阿托西班在晚期流产和早产治疗中的临床价值

目的 探讨缩宫素受体拮抗剂--阿托西班在晚期流产和早产治疗中的临床价值.方法 对应用B2受体激动剂--利托君、硫酸镁后子宫收缩仍不能被抑制、产程仍然进展、或出现不良反应的35例晚期流产和早产患者,应用阿托西班短期用药方案进行治疗,观察阿托西班抑制宫缩的疗效、药物不良反应和妊娠结局.结果 应用阿托西班48 h时抑制宫缩的有效率为77%(27/35),7 d时抑制宫缩的有效率为60%(21/35).1例(3%)出现轻微恶心和呕吐反应.35例患者中分娩34例,1例双胎妊娠在随访中.34例已分娩患者中,孕周＜28周分娩11例,28～34周分娩17例,＞34周分娩3例,足月分娩3例.应用阿托西班后妊娠时间最短延长4 h,最长延长14周+2.新生儿存活34例,死亡9例(孕周均＜28周),34个存活新生儿中发生新生儿呼吸窘迫综合征14例.结论 对早产或晚期流产患者应用利托君、硫酸镁治疗无效或出现不良反应时,阿托西班仍有明显延长妊娠时间的作用,且患者的妊娠结局良好.

Clinical experience of using oxytocin antagonist atosiban in the rescue therapy of preterm labour

OBJECTIVE: To investigate the effectiveness of oxytocin antagonist atosiban in the alternative rescue therapy of preterm labor. METHODS: Alternative tocolysis atosiban was given as rescue therapy to 35 women, who had received ritodrine or magnesium sulphate but failed, due to either progression of labour or intolerable adverse events. Atosiban was administered for up to 48 hours. Efficacy and tolerability were assessed based on the proportion of women who did not deliver and did not need alternative tocolytic therapy at 48 hours and 7 days after therapy initiation. The numbers of maternal adverse events and neonatal morbidity were also assessed. RESULTS: Efficacy and tolerability at 48 hours and 7 days after atosiban initiation were 77% (27/35) and 60% (21/35). One woman presented drug-related side effects with mild nausea and vomiting. Thirty-four women have delivered and one bigemina (28 weeks) is being followed-up. In 34 women, 11 delivered before 28 gestational weeks, 17 delivered after 28 gestational weeks, 3 delivered after 34 weeks and 3 had term delivery. Pregnancies were prolonged by 4 hours to 14(+2) weeks. There were nine neonatal deaths, with gestational ages less than 28 weeks at delivery. CONCLUSION: Oxytocin antagonist atosiban could be given as alternative rescue therapy if therapy with ritodrine or magnesium sulphate fails in the treatment of preterm labor, and it is safe and effective.