentrations does not affect the production of vasoactive PGI₂ and TxA₂ in preeclamptic patients.     

Labetalol in the difficult hypertensive patient in general practice

Summary

An open study was carried out in general practice to assess the effectiveness and tolerance of labetalol in the treatment of 53 difficult hypertensive patients, most of whom had failed to respond to previous hypotensive therapy. The results showed that in the 49 patients receiving treatment for more than 3 months good blood pressure control was readily achieved, and with labetalol alone in all but 6 of them. The majority were controlled on doses ranging from 300 to 600?mg per day. Treatment was discontinued in 3 patients because of severe side-effects. Mild, tolerable side-effects, similar to those found with beta-adrenergic blocking agents, were reported by 35 patients.     

拉贝洛尔治疗妊娠高血压的临床效果

目的：观察拉贝洛尔治疗妊娠高血压的临床疗效。方法：选取我院在2013～2014年收治的90例妊娠高血压患者为研究对象,随机分为对照组和实验组各45例,对照组给予硫酸镁常规治疗,实验组在对照组治疗的基础上给予拉贝洛尔治疗,对比两组治疗期间的平均收缩压和舒张压、平均24h尿蛋白、并发症及妊娠结局。结果：实验组治疗期间收缩压、舒张压和24h尿蛋白水平分别为（112.51±16.19）mmHg、（80.39±3.28）mmHg、（1.77±0.03）g,显著低于对照组,差异有统计学意义（P<0.05）;实验组胎儿窘迫、新生儿窒息及产后出血发生率均显著低于对照组（P<0.05）,差异有统计学意义。胎儿娩出后分别于1min、5min时作Agar评分,分别对比1min、5min时两组新生儿的Agar评分,实验组均显著优于对照组,差异显著（t=4.003,P=0.010）,有统计学意义。结论：应用拉贝洛尔治疗妊娠高血压,能有效降低患者的血压,进而降低不良妊娠结局的发生率。     

Labetalol binding to specific alpha- and beta-adrenergic sites in vitro and its antagonism of adrenergic responses in vivo.

Labetalol was found to compete with [³H]dihydroergocryptine for specific alpha-adrenergic binding sites in rabbit uterine membrane preparations. Based on IC50 values from binding-competition curves, labetalol had 536 times lower affinity for alpha-sites than phentolamine. Labetalol competed with [³H]dihydroalprenolol for specific beta-adrenergic binding sites in guinea pig heart and lung membranes. The drug had 53 times lower affinity for the heart beta-sites than propranolol, and was significantly less potent than propranolol in inhibiting stimulation of cardiac adenylate cyclase by 10⁻⁵ m isoproterenol. Labetalol had 19 times greater binding affinity for beta binding sites in heart membranes than alpha binding sites in uterine membranes. In vivo studies in anesthetized dogs indicate that blockade of beta adrenergic responses predominates at lower dose of labetalol and that blockade of alpha responses was observed when the dose was increased by a factor of 10. These data are consistent with the hypothesis that labetalol antagonizes both alpha and beta adrenoceptors, and that labetalol is a more potent antagonist at beta than alpha-adrenergic sites.     

拉贝洛尔联合硫酸镁对妊娠期高血压患者妊娠结局的影响

目的：探讨在妊娠期高血压患者中采用拉贝洛尔与硫酸镁联合进行治疗对妊娠结局的影响。方法选取2014年4月-2016年4月我院收治的58例妊娠期高血压患者,根据住院顺序随机分为实验组和对照组,每组各29例患者。对照组患者通过硫酸镁进行治疗,实验组患者通过拉贝洛尔与硫酸镁联合进行治疗,对比两组患者血压情况、分娩方式以及新生儿结局。结果两组患者在治疗后血压均有明显的下降,但是实验组患者治疗后的血压值低于对照组,两组患者间差异有统计学意义(P＜0.05)。实验组患者的自然分娩率明显高于对照组患者,两组患者自然分娩率间的差异有统计学意义(P＜0.05)。实验组早产率、宫内窘迫率以及新生儿窒息率均明显低于对照组,两组间差异有统计学意义(P＜0.05)。结论在妊娠期高血压患者中采用拉贝洛尔与硫酸镁联合进行治疗,有效地降低了患者的血压,提高了自然分娩率,也改善了新生儿结局情况,值得在临床上进行推广应用。     

