目的 探讨硫酸镁联合拉贝洛尔或硝苯地平治疗子痫前期的疗效.方法 选取2013年1月至2017年1月于本院确诊并接受治疗的186例子痫前期患者为研究对象,按治疗方式将入选患者分为A组(硫酸镁联合拉贝洛尔,101例)和B组(硫酸镁联合硝苯地平,85例).比较两组患者临床疗效、平均动脉压(mean arterial pressure,MAP)、24小时尿蛋白定量(24 hour urine protein value, 24hrUprV)、肾功能指标[血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)及尿酸(uric acid,UA)]、凝血功能指标[凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activited partial thomboplastin time,APTT)、纤维蛋白原(Fibrinogen,Fib)、凝血酶时间(thrombin time,TT)、血清D-二聚体]及分娩结局.结果 两组患者治疗总有效率比较无显著差异(P>0.05).两组中的重度前期子痫患者治疗总有效率比较差异具有显著性(P<0.05).两组患者治疗后MAP、24hrUprV、BUN、Cr及UA水平均显著低于治疗前(P<0.05),两组患者治疗后上述指标组间比较均无显著差异(P>0.05).治疗后两组患者PT、APTT、TT较治疗前均显著延长(P<0.05),血浆Fib和D-二聚体水平均显著低于治疗前(P<0.05).治疗后两组患者PT、APTT、TT、血浆Fib及D-二聚体水平均无显著差异(P>0.05).两组宫内窘迫、新生儿窒息、终止妊娠、剖宫产、早产儿占比均无显著差异(P>0.05);B组宫缩乏力和产后出血发生率均显著高于A组(P<0.05),围生儿死亡率低于A组(P<0.05).结论 硫酸镁联合拉贝洛尔或硝苯地平治疗子痫前期,总体疗效、肾功能及凝血功能改善方面并无显著差异.硝苯地平有可能增加产妇术后宫缩乏力、产后出血的发生风险,但其可降低围生儿死亡率,值得进一步研究.
Objective To explore the therapeutic effect of Magnesium sulfate combined with Labetalol or Nifedipine on preeclampsia. Method 186 cases of preeclampsia patients who were diagnosed and treated in our department from January 2013 to January 2017 were included in this study and divided into group A (Magnesium sulfatecombined with Labetalol, 101 cases) and group B (Magnesium sulfate combined with Nifedipine, 85 cases). The effective rate, mean arterial pressure (MAP), 24 hour urine protein value (24hrUprV), kidney function [blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA)], coagulation function [prothrombin time (PT), activited partial thomboplastin time (APTT), Fibrinogen (Fib), thrombin time (TT), D-dimers] and delivery outcome between the two groups were compared. Result There was no significance between the overall effective rate between the two groups (P > 0.05). There was a significant difference in the total effective rate of treatment between the two groups of severe preeclampsia (P < 0.05). After treatment, the levels of MAP, 24hrUprV, BUN, Cr and UA in the two groups were significantly lower than those before treatment (P < 0.05). After treatment, there were no significant differences of the above indicators between the two groups (P>0.05). After treatment, the PT, APTT and TT were significantly increased and the plasma Fib and D-dimer levels were significantly decreased (P<0.05), while there were no significant differences of the above indicators between the two groups after treatment (P>0.05). The accidence rates of uterine inertia and postpartum hemorrhage in group B were significantly higher than group A (P < 0.05), while neonatal death rate was significantly lower than group A (P<0.05). Conclusion Magnesium sulfateis combined with Nifedipineas efficacious as Magnesium sulfateiscombined with Labetalol in improving kidney fuction and coagulation function. However, Magnesium sulfateis combined with Nifedipinehave higher risks of uterine atony and postpartum hemorrhage, but can reduce the incidence of neonatal death, it is worth further study.