Pryde P G, Besinger R E, Gianopoulos J G, Mittendorf R
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, USA.
Semin Perinatol. 2001 Oct;25(5):316-40. doi: 10.1053/sper.2001.27547.
In addition to questions raised about the efficacy of many tocolytics, appropriate concern has been voiced about the safety of these potent drugs. Although some degree of risk for adverse effects with drugs promising a strong therapeutic effect can be accepted, caution needs to be exercised when benefits are marginal or unproven. Unfortunately, some of the tocolytics, most notably the betamimetics and magnesium sulfate, have been found to have considerable potential for adverse maternal cardiovascular and respiratory effects. Although less clearly established, the use of indomethacin appears to be associated with increased fetal and neonatal risks. Concerning magnesium sulfate, in addition to the well-known maternal effects, the accumulating evidence showing an increased frequency of adverse outcomes in the fetus and neonate has led to the recommendations to abandon its use entirely as a tocolytic. Given the limitations of our current state of knowledge, nifedipine would appear to be among the more efficacious and safer tocolytics available to use when properly indicated.
除了对许多宫缩抑制剂的疗效提出疑问外，人们也对这些强效药物的安全性表示了适当的关注。尽管对于具有强大治疗效果的药物，一定程度的不良反应风险是可以接受的，但当益处微乎其微或未经证实时，仍需谨慎行事。不幸的是，一些宫缩抑制剂，最显著的是β-拟交感神经药和硫酸镁，已被发现有相当大的潜在母体心血管和呼吸系统不良影响。虽然吲哚美辛的影响不太明确，但使用吲哚美辛似乎与胎儿和新生儿风险增加有关。关于硫酸镁，除了众所周知的母体影响外，越来越多的证据表明胎儿和新生儿不良结局的发生率增加，这导致了完全放弃将其用作宫缩抑制剂的建议。鉴于我们目前知识水平的局限性，硝苯地平在正确使用时似乎是可用的更有效、更安全的宫缩抑制剂之一。
