Chau A C, Gabert H A, Miller J M
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, New Orleans.
Obstet Gynecol. 1992 Nov;80(5):847-51.
To compare the tocolytic efficacy and side effects of parenteral and oral magnesium and terbutaline.
Ninety-eight patients in labor between 23-35 weeks were prospectively entered into a controlled trial of intravenous and oral magnesium versus subcutaneous and oral terbutaline. Tocolytic effectiveness was judged by delay of delivery for 48 hours or 1 week, and to 37 weeks or more. The need to change therapy to the alternate drug was identified, as were side effects. Entrance characteristics of the population, initial pelvic examination, and concomitant infection or cervicovaginal isolates were noted. Outcomes included gestational age at delivery, birth weights, and Apgar scores. Outcome analysis was based on initial tocolytic therapy.
Significantly more patients in the magnesium group delivered at 37 weeks or more: 34 of 46 versus 27 of 52 (P < .05). No significant differences were found for delivery by 48 hours or 1 week. The interval between treatment and delivery was greater for magnesium: 7.1 +/- 3.9 versus 5.0 +/- 3.2 weeks (P < .005). Failure to achieve 37 completed weeks was more often due to obstetric complications than to preterm labor itself. Tocolytic effectiveness was reduced if secondary therapy or re-treatment was required or if the patient had cervical dilatation of 3 cm or greater. Infectious complications were common but were not associated with tocolytic effectiveness. Side effects were more noticeable with oral magnesium and subcutaneous terbutaline.
For short-term tocolysis, no significant difference was found between magnesium and terbutaline. Magnesium was associated with a higher term delivery rate. Idiopathic preterm labor accounted for only a small part of the overall prematurity in the study population.
比较胃肠外及口服镁剂与特布他林的保胎疗效及副作用。
前瞻性纳入98例孕23 - 35周的分娩患者，进行静脉及口服镁剂与皮下及口服特布他林的对照试验。通过分娩延迟48小时或1周、延迟至37周或更久来判断保胎效果。确定更换为替代药物治疗的必要性以及副作用情况。记录研究人群的入院特征、首次骨盆检查结果以及合并感染情况或宫颈阴道分离菌情况。结局指标包括分娩时的孕周、出生体重及阿氏评分。结局分析基于初始保胎治疗。
镁剂组中在37周或更久分娩的患者显著更多：46例中有34例，而52例中有27例（P < 0.05）。在分娩延迟48小时或1周方面未发现显著差异。镁剂治疗至分娩的间隔时间更长：7.1 ± 3.9周对比5.0 ± 3.2周（P < 0.005）。未能达到37足周更多是由于产科并发症而非早产本身。如果需要二次治疗或再次治疗，或者患者宫颈扩张达3厘米或更大，则保胎效果会降低。感染并发症很常见，但与保胎效果无关。口服镁剂和皮下注射特布他林的副作用更明显。
对于短期保胎，镁剂与特布他林之间未发现显著差异。镁剂与更高的足月分娩率相关。特发性早产在研究人群的总体早产中仅占一小部分。
