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(...     

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     

常见宫缩抑制剂的临床应用

在先兆早产的治疗中,及时有效的使用宫缩抑制剂是最重要的治疗手段。临床上常用的宫缩抑制剂包括：β2肾上腺素能受体激动剂、钙离子通道阻滞剂、缩宫素受体拮抗剂、前列腺素合成酶抑制剂和硫酸镁。但每种宫缩抑制剂的作用效果及临床特点各不相同,文章汇总了几种常用的宫缩抑制剂在治疗先兆早产方面的研究进展进行阐述。     

消炎痛用于早产宫缩抑制治疗的争议

消炎痛抑制前列腺素合成,属非甾体抗炎药类宫缩抑制剂,许多安慰剂对照试验认为其有效并延迟分娩＞48 h,近期一些观察性研究揭示,其增加新生儿脑室内出血和坏死性小肠结肠炎发生率.由于方法学上的错误这些观察研究的结论应谨慎对待,最近的一项决策性分析支持其危险性及益处并存,消炎痛在早产的应用研究应进行精心设计的前瞻性临床试验.     

常用宫缩抑制药物对胎儿的影响

多数宫缩抑制药物并非专门用于抑制自发性早产。各种宫缩抑制药物对母体多种器官都有一定的副反应,但对于胎儿一般是安全的。β2-肾上腺素受体激动剂、缩宫素受体拮抗剂和钙通道阻滞剂对于胎儿相对安全;硫酸镁对早期早产儿的神经保护作用已经得到肯定,长期大量硫酸镁宫内暴露,可能导致胎儿及新生儿骨质减少和骨折;妊娠晚期应用前列腺素合成酶抑制剂对胎儿和新生儿有潜在的副反应,妊娠中期相对安全;阴道应用孕酮对胎儿影响轻微。     

孕妇产心率变异性与妊娠期心功能变化的关系

目的 探讨心率变异性（ＨＲＶ）对妊娠合并器质性心脏病患者发生心功能衰竭的预测价值。方法 对６１例妊娠合并器质性心脏病患者,分别于妊娠２８￣３２周及分娩后７天进行动态心电图及心率变异性的测定。结果 ９例患者发生心功能衰竭,以未发生心功能衰竭者作为对照进行比较,发现心功能衰竭患者心率变异性时域指标明显下降,差异有显著性（Ｐ〈０．０５）。分娩后７天,当心功能衰竭患者一般状况得到改善后,心率变异性标准均值     

消炎痛用于早产宫缩抑制治疗的争议

消炎痛抑制前列腺素合成，属非甾体抗炎药类宫缩抑制剂，许多安慰剂对照试验认为其有效并延迟分娩＞48h，近期一些观察性研究揭示，其增加新生儿脑室内出血和坏死性小肠结肠炎发生率。由于方法学上的错误这些观察研究的结论应谨慎对待，最近的一项决策性分析支持其危险性及益处并存，消炎痛在早产的应用研究应进行精心设计的前瞻性临床试验。     

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。     

孕妇心率变异性与妊娠期心功能变化的关系

目的探讨心率变异性（ＨＲＶ）对妊娠合并器质性心脏病患者发生心功能衰竭的预测价值。方法对６１例妊娠合并器质性心脏病患者，分别于妊娠２８～３２周及分娩后７天进行动态心电图及心率变异性的测定。结果９例患者发生心功能衰竭，以未发生心功能衰竭者作为对照进行比较，发现心功能衰竭患者心率变异性时域指标明显下降，差异有显著性（Ｐ＜０．０５）。分娩后７天，当心功能衰竭患者一般状况得到改善后，心率变异性标准差均值、平均Ｒ－Ｒ间期标准差之标准差值上升（Ｐ＜０．０５）。结论心率变异性对判断心脏储备力，预测妊娠期心功能衰竭的发生具有一定的价值     

盐酸利托君治疗20例先兆早产的疗效观察

目的:观察盐酸利托君治疗先兆早产的疗效。方法:随机选取2010年1月至12月先兆早产孕妇20例应用盐酸利托君为观察组,随机选取2010年1月至12月早产孕妇20例应用25%硫酸镁为对照组。结果:盐酸利托君控制子宫收缩和延长孕周的效果明显好于硫酸镁,且显效时间短。结论:盐酸利托君是治疗先兆早产的安全有效的药物。     

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.     

孕妇血浆纤维结合蛋白变化预测胎膜早破早产的临床研究

目的　探讨孕妇血浆纤维结合蛋白 (fibronectin ,FN)的变化及对妊娠结局的影响。方法　 2 0 0 1年 12月至 2 0 0 2年 12月采用酶联免疫固相吸附法测定 110例妊娠 2 0～ 2 8周妇女FN值 ,并观察妊娠结局。结果　胎膜早破、早产组FN明显低于对照组 (P <0 0 1) ,宫内感染、产褥感染发生率明显高于对照组 (P <0 0 0 1)。结论　FN水平降低 ,可作为预测胎膜早破发生、早产及提示感染的早期监测指标     

Treatment of premature labor contractions with combined ritodrine and indomethacine

The results of combined ritodrine and indomethacine treatment (RI) in premature labor contractions were compared with ritodrine alone (R). One hundred and twenty patients with threatened premature labor in weeks 26-34 were studied. Sixty RI women received 100 mg ritodrine in infusion followed by 60 mg daily orally until 35 weeks and indomethacine 200 mg on the first day of treatment only. The R group included 60 women with identical tocolysis indices, age of pregnancy and anamnestic parameters who received ritodrine only. The mean prolongation index (PI) was 18.2 in the RI group, against 11.5 in the R patients (P less than 0.05). The mean prolongation of pregnancy was 5.6 weeks in the first and 3.6 in the control group (P less than 0.05). Birthweight and Apgar scores were similar in the two groups. In order to examine the possible early closure of the ductus arteriosus due to the indomethacin therapy, echocardiograms were done on all newborn in the RI group: the pre-ejection period and right ventricular ejection time ratio was 0.19-0.26 after delivery and 0.17-0.22 1 month later, which excludes pulmonary diastolic hypertension due to premature closure of the duct. The combined RI treatment is more effective that R alone and does not give rise to any complications in the mother or the fetus.     

