硝酸甘油用于妊娠高血压综合征治疗的研究

目的探讨硝酸甘油在妊娠高血压综合征（妊高征）治疗中的应用价值及其可行性。方法选择中、重度妊高征患者34例；其中单纯用硫酸镁治疗11例（硫酸镁组），单纯用硝酸甘油治疗11例（硝酸甘油组），硫酸镁+硝酸甘油联合用药治疗12例（联合用药组）。另选取正常晚期妊娠妇女11例(正常妊娠组)作对照。采用免疫组织化学及图像分析仪测定以上4组产妇胎盘的内皮型一氧化氮合酶（eNOS）含量，血小板聚集仪检测血小板聚集率，彩色多普勒超声检测应用硝酸甘油后脐动脉收缩期及舒张期（S/D）比值和阻力指数，并记录各组应用药物后的血压变化。结果（1）胎盘eNOS含量硫酸镁组为0.24±0.07，硝酸甘油组为0.25±0.08，联合用药组为0.26±0.07，正常妊娠组为0.35±0.08。妊高征各组与正常妊娠组比较，差异均有极显著性(P<0.01)。（2）硝酸甘油组用药后，脐动脉S/D比值及阻力指数较用药前明显降低，用药前后比较，差异有显著性(P<0.05)。（3）血小板聚集率硝酸甘油组、联合用药组用药后明显降低，用药前后比较，差异有极显著性(P<0.01)；硫酸镁组则无明显改变。（4）降压作用硫酸镁组用药后,血压变化不明显；硝酸甘油组及联合用药组，用药后血压降低，用药前后比较，差异有显著性(P<0.05)。结论硝酸甘油有抑制血小板聚集、降低胎儿-胎盘循环阻力及降低血压的作用。能改善妊高征患者的病理状态，从而对妊高征引起的胎儿宫内生长迟缓有治疗作用。

Therapeutic effects of nitroglycerin on pregnancy induced hypertension

OBJECTIVE: To evaluate the effects and possibility of nitroglycerin on Pregnancy induced hypertension (PIH) treatment. METHODS: In comparison with the third trimester normal pregnant women (Normal group) (n = 11), 34 moderate/severe PIH cases were divided into three groups: PIH treated only with magnesium sulfate (Mg group) (n = 11); PIH treated only with nitroglycerin (Ng group) (n = 11); and PIH treated with Mg + Ng (Combination group) (n = 12). The endothelial nitric oxide synthase (eNOS) in placenta was investigated immunohistochemically and quantitatively. Data such as platelet aggregation (PAg), umbilical artery of S/D ratio and resistance index (RI) with color Doppler and the effect of decrement of blood pressure on PHI groups were evaluated. RESULTS: In comparision with Normal group, (1) the quantity of eNOS of PIH cases was significantly lower (P < 0.01). (2) umbilical artery S/D ratio and RI in Ng group were significantly lower after introvascular drip of Ng (P < 0.05). (3) Pag in Ng group and Combination group decreased significantly after treatment (P < 0.01), but no difference in Mg group. (4) the decrement of blood pressure on PIH groups, compared with Mg group, was significant in Ng group and Combination groups (P < 0.05). CONCLUSIONS: Ng can reduce blood pressure, fetal-placenta circulation resistance, and inhibit PAg. It probably play a role on intrauterine growth retardation (IUGR) caused by PIH.