Scardo J A, Vermillion S T, Hogg B B, Newman R B
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425-2233, USA.
Am J Obstet Gynecol. 1996 Aug;175(2):336-8; discussion 338-40. doi: 10.1016/s0002-9378(96)70143-6.
Our purpose was to evaluate the hemodynamic effects of oral nifedipine in preeclamptic hypertensive emergencies.
A prospective observational study of the hemodynamic effects of oral nifedipine was conducted with severely preeclamptic patients receiving magnesium sulfate infusion during a hypertensive emergency. Patients were eligible for the study if systolic blood pressure was > or = 170 m Hg or the diastolic blood pressure was > or = 105 mm Hg on repeat measurements 15 minutes apart at > or = 24 weeks' gestation. Nifedipine was given with an initial dose of 10 mg orally followed by 20 mg orally every 20 minutes until systolic blood pressure was > 160 mm Hg and the diastolic blood pressure was < 100 mm Hg, or for a total of five doses. Patients were hemodynamically monitored in the lateral recumbent position by thoracic electrical bioimpedance before during, and after oral nifedipine dosing. Cardiac index, systemic vascular resistance index, mean arterial pressure, heart rate, and stroke index were all recorded at baseline and during treatment. Data were analyzed by analysis of variance for repeated measures (alpha 0.05) and paired t tests, baseline versus 15 minutes (alpha 0.01).
Ten severely preeclamptic patients at 33.2 +/- 3.0 (mean +/- SD) weeks' gestation were enrolled in the study. Mean arterial pressure measurements taken at baseline, 0.25, 0.5, 1, and 4 hours were 133 +/- 10, 119 +/- 8, 109 +/- 8 89 +/- 12, and 100 +/- 13 mm Hg (mean +/- SD, p < 0.0001, analysis of variance repeated measures). Cardiac index increased over time (p = 0.0011, analysis of variance repeated measures). There was no significant effect on maternal heart rate or stroke index. No periodic fetal heart rate changes were noted. One patient had nausea.
Oral nifedipine appears to be an effective antihypertensive agent in preeclamptic hypertensive emergencies. A steady decrease in mean arterial pressure, systemic vascular resistance, and a mirrored increase in cardiac index are noted.
我们的目的是评估口服硝苯地平对先兆子痫高血压急症的血流动力学影响。
对在高血压急症期间接受硫酸镁输注的重度先兆子痫患者进行口服硝苯地平血流动力学影响的前瞻性观察研究。如果在妊娠≥24周时，间隔15分钟重复测量的收缩压≥170mmHg或舒张压≥105mmHg，则患者符合研究条件。硝苯地平初始剂量为口服10mg，随后每20分钟口服20mg，直至收缩压>160mmHg且舒张压<100mmHg，或总共服用五剂。在口服硝苯地平给药前、给药期间和给药后，通过胸部电阻抗在侧卧位对患者进行血流动力学监测。在基线和治疗期间记录心脏指数、全身血管阻力指数、平均动脉压、心率和每搏指数。数据通过重复测量方差分析（α=0.05）和配对t检验进行分析，基线与15分钟时的数据比较（α=0.01）。
10例妊娠33.2±3.0（均值±标准差）周的重度先兆子痫患者纳入研究。在基线、0.25、0.5、1和4小时测量的平均动脉压分别为133±10、119±8、109±8、89±12和100±13mmHg（均值±标准差，p<0.0001，重复测量方差分析）。心脏指数随时间增加（p=0.0011，重复测量方差分析）。对母体心率或每搏指数无显著影响。未观察到周期性胎儿心率变化。1例患者出现恶心。
口服硝苯地平似乎是先兆子痫高血压急症的有效降压药物。观察到平均动脉压、全身血管阻力稳步下降，心脏指数呈镜像增加。
