普萘洛尔在甲状腺功能亢进症孕产妇中的应用

甲状腺功能亢进症(甲亢)和妊娠同时存在的病例临床并不少见,这类孕妇的药物治疗中,普萘洛尔的适应证和禁忌证大多教科书常常没有提及,因此值得讨论.少数文献报道该药可增加自然流产几率,并可致胎儿宫内发育迟缓、心动过缓、出生后呼吸窘迫等异常.相关动物试验显示,普萘洛尔可减缓心率,且对胎肺β受体的阻滞可能导致胎儿出生后呼吸窘迫.大部分学者认为,在常规剂量下,该药没有临床致畸性,应用于妊娠期是相对安全的.也有专家认为,普萘洛尔应尽量短期使用以减少其可能的副作用,如在抗甲状腺药物起效之前的数周以及甲状腺危象时应用.胎儿在出生以后因药物在体内重新分布导致血浆药物浓度升高,建议产前减少药物用量.而在哺乳期,婴儿经乳汁摄取的药物极少,治疗剂量的产妇哺乳是安全的.另外,普萘洛尔还可安全地用于保守治疗难以控制的妊娠剧吐.

Application of propranolol in women with hyperthyroidism during pregnancy and lactation

Physicians often encounter patients with both hyperthyroidism and pregnancy in clinical practice. Proper treatment will help a lot for both mother and fetus. However, whether propranolol could be applied routinely in the medical therapy other than antithyroid drugs is not regularly mentioned in text book, because there were few literatures reporting its side effects including miscarrage, intrauterine growth retardation, bradycardia, respiratory depression, hypoglycemia, and hyperbilirubinemia. Animal experiments revealed bradycardia after propranolol administration, and respiratory depression after birth due to blockage of β receptors in the lungs. Nevertheless, this drug has been considered safe in pregnant hyperthyroid women according to long-term experience, as no malformation has been demonstrated in the offsprings, and it helps a lot in hyperemesis gravidarum as well. Specialists also recommend short-term use like a few weeks before antithyroid drugs set in action and during thyroid storm, in order to avoid potential side effects. It is suggested that less than routine-dose of the drug be administered before labor, as the plasma drug concentration in the neonate would elevate after birth. As for lactating mother, it's safe to take regular dose of the drug because only extremely low dose will be taken by the neonate through milk.