拉贝洛尔联合硫酸镁治疗中重度妊娠期高血压疾病疗效观察

目的：观察拉贝洛尔联合硫酸镁治疗中重度妊娠期高血压疾病的临床疗效及安全性。方法78例中重度妊娠期高血压疾病患者按照随机数字表法分为对照组和观察组各39例,对照组单用硫酸镁治疗,观察组在应用硫酸镁基础上联合拉贝洛尔治疗,观察两组患者治疗前后平均收缩压和舒张压、24 h尿蛋白、孕产妇心率、胎心率和治疗后母婴结局情况。结果观察组治疗后收缩压（134．5±9．7） mmHg和舒张压（85．7±5．9）mmHg,较对照组的（145．2±10．8）mmHg、（96．1±6．8）mmHg显著下降（t＝4．60、7．21,均P＜0.05）;两组24 h尿蛋白、心率及胎心率等差异均无统计学意义（t＝0．52、0．56、0．15,均P＞0．05）;治疗后终止妊娠（7．7％）、胎盘早剥（0．0％）、胎儿窘迫（5．1％）、新生儿窒息发生率（7．7％）、产后出血（12．8％）、低体质量儿（12．8％）均显著低于对照组（33．3％、12．8％、20．5％、25．6％、33．3％、35．9％）（χ^2=7．86、5．34、4.13、4．52、4．62、5．64,均P＜0．05）;观察组治疗后总有效率94．9％,明显高于对照组的79．5％（χ^2=4．13,P＜0.05）;观察组不良反应的发生率15．4％,明显低于对照组的35．9％（χ^2=4．30,P＜0．05）。结论拉贝洛尔联合硫酸镁治疗中重度妊娠期高血压疾病效果满意,能有效降低平均血压,减少24 h尿蛋白含量,改善母婴结局,值得临床推广应用。     

右美托咪定与拉贝洛尔在治疗颈丛神经阻滞颈部手术中不良心血管反应的临床比较

目的观察右美托咪定与拉贝洛尔在治疗颈丛神经阻滞颈部手术中不良心血管反应的效果差异。方法选择2009年5月～2013年5月本院采用颈丛神经阻滞麻醉行颈部手术患者100例,随机分成右美托咪定组（D组）和拉贝洛尔组（L组）,每组各50例。D组患者在颈丛神经阻滞后辅助应用右美托咪定,维持血流动力学;L组在颈丛神经阻滞后辅助应用拉贝洛尔。观察两组患者并发症的发生情况。结果D组的并发症发生率（14．0％）显著低于L组（34．O％）（P〈0．05）。D组能很好地维持术中血流动力学稳定,且患者感觉舒适,能很好地耐受手术体位;L组血流动力学有所波动,且患者难以耐受手术体位,需加用镇静剂才可完成手术。结论在颈丛神经阻滞下行颈部手术时,使用右美托咪定能很好地维持术中血流动力学稳定,且患者能很好地耐受手术体位。     

拉贝洛尔和尼卡地平治疗主动脉夹层时高血压的疗效比较

目的:评估静脉应用拉贝洛尔或尼卡地平治疗主动脉夹层时高血压的疗效及安全性。方法:60例主动脉夹层伴高血压者随机接受拉贝洛尔或尼卡地平治疗。结果:治疗10min平均动脉压下降10%~15%者,拉贝洛尔组为38%,尼卡地平组为45%(P>0.05);30min后血压控制在120/80mmHg以下者,拉贝洛尔组为93%,尼卡地平组为90%(P>0.05);治疗后10min平均心率下降拉贝洛尔组((77±7)次.min-1)较尼卡地平组((83±10)次.min-1)明显(P<0.05)。结论:拉贝洛尔或尼卡地平均可有效控制主动脉夹层时血压,拉贝洛尔单独静脉使用较尼卡地平单用更适合此临床急症。