van Dijk K G, Dekker G A, van Geijn H P
Department of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands.
J Perinat Med. 1995;23(5):409-15.
The effectiveness of the tocolytic agent and other betamimetic drugs in the treatment of preterm labor remains controversial. Effectiveness or efficancy of ritodrine has not yet convincingly been proven. A major concern are the marked side effects of beta-mimetics. The calcium channel blocker nifedipine has been used for tocolysis shortly after its introduction in clinical practice and is considered to be a probable good alternative for ritodrine. The efficacy of nifedipine versus ritodrine in the treatment of preterm labor was assessed in a retrospective study. 32 patients received intravenous ritodrine and 29 oral nifedipine. As endpoints were used: postponement of delivery, maternal side effects and perinatal outcome. The results of this retrospective study suggest that nifedipine is more successful in postponing delivery than ritodrine. Maternal side effects seemed to occur more frequently and be more serious in patients treated with ritodrine as compared to nifedipine. Perinatal outcome seemed better in the nifedipine group than in the ritodrine group. The promising data from small prospective studies and the results of this retrospective study warrant further large prospective studies on the definitive place of nifedipine in the treatment of premature labor. Until the results of such a trial are available we advocate the use of nifedipine in case of preterm labor, especially in a patient with diabetes mellitus, ruptured membranes, cardiac disease or multiple pregnancy, in order to avoid the characteristic side effects of beta-mimetics.
宫缩抑制剂及其他β-拟交感神经药物在治疗早产方面的有效性仍存在争议。利托君的有效性尚未得到令人信服的证实。β-拟交感神经药物的显著副作用是一个主要问题。钙通道阻滞剂硝苯地平在临床应用后不久就被用于抑制宫缩，被认为可能是利托君的一个很好的替代品。一项回顾性研究评估了硝苯地平与利托君在治疗早产方面的疗效。32例患者接受静脉注射利托君，29例患者口服硝苯地平。使用的终点指标包括：分娩延迟、母体副作用和围产期结局。这项回顾性研究的结果表明，硝苯地平在延迟分娩方面比利托君更成功。与硝苯地平相比，接受利托君治疗的患者母体副作用似乎更频繁且更严重。硝苯地平组的围产期结局似乎比利托君组更好。小型前瞻性研究的有前景的数据以及这项回顾性研究的结果，使得有必要对硝苯地平在治疗早产中的明确地位进行进一步的大型前瞻性研究。在获得此类试验结果之前，我们主张在早产情况下使用硝苯地平，尤其是对于患有糖尿病、胎膜破裂、心脏病或多胎妊娠的患者，以避免β-拟交感神经药物的典型副作用。
