Allbert J R, Wise C A, Lou C H, Gookin K S, Parmenter M A, Morrison J C
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
J Perinatol. 1992 Mar;12(1):28-31.
Patients with multiple gestations or recalcitrant preterm labor are at very high risk for preterm birth in spite of adequate tocolysis. Subcutaneous infusion of tocolytic medications on an ambulatory basis has been used in several small series and has effectively prolonged gestation. This retrospective analysis presents data from 992 patients at very high risk for preterm delivery who were prescribed this therapy. The amount of tocolytic medication was individualized by utilizing the patient's volume of distribution and clearance. Pharmacists adjusted the dosage based on uterine activity strips received by nursing personnel. The average basal rate was .073 +/- .020 mg/h. Patients received an average of seven scheduled boluses per day and 1.54 +/- .93 unscheduled boluses per week (.25 +/- .03 mg each). The therapy extended the gestation a mean of 38 +/- 23 days and average gestational age at delivery was 36.3 +/- 2.6 weeks with a mean birthweight of 2759 +/- 681 g. This study, utilizing a large number of patients, confirms earlier reports that for women at very high risk for preterm delivery subcutaneous tocolytic infusion therapy is beneficial. Prospective studies evaluating such treatment on a randomized basis are indicated.
尽管进行了充分的宫缩抑制治疗，但多胎妊娠或顽固性早产患者发生早产的风险仍然非常高。门诊皮下输注宫缩抑制药物已在几个小系列研究中使用，并有效地延长了孕周。这项回顾性分析呈现了992例早产风险极高且接受该治疗的患者的数据。宫缩抑制药物的用量根据患者的分布容积和清除率进行个体化调整。药剂师根据护理人员收到的子宫活动监测条调整剂量。平均基础速率为0.073±0.020毫克/小时。患者平均每天接受7次预定推注，每周接受1.54±0.93次非预定推注（每次0.25±0.03毫克）。该治疗使孕周平均延长38±23天，平均分娩孕周为36.3±2.6周，平均出生体重为2759±681克。这项纳入大量患者的研究证实了早期报告，即对于早产风险极高的女性，皮下宫缩抑制药物输注治疗是有益的。需要进行前瞻性随机研究来评估这种治疗方法。
