盐酸利托君在先兆早产合并糖代谢异常孕妇中的应用

<正>治疗早产的目的是抑制子宫收缩,延长孕龄以赢得促胎肺成熟的时间,改善围产儿预后。妊娠期糖代谢异常合并先兆早产或早产的患者,更需要赢得时间使用糖皮质激素促胎肺成熟。盐酸利托君(ritodrine hydrochloride,中文商品名安宝,英文商品名Anpo)抑制子宫收缩的同时有升高血糖的作用,因此当妊娠期糖代谢异常孕妇出现先兆早产症状时,使用安宝会升高血糖,影响妊娠预后。本文回顾性分析了2007年1月至2009年12月我院收治的妊娠期糖代谢异常合并先兆早产使用安宝保胎21     

盐酸利托君联合烯丙雌醇治疗先兆早产的效果评价

目的:探讨盐酸利托君联合烯丙雌醇治疗先兆早产的临床疗效。方法:选取在郑州大学第三附属医院住院治疗的先兆早产孕妇367例,随机分为28~31+6周对照组(对照组A1组)83例和治疗组(治疗组B1组)91例、32~33+6周对照组(对照组A2组)92例和治疗组(治疗组B2组)101例。对照组A组均采用静滴利托君治疗,治疗组B组均采用静滴利托君联合口服烯丙雌醇治疗48h后继续口服烯丙雌醇,分析对照组和治疗组的用药效果、不良反应及围产儿结局。结果:(1)妊娠时间延长48h和7d的有效率及平均延长妊娠时间:治疗组B1组高于对照组A1组,治疗组B2组高于治疗组B1和对照组A2组,差异均有统计学意义(P0.05),对照组A1组与A2组差异无统计学意义(P0.05)。(2)A、B两组孕妇用药过程中所出现的不良反应比较,差异无统计学意义(P0.05)。(3)平均分娩孕周及新生儿平均出生体重:治疗组B1组高于对照组A1组、治疗组B2组高于对照组A2组,差异均有统计学意义(P0.05);早产率、低出生体重儿的发生率:治疗组B1组低于对照组A1组、治疗组B2组低于对照组A2组,差异均有统计学意义(P0.05);新生儿RDS(NRDS)、颅内出血等的发病率:治疗组B1组低于对照组A1组,治疗组B2组低于治疗组B1组,差异均有统计学意义(P0.05);各组的坏死性小肠结肠炎、新生儿败血症的发病率及新生儿死亡率比较,差异均无统计学意义(P0.05)。结论:先兆早产孕妇应用盐酸利托君联合烯丙雌醇治疗48h后继续口服烯丙雌醇的临床疗效及围产儿结局均优于单独应用盐酸利托君;≥32孕周的先兆早产孕妇联合用药效果更显著,且不增加孕妇的不良发应。     

盐酸利托君联合硝苯地平在防治先兆早产中的临床应用分析

目的 探究盐酸利托君联合硝苯地平在防治先兆早产中的临床效果。方法 选取33例先兆早产患者,采用计算机随机分为对照组（16例）与研究组（17例）。对照组患者给予盐酸利托君治疗,研究组患者在对照组基础上给予硝苯地平治疗。比较两组患者分娩结局、不良情绪、不良反应发生情况及满意度。结果 研究组患者分娩孕周长于对照组,保胎成功率、新生儿出生体质量均明显高于对照组,差异有统计学意义（P<0.05）。治疗后研究组患者焦虑自评量表（SAS）、抑郁自评量表（SDS）评分明显低于对照组,差异有统计学意义（P<0.05）。研究组患者不良反应发生率5.88%明显低于对照组的37.50%,差异有统计学意义（P<0.05）。研究组患者满意度明显高于对照组,差异有统计学意义（P<0.05）。结论 盐酸利托君联合硝苯地平在防治先兆早产中,能够有效改善分娩结局,降低不良反应发生率,缓解不良情绪,提升满意度,具有较高的推广价值。     

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

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(...     

刍议盐酸利托君与硫酸镁在中央前置胎盘期待治疗中的疗效分析

目的：研究盐酸利托君与硫酸镁在中央型前置胎盘期待治疗中的临床治疗效果。方法：选取18例在我院就诊的进行期待治疗的中央型前置胎盘患者,分为盐酸利托君组（对照组）和硫酸镁组（实验组）,每组各9例进行治疗。结果：对照组患者各项指标均明显优于实验组;两组不良反应发生率相比无明显差异。结论：盐酸利托君组在治疗前置胎盘方面安全有效,值得推广。     

先兆早产的治疗

确因宫缩所引起的先兆早产应行药物治疗，宫缩抑制剂主要有β2－兴奋剂，MgSO4及消炎痛。β2－兴奋剂可使心律增快，母体左侧卧位后能够缓解。单独用MgSO4每日必须12g以上。如有感染特征角需加用抗生素。     

