拉贝洛尔片与硝苯地平缓释片对妊娠期高血压患者血压、血浆同型半胱氨酸水平及脐动脉血流动力学的影响:基于无创血流动力学监测的妊娠期高血压精准控压策略初探  

Impact on Blood Pressure,Plasma Homocysteine Level and Hemodynamics of Umbilical Artery between Labetalol Tablets and Nifedipine Sustained-release Tablets in Patients with Pregnancy-induced Hypertension:the Precise Blood Pressure Control Strategy for Pregnancy-induced Hypertension Based on Non-invasive Hemodynamic Monitoring

作　　者：王晓君 夏剑清 侯洁 张烈民 王平[1] 苏勇 吴文娜 黄大健 徐丹[1] 成慧娟 薛艳 徐志平 周晓阳[3] WANG Xiaojun;XIA Jianqing;HOU Jie;ZHANG Liemin;WANG Ping;SU Yong;WU Wenna;HUANG Dajian;XU Dan;CHENG Huijuan;XUE Yan;XU Zhiping;ZHOU Xiaoyang(Department of Internal Medicine,Women and Children's Hospital of Hubei Province/Maternal and Child Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430070,China;Xinzhou District Branch of Wuhan Central Hospital,Wuhan 430400,China;Department of Cardiovascular Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]湖北省妇女儿童医院华中科技大学同济医学院附属湖北妇幼保健院内科,湖北省武汉市430070 [2]湖北省武汉市中心医院新洲区分院,430400 [3]武汉大学人民医院心血管内科,湖北省武汉市430060

出　　处：《实用心脑肺血管病杂志》2020年第4期62-69,共8页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金资助项目(81370337,81970331)。

摘　　要：背景合理控制血压并不能有效降低妊娠期高血压(PIH)患者子痫前期发生风险,而控制PIH患者血压的同时最大限度地增加脐动脉血流直接关系到母婴结局,因此探讨PIH患者精准控压策略具有重要现实意义。目的对比拉贝洛尔片与硝苯地平缓释片对PIH患者血压、血浆同型半胱氨酸(Hcy)水平、脐动脉血流动力学的影响,以初步探索基于无创血流动力学监测的PIH精准控压策略。方法选取湖北省妇女儿童医院内科及武汉市中心医院新洲区分院内科门诊2015年6月—2019年3月收治的PIH患者120例,采用SPSS 16.0统计学软件完全随机化设计分组法分为A组和B组,每组60例;另选取同期在湖北省妇女儿童医院进行产检及分娩的健康孕妇60例作为对照组。本研究启动降压治疗的血压阈值为≥150/100 mm Hg(1 mm Hg=0.133 kPa),以治疗后血压控制在130~140/80~90 mm Hg为达标。A组患者口服拉贝洛尔片,B组患者口服硝苯地平缓释片;两组患者均连续治疗4周。比较三组受试者入组次日及A组与B组患者治疗后收缩压(SBP)、舒张压(DBP)、血浆Hcy水平及脐动脉收缩末期血流速度/舒张末期血流速度比值(S/D)、时间平均流速(VM)、搏动指数(PI)、阻力指数(RI),并比较A组与B组患者治疗2、3、4周血压达标率,母婴结局,治疗期间药物不良反应发生情况;入组次日血浆Hcy水平与PIH患者脐动脉血流动力学指标的相关性分析采用Pearson相关分析。结果B组2例患者因药物不良反应不能耐受而未按规定完成4周治疗。A组、B组患者入组次日SBP、DBP、血浆Hcy水平及脐动脉S/D、PI、RI高于对照组,脐动脉VM慢于对照组(P<0.01),而A组与B组患者入组次日SBP、DBP、血浆Hcy水平及脐动脉S/D、VM、PI、RI比较,差异无统计学意义(P>0.05);B组患者治疗后SBP、DBP、血浆Hcy水平及脐动脉S/D、PI、RI高于A组,脐动脉VM慢于A组(P<0.05)。Pearson相关分析结果显示,入组次日Background Reasonable control of blood pressure can not effectively reduce the risk of preeclampsia in patients with pregnancy-induced hypertension(PIH),however reasonable control of blood pressure and simultaneously increasing the umbilical artery blood flow to the utmost extent are directly related to maternal and child outcomes in patients with PIH,thus it is of great practical significance to discuss the precise blood pressure control strategy for PIH.Objective To compare the impact on blood pressure,plasma homocysteine level and hemodynamics of umbilical artery between labetalol tablets and nifedipine sustained-release tablets in patients with PIH,to tentatively explore the precise blood pressure control strategy for PIH based on non-invasive hemodynamic monitoring.Methods From June 2015 to March 2019,a total of 120 patients with PIH were selected in the General Clinics of Women and Children's Hospital of Hubei Province and Xinzhou District Branch of Wuhan Central Hospital,and they were divided into A group and B group according to completely randomized design grouping method by using SPSS 16.0 statistical software,with 60 cases in each group;meanwhile 60 healthy pregnant women admitted to Women and Children's Hospital of Hubei Province for antenatal care and childbirth were selected as control group.Taking≥150/100 mm Hg as the blood pressure threshold of initiating antihypertensive therapy and 130~140/80~90 mm Hg as blood pressure control up to standard,patients in A group received oral labetalol tablets,while patients in B group received nifedipine sustained-release tablets;both groups continuously treated for 4 weeks.SBP,DBP,plasma Hcy level as well as S/D,VM,PI and RI of umbilical artery were compared in the three groups the day after grouping,between A group and B group after treatment;rate of blood pressure control up to standard 2,3,4 weeks after treatment,maternal and child outcomes and incidence of adverse reactions were compared between A group and B group;Pearson correlation analysis was used to

关 键 词：高血压 妊娠性 拉贝洛尔 硝苯地平 血压 半胱氨酸 脐动脉 血流动力学 对比研究 

分 类 号：R714.246[医药卫生—妇产科学]