Räsänen J, Jouppila P
Department of Obstetrics and Gynecology, University of Oulu, Finland.
Eur J Obstet Gynecol Reprod Biol. 1995 Oct;62(2):195-201. doi: 10.1016/0301-2115(95)02197-f.
To evaluate the short-term effects of intravenously given atenolol and pindolol on utero- and umbilicoplacental vascular impedance, fetal hemodynamics and cardiac function in patients suffering from pregnancy-induced hypertension.
A total of 24 women were randomized to receive atenolol or pindolol infusion. By using pulsed color Doppler techniques, uterine, placental arcuate, umbilical fetal middle cerebral and renal arteries were examined before, at the end and 30 min after the end of infusion. Pulsatility indices (PI) were calculated to assess vascular impedance. Fetal myocardial function was evaluated by using pulsed Doppler and M-mode echocardiography. Peak systolic velocities from the ascending aorta and pulmonary trunk, and also inner diameters and fractional shortenings of both ventricles were measured.
Both drugs significantly decreased maternal blood pressure. Immediately after the infusion, maternal heart rate was significantly decreased in both groups; but the decrease was clearer and lasted longer in the atenolol group. Pindolol caused no changes in utero- or umbilicoplacental vascular impedance, while atenolol increased it in the nonplacental uterine artery. After atenolol infusion, PI in the umbilical artery was higher than after pindolol. Pindolol had no effects on fetal hemodynamics, while atenolol decreased PI value in the fetal renal artery. Peak systolic velocity in the pulmonary trunk was decreased after atenolol. Pindolol did not affect the fetal cardiac function. In subgroups with originally increased utero- or umbilicoplacental vascular impedance, the responses in uterine and umbilical vascular impedance and in fetal hemodynamics and cardiac function after atenolol and pindolol were different compared to whole groups.
Differently acting antihypertensive agents seem to affect differently uteroplacental vascular impedance. Atenolol may have some direct effects on fetal hemodynamics and cardiac function. According to our results, pindolol seems to be more preferable in the treatment of pregnancy-induced hypertension than atenolol.
评估静脉注射阿替洛尔和吲哚洛尔对妊娠高血压患者子宫及脐胎盘血管阻抗、胎儿血流动力学和心功能的短期影响。
总共24名女性被随机分为接受阿替洛尔或吲哚洛尔输注。采用脉冲彩色多普勒技术，在输注前、结束时及结束后30分钟检查子宫、胎盘弓状动脉、脐动脉、胎儿大脑中动脉和肾动脉。计算搏动指数（PI）以评估血管阻抗。使用脉冲多普勒和M型超声心动图评估胎儿心肌功能。测量升主动脉和肺动脉干的收缩期峰值速度，以及两个心室的内径和缩短分数。
两种药物均显著降低母体血压。输注后即刻，两组母体心率均显著降低；但阿替洛尔组的降低更明显且持续时间更长。吲哚洛尔对子宫或脐胎盘血管阻抗无影响，而阿替洛尔使非胎盘子宫动脉的血管阻抗增加。阿替洛尔输注后，脐动脉的PI高于吲哚洛尔输注后。吲哚洛尔对胎儿血流动力学无影响，而阿替洛尔降低了胎儿肾动脉的PI值。阿替洛尔输注后肺动脉干的收缩期峰值速度降低。吲哚洛尔不影响胎儿心功能。在子宫或脐胎盘血管阻抗最初升高的亚组中，与整个组相比，阿替洛尔和吲哚洛尔后子宫和脐血管阻抗以及胎儿血流动力学和心功能的反应不同。
作用不同的抗高血压药物似乎对子宫胎盘血管阻抗有不同影响。阿替洛尔可能对胎儿血流动力学和心功能有一些直接影响。根据我们的结果，在妊娠高血压的治疗中，吲哚洛尔似乎比阿替洛尔更可取。