盐酸利托君、间苯三酚用于孕20周后先兆流产的保胎效果对比研究CSCD

目的 探讨盐酸利托君、间苯三酚应用于孕20周后先兆流产的临床效果。方法 选取孕20周后先兆流产患者122例为研究对象,随机分为A组(盐酸利托君)和B组(间苯三酚)各61例。比较两组临床指标、妊娠结局、新生儿结局、药物不良反应,对比治疗前、治疗1周后患者血清性激素、流产预后评估指标的变化。结果 A组起效时间、症状消失时间均显著低于B组,用药后平均心率、心悸发生率均显著高于B组(P均<0.05),组间流产率、分娩孕周、新生儿体重、新生儿结局差异均无统计学意义(P>0.05)。治疗1周后,两组患者血清血清性激素显著高于治疗前,且A组高于B组(P均<0.05);两组患者流产预后评估指标显著低于治疗前(P <0.05),两组组间比较差异无统计学意义(P>0.05)。结论 盐酸利托君药物起效快,但副作用较间苯三酚突出,建议孕20周后先兆流产患者根据自身情况在医嘱下选择合适的用药方案。     

醋酸阿托西班治疗晚期流产及早产的疗效观察

目的：探讨醋酸阿托西班治疗晚期流产及早产的疗效。方法：对应用盐酸利托君注射液后子宫收缩不能被抑制或不能耐受药物不良反应的50例患者,改用醋酸阿托西班进行治疗,观察其疗效、药物不良反应及妊娠结局。结果：43例患者宫缩被抑制,7例未被抑制。50例患者均已分娩,其中足月分娩30例,晚期流产或早产20例,新生儿存活32例,死亡18例。妊娠时间延长4 d～12周。结论：醋酸阿托西班能有效抑制宫缩,且无明显不良反应。     

椎管内麻醉联合盐酸利托君对臀位外倒转术效果分析

目的 探讨采取椎管内麻醉联合静脉推注盐酸利托君注射液应用于臀位外倒转术的效果及对母儿妊娠结局的影响.方法 回顾性分析2015年1月至2020年12月在首都医科大学附属北京妇产医院行臀位外倒转术的孕37 ～40周单胎孕妇的临床资料,分为药物组(101例)和对照组(261例).两组均在椎管内麻醉后超声监测下行外倒转术,药物...     

Effect of Intravenous Tocolytics on Uteroplacental and Fetoplacental Doppler Flow Velocity Waveforms

The vasodilatory effects of ritodrine hydrochloride and magnesium sulfate (MgSO₄) were investigated by analyzing fetoplacental and uteroplacental Doppler flow velocity waveforms (FVWs) obtained from pregnant women about to undergo external version for abnormal fetal lie. These healthy women were chosen for study because they were known to have uncomplicated pregnancies at 37-38 weeks gestation by a reliable last menstrual period and confirming ultrasound. Twenty patients were studied with continuous wave Doppler ultrasound immediately prior to and at least 30 min after intravenous infusion of 100 μ.g/min of ritodrine, and 20 patients were studied before and after the administration of a 6 g intravenous bolus of MgSO₄. No statistically significant alterations of maternal or fetal FVW systolic to diastolic (S/D) ratios were detected after administration of either ritodrine or MgSO₄. We conclude that the intravenous infusion of 100 μ.g/min of ritodrine hydrochloride or 6 g of MgSO₄ in normal healthy women at term has no effect on impedance to placental perfusion as measured by Doppler ultrasound.     

The use of ritodrine and magnesium sulfate in the arrest of premature labor

Sixty-seven cases of premature labor (48 with unruptured and 19 with ruptured membranes) were treated with ritodrine or magnesium sulfate infusion supplemented with oral ritodrine in case of initial success. Both treatment regimens were found effective irrespective of maternal age, parity, ethnic background and number of previous abortions. The study supports the clinical experience indicating that early administration of tocolytic agents is highly successful in arresting premature labor and preventing its dire consequences.     

