de Spirlet Marina, Treluyer Jean-Marc, Chevret Sylvie, Rey Elisabeth, Tournaire Michel, Cabrol Dominique, Pons Gérard
Pharmacologie Clinique, Groupe hospitalier Cochin Saint-Vincent-de-Paul (AP-HP), Université Paris V, Paris, France.
Fundam Clin Pharmacol. 2004 Apr;18(2):207-13. doi: 10.1111/j.1472-8206.2003.00231.x.
Currently available tocolytic agents have shown partial or transient efficacy on uterine contractions delaying delivery for 24 or 48 h without reduction in perinatal morbidity and mortality. These facts led us to study a new tocolytic compound. A double-blind dose finding study of the nitroglycerin tocolytic effect during preterm labor was conducted using a continual reassessment method among six different doses (0.2-1.2 mg/h for 2 h) in pregnant women who were unresponsive, intolerant to salbutamol, or with a contraindication to this therapy. Twenty-five pregnant women were included. The probability of success in stopping uterine contractions reached, for the maximal dose (1.2 mg/h), only a 54% rate (95% CI: 29-79%). Twelve patients complained of headaches and 16 experienced a decrease in arterial blood pressure suggesting that it would not be safe to increase the dose in order to obtain a higher success rate. The present study suggests that nitroglycerin is not as effective as expected in controlling uterine contractions during severe preterm labor in patients where beta2 agonists cannot be used.
目前可用的宫缩抑制剂已显示出对子宫收缩有部分或短暂的疗效，可将分娩延迟24或48小时，但围产期发病率和死亡率并未降低。这些事实促使我们研究一种新的宫缩抑制化合物。采用连续重新评估法，对无法使用沙丁胺醇、对其不耐受或有该疗法禁忌证的孕妇，在六种不同剂量（0.2 - 1.2毫克/小时，持续2小时）下进行了一项关于早产期间硝酸甘油宫缩抑制作用的双盲剂量探索研究。纳入了25名孕妇。对于最大剂量（1.2毫克/小时），停止子宫收缩成功的概率仅达到54%（95%置信区间：29 - 79%）。12名患者抱怨头痛，16名患者出现动脉血压下降，这表明为了获得更高的成功率而增加剂量是不安全的。本研究表明，在无法使用β2激动剂的患者中，硝酸甘油在控制严重早产期间的子宫收缩方面不如预期有效。
