Lancet:口服药物治疗重度妊高症的效果和安全性

2019-08-03 MedSci MedSci原创

高血压是妊娠期最常见的疾病,发生率高达10%。普遍认为需要对血压严重升高的患者进行治疗,以降低产妇并发症的风险。严重高血压的急性治疗方案通常包括输液。虽然有效,但需要建立静脉通路和密切监测胎儿情况,适用环境受限。现研究人员开展一多中心、平行组、开放的随机对照试验,对比拉贝他洛尔、硝苯地平缓释片和甲基多巴三种口服药物治疗妊娠期重度高血压的疗效和安全性。招募年满18岁、孕周达28周、需要药物控制的重度

高血压是妊娠期最常见的疾病,发生率高达10%。普遍认为需要对血压严重升高的患者进行治疗,以降低产妇并发症的风险。严重高血压的急性治疗方案通常包括输液。虽然有效,但需要建立静脉通路和密切监测胎儿情况,适用环境受限。

现研究人员开展一多中心、平行组、开放的随机对照试验,对比拉贝他洛尔、硝苯地平缓释片和甲基多巴三种口服药物治疗妊娠期重度高血压的疗效和安全性。招募年满18岁、孕周达28周、需要药物控制的重度高血压(收缩压≥160 mm Hg或舒张压≥110 mm Hg)的孕妇。随机分至10mg 硝苯地平、200mg 拉贝洛尔或1000mg甲基多巴组(均为口服)。主要结点是6h内无副作用的前体下的血压控制情况(收缩压120-150mm Hg/舒张压70-100mm Hg)。

2015年4月1日-2017年8月21日,共筛查了2307位女性,最终894位被纳入意向治疗分析:服用硝苯地平、拉贝洛尔和甲基多巴的患者分别有298位(33%)、295位(33%)和301位(33%)。硝苯地平组的达到主要结点的患者明显多于甲基多巴组(84% vs 76%,p=0.03),但硝苯地平和拉贝洛尔组之间无显著差异(84% vs 77%,p=0.05),拉贝洛尔和甲基多巴组之间也无显著差异。共发生7例严重副反应:拉贝洛尔组 1例产时发作、2例死产;硝苯地平组 1例死产;甲基多巴组3例死产。

所有口服降压药都能使大多数孕妇血压降至参考范围。作为单一药物,硝苯地平缓释片比拉贝洛尔或甲基多巴的效果更好。三种口服药物—甲基多巴、硝苯地平和拉贝洛尔—都可作为低资源环境下治疗严重高血压的有效选择。

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    2020-03-12 howi
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    2020-03-29 zxxiang
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    2019-12-10 gdsun
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    2019-08-03 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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