Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Am J Perinatol. 2011 Jan;28(1):57-66. doi: 10.1055/s-0030-1262512. Epub 2010 Jul 16.
Preterm birth continues to be the leading cause of perinatal morbidity and mortality. A wide range of tocolytics have been utilized for the management of preterm labor. Calcium channel blockers, namely nifedipine, gained popularity as tocolytics due to the oral route of administration, availability of immediate- and slow-release preparations, the low incidence of maternal adverse effects associated with their use, and the fact that they are inexpensive. This article reviews the available literature on the clinical utility of calcium channel blockers for acute and maintenance tocolysis with special emphasis on potential adverse effects, the most appropriate dose/regimen, and contemporary practice patterns among obstetricians. There are no randomized, placebo-controlled studies demonstrating the benefit of nifedipine in preterm labor. A suggested tocolytic protocol would be to start with the lowest dose of oral immediate-release nifedipine. For the first 48 hours thereafter, all attempts should be made not to exceed 60-mg daily doses.
早产仍是围产期发病率和死亡率的主要原因。广泛使用了多种保胎药物来治疗早产。钙通道阻滞剂，即硝苯地平，因其可口服、有速释和缓控释制剂、与使用相关的母体不良反应发生率低、且价格低廉，而作为保胎药物广受欢迎。本文综述了钙通道阻滞剂在急性和维持性保胎中的临床应用，特别强调了潜在的不良反应、最合适的剂量/方案，以及产科医生的当代实践模式。没有随机、安慰剂对照研究证明硝苯地平在早产中的益处。建议的保胎方案是从最低剂量的口服硝苯地平速释片开始。此后的 48 小时内，应尽量不超过 60mg/天的剂量。