利托君抑制宫缩时孕妇心率变化的初步研究

目的探讨利托君抑制宫缩时孕妇心率的变化与治疗的关系。方法选择先兆早产孕妇110例。将利托君100mg加入5％葡萄糖溶液500mL中静脉滴注,从6滴(每分钟)开始,根据疗效调整药物剂量,待宫缩消失后维持40～48小时或更长,以后改口服,病情反复者可重复用药。比较用药前后孕妇心率的变化及与药物剂量的关系,并分析分娩时间、胎儿重量和Apgar评分等指标。结果孕妇基础心率与孕周之间呈较典型的先升后降的变化趋势。静滴利托君至宫缩停止时,孕妇心率明显增加(P＜0.01),但不同孕周之间的心率无显著差异(P＞0.05)。随着利托君用药剂量的增加,孕妇心率呈剂量依赖性升高,最高峰不超过140/min。用药后孕妇分娩时间明显延长(P＜0.01),其中单纯先兆早产者延长最多(P＜0.05)。胎儿平均体重(2.42±0.49)kg,平均Apgar评分≥8分。结论在抑制宫缩治疗中利托君介导的孕妇心率增加可作为评价药物疗效的指标之一。     

The effects of ritodrine and magnesium sulfate on maternal and fetal Doppler blood flow patterns in women with preterm labor

Objective

To determine the effects of ritodrine and magnesium sulfate on maternal-fetal blood flows.

Study design

A total of 85 pregnant women between 26th and 36th weeks with preterm labor, and 83 healthy pregnant women were included. Patients in the study group were randomly assigned to receive either ritodrine (with the addition of verapamil) (n = 46) or magnesium sulfate (n = 39). Blood flow examinations on the umbilical artery (UA), middle cerebral artery (MCA), bilateral uterine arteries (Ut.A) and ductus venosus (DV) were performed before and 48 h after initiating therapy.

Results

UA pulsatility index (PI) significantly differed in women receiving tocolysis compared to controls after 48 h. DV PI increased in women receiving MgSO₄, whereas it decreased in the ritodrine and control groups. Ut.A values did not significantly change after 48 h in the groups.In women between the 26th and 32nd weeks, UA, MCA and DV PI did not significantly change after 48 h in the three groups. However, in women between the 32nd and 36th weeks UA and MCA PI significantly differed in the treatment groups compared to controls after 48 h. DV PI increased in women receiving MgSO₄, whereas it decreased in the ritodrine and control groups.

Conclusions

MgSO₄ and ritodrine affect blood flow patterns after 48 h in some maternal-fetal vessels. These effects on blood flow are particularly significant in women between 32nd and 36th weeks. The effects of both drugs on fetal and maternal Doppler flows seem similar, except the increased resistance to flow in DV in women receiving MgSO₄.     

利托君对孕妇心脏储备功能影响的临床监测分析

目的:探讨利托君抑制宫缩时对孕妇心脏储备功能的影响.方法:2010年3～9月收治入重庆医科大学附属第一医院的符合先兆早产诊断的孕妇51例(用药组)与正常孕妇50例(对照组)作为研究对象.采用心音信号处理技术检测两组孕妇心脏储备功能各项指标,包括心率、第一心音幅值与第二心音幅值(S1/S2)比值、舒张期时限与收缩期时限(D/S)比值.用药组孕妇在用药前以及用药后5分钟、0.5小时、1小时、4小时、24小时各测量1次以上指标,然后隔日测量1次直到停止用药,数据取其均值.对照组只测量1次.比较用药前后及正常孕妇的血压和心脏储备功能指标的变化与用药时间的关系.结果:①用药组用药后孕妇的舒张压显著低于用药前和对照组,差异有统计学意义(P＜0.05);用药组用药后孕妇的心率和S1/S2比值均显著高于用药前和对照组,D/S比值显著低于用药前和对照组,差异均有高度统计学意义(P＜0.01).②利托君使用过程中孕妇的心率与S1/S2比值呈正相关(r=0.466,P＜0.05),与D/S比值呈负相关(r=-0.680,P＜0.01),当孕妇心率＞120/min时,D/S比值≤1.0的发生率为74.51％,孕妇心率≥140/min者有4例,D/S比值均≤0.8.③用药组用药24小时使用过程中孕妇心率的增加值随用药时间逐渐增大,并于用药后4小时达到最高值,用药后24小时心率增加值基本稳定.结论:利托君应用过程中随着孕妇心率的增加,心脏储备功能下降,应给予严密监测,以防发生妊娠不良结局.     

早产相关因素及早产儿结局临床分析

目的探讨早产发生的高危因素及早产对围生儿的影响。方法选取2001年1月1日-2007年6月30日在我院分娩的早产儿508例作为病例组，并随机选取同期足月分娩产妇508例作为对照组，比较两组产妇的相关情况，围产儿结局，分析早产的高危因素。结果早产儿窒息、RDS发生率及死亡率与足月儿相比差异显著；孕周越小，发病率及死亡率越高。胎膜早破、胎位异常、胎盘因素是造成早产的高危因素。应用地塞米松与未应用者相比，足量应用地塞米松与未足量应用者相比，新生儿并发症发生率、早产儿死亡率均明显降低。孕35周后早产患者，延长孕周并不能降低早产儿并发症发生率及死亡率。结论早产的发生是多种因素的结果。孕周越小，早产儿发病率及死亡率越高。应用糖皮质激素是改善早产儿结局的重要治疗措施。35～36^＋6周PPROM者建议在破膜48h内分娩，以减少早产儿并发症。     

Association between the use of magnesium sulfate as neuroprotector in prematurity and the neonatal hemodynamic effects

Purpose: Cerebral palsy is often associated with prematurity and magnesium sulfate (MgSO₄) has been used as a neuroprotector, with favorable results. However, its mechanism of action has not been fully elucidated. This study aimed to evaluate the association between MgSO₄ at the imminent premature delivery and neonatal hemodynamic effects.

