沐舒坦和地塞米松对未足月胎膜早破产前预防NRDS的对照研究  

Effect of antenatal Ambroxol versus Dexamethasone on NRDS prevention in PPROM

作　　者：周健[1] 段涛[1] 严晓玲[1] 

机构地区：[1]上海市第一妇婴保健院,200040

出　　处：《中华围产医学杂志》2006年第3期157-160,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的 对照沐舒坦和地塞米松在未足月胎膜早破（preterm premature rupture of membranes，PPROM）产前预防新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS）的作用，以及对母儿感染的影响。方法 应用前瞻性研究的方法将2003年2月至2004年8月间入院的孕28～34周的PPROM孕妇分为两组。沐舒坦治疗组36例，予1g沐舒坦稀释在500ml 5％的葡萄糖溶液中静脉点滴4h；地塞米松组（40例），予地塞米松10mg稀释在25％葡萄糖溶液20ml中静脉推注，QD×3次。比较用药后两组新生儿NRDS的发生情况以及宫内感染率、新生儿感染率。结果 1．两组孕妇平均年龄、胎膜早破时平均孕龄、破膜到分娩的平均时间比较无统计学差异。沐舒坦组有可耐受的恶心、呕吐和心动过速等副作用。2．沐舒坦组新生儿NRDS的发病率为5．1％，和地塞米松组（14．3％）无统计学差异（P〉0．05）。3．沐舒坦组孕妇临床绒毛膜羊膜炎及组织学绒毛膜羊膜炎发病率分别为5.6％和58．3％，均低于地塞米松组（分别为27．5％和82．5％）（P〈0．05）。4．地塞米松组新生儿感染率为16．7％，沐舒坦组未发现新生儿感染（P〈0．05）。结论 和地塞米松相比，沐舒坦产前用于PPROM预防NRDS的效果相似，其不良反应较轻微，且临床和组织学绒毛膜羊膜炎的发生率较低，新生儿感染率较低，故推荐可在PPROM中将其作为糖皮质激素的替代药物。Objective To compare the effects of antenatal ambroxol and dexamethasone on NRDS （neonatal respiratory distress syndrome） prevention, IAI （intraamnionic infection） and neonatal infection in pregnancy preterm premature rupture of membrane（PPROM）. Methods A prospective study was conducted between Feb. 2003 and Aug. 2004. Pregnant women with PPROM happened between 28th and 34th week of gestation were divided into two groups. The women in the ambroxol group （36 cases） were given 1 g ambroxol intravenously, which was added into 500 ml 5%GS, Q12 hr×4, and those in the dexamethasone group （40 cases） were given dexamethasone 10 mg intravenously, which was added into 20 ml 25 %GS, QD× 3. The incidence of NRDS, IAI and neonatal infection in these two groups was compared. Results 1. The average maternal age, gestational age at PPROM and the period between PPROM and delivery showed no difference between the two groups. Mild and torelable side effects like nausea, vomit and tachycardia were mentioned in those women in the ambroxol group. 2. No significant differene was shown in the rate of NRDS ambroxol （5. 1%）and dexamethasone（14.3%） between the （P〈0.05）. 3. The morbidity of clinical and histological chorioamnionitis in ambroxol group （5.6% and 58.3%, respectively） was significantly lower than that in dexamethasone group （27.5 % and 82.5 %,respectively, P〈0.05）. 4. Neonatal infection was found in 7 cases in the dexamethasone group （16.7%）, while none in the ambroxol group（P〈0.05）. Conclusions When compared to dexamethasone, the effect of antenatal ambroxol on NRDS prevetion in PPROM is similar without any severe side effects. The incidences of clinical and histological chorioamnionitis, neonatal infection after ambroxol treatment is lower than that of dexamethasone. So we recommend ambroxol as asubstitute of corticosteroid therapy in PPROM.

关 键 词：沐舒坦 糖皮质激素 早产胎膜早破 绒毛膜羊膜炎 新生儿呼吸窘迫综合征 

分 类 号：R714.4[医药卫生—妇产科学]