Nifedipine versus ritodrine for suppression of preterm labor. Comparison of their efficacy and secondary effects

OBJECTIVES: To compare the efficacy of nifedipine and ritodrine in prolonging pregnancy beyond 48 h, 1 week and 36.0 weeks and to evaluate maternal side effects and adverse perinatal outcome. STUDY DESIGN: Non-blinded, randomized controlled trial. Eighty patients with singleton pregnancies admitted for preterm labor with intact membranes between 22 and 35 weeks of gestation were included in the study. Preterm labor was defined as the persistence of at least two symptomatic uterine contractions within a 10 min period during 60 min after admission and despite bed rest. RESULTS: Forty women received oral nifedipine and forty intravenous ritodrine. Two patients, one from each group, were excluded because of loss to follow-up after discharge. Therefore, 39 women in the nifedipine and the ritodrine groups, respectively, were evaluable for the final analysis. Baseline characteristics were comparable in both groups. The percentage of initial response, the speed of onset of action and the rate of successful treatment within 48 h were significantly better in the ritodrine group. However, prolongation of pregnancy beyond 7 days and 36 weeks of pregnancy was similar with a significantly lower rate of side effects in the nifedipine group. CONCLUSIONS: In this small trial, ritodrine provided more effective tocolysis within the first 48 h than nifedipine at the doses used in this study, although with a significantly higher rate of side effects.     

Social support during premature labor: effects on labor and the newborn

Prematurity is the single most frequent abnormality associated with birth, and is associated with both neonatal deaths and developmental deficits. In uncomplicated labors at term, the presence of a supportive companion has been found to lead to reduced length of labor, reduced need for medication for pain management, and improved neonatal well being. The relationships have not been explored in premature labor. Women in premature labor between 26 and 37 weeks of gestation were randomly assigned to a control group (n = 11) or to a supported group (n = 14), who were accompanied during labor by a supportive companion. Support during labor was associated with fewer abnormally long labors, less frequent use of medication for pain management during labor, and improved neonatal wellbeing.     

第一产程异常胎心监护图形与新生儿结局的关系

目的　探讨第一产程异常胎心监护图形与新生儿结局的关系。方法　回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果　第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论　第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 ,其他图形可在严密监护下继续试产     

The effect of diazepam administration during pregnancy or labor on the heart rate variability of the newborn infant

Maternal diazepam medication during labor reduces beat-to-beat variability of the fetal heart rate. In this study, the prolongation of the effect was examined in the newborn. The mother received diazepam: (A) during labor as a tranquillizer, (B) daily in low doses at the end of pregnancy, or (C) in high doses i.v. for (pre-)eclampsia. A control group had no analgesic or sedative during pregnancy or labor. The electrocardiogram (ECG) was recorded daily from each newborn during the first 6 days after birth. After preprocessing of the ECG, the median R-R interval, the long-term irregularity index (LTI index) and the interval difference index (ID index) were calculated. A cubic spline interpolation method was applied to compare the various groups with respect to these heart rate parameters. The median R-R interval showed no particular differences in trend for all groups. The LTI index was decreased in the first days after birth in the chronic diazepam (B), and in the diazepam infusion groups (C), but statistical significance was not reached. The ID index was significantly decreased in the first 1–2 days in the newborns of the acute and chronic diazepam group. In the diazepam infusion group, an even longer-lasting effect was observed. Maternal diazepam medication affects the beat-to-beat variability in the newborn. The duration of the effect is dependent on dosage and route of administration.     

第二产程胎心监护异常的处理及临床意义

目的 探讨第二产程胎心监护异常者的分娩方式,及其与产妇并发症和围产儿结局的关系。方法 回顾性分析我院足月单胎头位分娩产妇第二产程中胎心率（FHR）正常的111例（对照组）和胎心率异常的121例（观察组）的资料。结果 FHR异常的发生率为52.2%（121／232）,异常胎心率类型包知中、重度变异减速（VD）81例,占66.9%;晚期减速（LD）27例,占22.3%,其中仅1例发生连续LD;延长减速（PD）4例,占3.3%;VD合并LD2例,占1.7%;VD合并PD3例,占2.5%;基线变异减弱4例,占3.3%。对照组中,阴道助产13例（11.7%）,顺产98例（88.3%）;观察组中,顺产86例（71.1%）,阴道助产35例（28.9%）,其中29例（82.9%）为FHR异常而施术者,两组间比较,差异有显著性（P＜0.05）。观察组、对照组新生儿窒息的发生率（分别为5.0%、1.8%）及产伤的发生率（14.3%、15.4%）比较,差异均无显著性（P＞0.05）;观察组中有1例产妇会阴Ⅲ度撕伤。结论 第二产程中FHR异常的发生率高,多为产程中胎头受压或脐带受压而引起的迷走神经反射或暂时性子宫胎盘血流减少,并非缺氧所致,不必急于干预,以免造成母、儿损伤。