Materials and methods: A cross-sectional study involving 94 newborns (NB) between 24 and 32?weeks at a Brazilian hospital was performed. Bivariate analysis between the use or the non-use of MgSO₄ and hemodynamic characteristics was performed, using the Chi-square test.

Results: NB were evaluated between those who received MgSO₄ (27.7) and those who did not (72.3%). Normal heart rate was verified in 62.8% of NB, normal respiratory rate in 70.2%, and normal temperature in 22.3%. Oxygen saturation higher or equal than 95% was evidenced in 85.1% of NB, normal hemoglucotest in 74.5%, and hemoglobin greater or equal than 16.4?g/dL in 30.9%. Non-invasive ventilation was performed in 48.9% of NB, while 51.1% were submitted to endotracheal ventilation. There was no significance relation detected between the use of MgSO₄ and the hemodynamic characteristics.

Conclusions: MgSO₄ does not appear to influence hemodynamic factors as a cause of the neuroprotection in premature NB.     

孕母产前应用硫酸镁与早产儿动脉导管未闭的关系

目的 探讨孕母产前应用硫酸镁与早产儿动脉导管未闭(patent ductus arteriosus,PDA)的关系.方法 应用1∶1配对的病例对照研究方法,对2008年1月至2009年12月在我院新生儿科住院的93例确诊PDA的早产儿(PDA组)和93例胎龄和超声心动图检测时间匹配的动脉导管已关闭的早产儿(对照组)进行回顾性分析,收集孕母产前应用硫酸镁情况及新生儿资料.采用单因素分析、多因素Logistic回归分析等方法进行统计学分析.结果 PDA组孕母产前应用硫酸镁51例,而对照组中孕母产前应用硫酸镁34例.PDA组患儿血清镁中位浓度及百分位间距(P25～P75)为0.98 mmol/L(0.92～1.32 mmol/L),高于对照组[0.90 mmol/L(0.82～1.09)mmol/L],差异有统计学意义(Z=3.56,P=0.00).Logistic回归分析表明孕母产前应用硫酸镁(OR=2.646,95%CI:1.356～5.163,P=0.004)、胎儿窘迫(OR=7.189,95%CI:1.209～42.756,P=0.030);早产儿出生体重(OR=1.842,95%CI:1.087～3.438,P=0.049)、呼吸衰竭(OR=3.499,95%CI:1.256～9.752,P=0.017)和吸氧(OR=0.482,95%CI:0.233～0.999,P=0.045)与早产儿PDA的发生有关.而且趋势卡方检验显示,孕母产前应用硫酸镁累积量、血清镁水平与早产儿PDA呈正相关,具有剂 量效应关系(x2趋势=7.41,P=0.007;x2趋势=12.13,P=0.000).结论 孕母产前应用硫酸镁可能增加早产儿发生PDA的风险,且硫酸镁累积量、早产儿血清镁水平越高,早产儿发生PDA的风险越大.     

Aggressive tocolysis does not prolong pregnancy or reduce neonatal morbidity after preterm premature rupture of the membranes

OBJECTIVE: This study was undertaken to evaluate whether aggressive tocolysis improves pregnancy outcome after preterm premature rupture of the membranes (PPROM). STUDY DESIGN: Retrospective case-control study of patients with PPROM before 34 weeks of gestation, followed by a prospective cohort study with historical controls. The retrospective phase covered 1995 through 1999 when we used tocolysis aggressively. With the use of survival analysis, we compared latency in our cases with 4 published control series in which tocolysis was never used. On the basis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective evaluation of this new protocol. RESULTS: In the retrospective phase, tocolysis was used in 94% of 130 cases and maintained during 84% of 1162 total antenatal patient-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospective study, 43% of 63 patients received tocolytics, but these were used at lower doses and were given during only 7% of 770 patient-days. Latency with this very limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive tocolysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. CONCLUSION: Aggressive tocolysis after PPROM causes significant maternal morbidity, but does not increase latency or decrease neonatal morbidity compared with either very limited tocolysis or no tocolysis at all.