Rozenberg P
Département d'Obstétrique et Gynécologie, Centre Hospitalier Poissy-Saint-Germain, rue du Champ-Gaillard, 78303 Poissy Cedex.
J Gynecol Obstet Biol Reprod (Paris). 2001 May;30(3):221-30.
Use of beta-sympatomimetics for threatening preterm delivery: a critical review. Preterm birth is the principal cause of perinatal and neonatal mortality and morbidity. Over the past 40 years, numerous treatments have been tested and used to try to inhibit preterm labor. This literature review is limited to the published studies of beta-adrenergic agonists (beta-sympathomimetics). Among 36 articles that have examined the treatment of acute phase preterm labor by intravenous beta-sympathomimetic administration, 26 are clinical studies with severe biases that make them unacceptable for analysis: non-randomized clinical trials, retrospective studies or retrospective control groups, inadequate recording of pregnancy outcome, exclusion of patients after randomization, confounding factors due to the use of multiple therapeutic agents, inadequate study power.Of the 10 acceptable placebo-controlled trials, seven, including the largest (the Canadian Preterm Labor Investigators' Group, with 708 women), found that beta-sympathomimetics were not better than placebo in prolonging pregnancy or reducing neonatal morbidity. Only three studies found that they were superior to placebo. These agents cause numerous maternal side effects that may be life-threatening, because beta-adrenergic receptors are present in many organs. The cardiovascular system is the most severely affected, but side effects also concern the pancreas, kidneys, intestines, and liver. beta-Sympathomimetics cross the placenta rapidly. Fetuses probably respond in the same way their mothers do to stimulation of their beta-adrenergic receptors. Nonetheless, data from the controlled clinical trials show no difference in neonatal mortality or severe morbidity between children born to mothers treated with beta-sympathomimetics and those born to mothers in control groups. The efficacy of preventive treatment by oral or subcutaneous administration of beta-sympathomimetics has also been assessed: a meta-analysis and 2 large randomized placebo-controlled trials have showed that oral maintenance treatment offers no advantages over placebo during the latency phase or for the recurrence rate of preterm labor and the rate of preterm delivery. A single - and smaller - placebo-controlled study found that oral maintenance treatment with ritodrine was beneficial. Treatment trials of subcutaneous administration of beta-sympathomimetics have been performed with a portable subcutaneous pump. Ten studies of this method have been reported, but only two were randomized trials. They found no significant difference in either the mean time until delivery or neonatal morbidity.
β-拟交感神经药用于治疗先兆早产：一项批判性综述。早产是围产期和新生儿死亡及发病的主要原因。在过去40年里，人们测试并使用了多种治疗方法来试图抑制早产。本综述仅限于已发表的关于β-肾上腺素能激动剂（β-拟交感神经药）的研究。在36篇研究静脉注射β-拟交感神经药治疗急性期早产的文章中，26篇是存在严重偏倚的临床研究，使其无法用于分析：非随机临床试验、回顾性研究或回顾性对照组、妊娠结局记录不充分、随机分组后排除患者、使用多种治疗药物导致的混杂因素、研究效能不足。在10项可接受的安慰剂对照试验中，7项（包括规模最大的一项，加拿大早产研究组，涉及708名女性）发现，β-拟交感神经药在延长孕周或降低新生儿发病率方面并不优于安慰剂。只有3项研究发现它们优于安慰剂。这些药物会引发众多可能危及生命的母体副作用，因为β-肾上腺素能受体存在于许多器官中。心血管系统受影响最为严重，但副作用也涉及胰腺、肾脏、肠道和肝脏。β-拟交感神经药能迅速穿过胎盘。胎儿对其β-肾上腺素能受体受到刺激的反应可能与母亲相同。尽管如此，对照临床试验的数据显示，接受β-拟交感神经药治疗的母亲所生子女与对照组母亲所生子女在新生儿死亡率或严重发病率方面并无差异。口服或皮下注射β-拟交感神经药进行预防性治疗的疗效也已得到评估：一项荟萃分析和2项大型随机安慰剂对照试验表明，口服维持治疗在潜伏期或早产复发率及早产发生率方面并不比安慰剂更具优势。一项规模较小的单一安慰剂对照研究发现，用利托君进行口服维持治疗是有益的。已使用便携式皮下泵进行了皮下注射β-拟交感神经药的治疗试验。已报道了10项关于该方法的研究，但只有2项是随机试验。他们发现，在平均分娩时间或新生儿发病率方面均无显著差异。
