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钙通道阻滞剂在产科中的应用与安全性。

Use and safety of calcium channel blockers in obstetrics.

作者信息

Tranquilli Andrea L, Giannubilo Stefano R

机构信息

Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.

出版信息

Curr Med Chem. 2009;16(26):3330-40. doi: 10.2174/092986709789057699.

DOI:10.2174/092986709789057699
PMID:19548865
Abstract

Calcium-Channel Blockers (CCBs), or calcium antagonists, are a heterogeneous group of drugs that produce cardiovascular effects by preventing the influx of calcium ions through L-type voltage-dependent calcium channels in specialized electrical system and conduction tissue cells, like myocardial and vascular smooth muscle cells. In recent years, CCBs have found their way in obstetrics and gynecology, especially in the management of hypertensive disorders of pregnancy and preterm labor. The lack of adequate data had created uncertainty about the safety of CCBs in pregnancy. Teratogenicity with these agents has been demonstrated in animals, but no cases of possible human malformation or deformity have been reported. Data from human studies suggest that CCBs may cause a clinically insignificant fall in maternal mean arterial pressure, but have little to no effect on uterine perfusion. In many countries, CCBs remain unlicensed for use in pregnancy and it is unlikely the manufacturers will ever apply for this status to change. We do believe that this is the situation of CCBs for those critical second- and third-trimester conditions such as Gestational hypertension, Preeclampsia, HELLP syndrome and preterm labor.

摘要

钙通道阻滞剂(CCBs),即钙拮抗剂,是一类异质性药物,它们通过阻止钙离子经特殊电系统和传导组织细胞(如心肌和血管平滑肌细胞)中的L型电压依赖性钙通道内流来产生心血管效应。近年来,CCBs已应用于妇产科领域,尤其是在妊娠高血压疾病和早产的管理中。由于缺乏足够的数据,CCBs在孕期的安全性存在不确定性。这些药物在动物实验中已证实具有致畸性,但尚未有人类可能出现畸形或发育异常的病例报告。人体研究数据表明,CCBs可能会使母体平均动脉压出现临床上无显著意义的下降,但对子宫灌注几乎没有影响。在许多国家,CCBs仍未获批用于孕期,而且制造商也不太可能申请改变这种状况。我们确实认为,对于妊娠中期和晚期的一些关键情况,如妊娠期高血压、子痫前期、HELLP综合征和早产,CCBs的情况就是如此。

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