硝苯地平片联合维生素E及钙剂对妊娠期高血压疾病患者妊娠结局及凝血纤溶功能的影响
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摘要
目的探讨硝苯地平片联合维生素E及钙剂对妊娠期高血压疾病患者妊娠结局及凝血纤溶功能的影响。方法选择2015年10月至2017年10月我院接诊的95例妊娠期高血压疾病患者为研究对象,通过随机数表法分为观察组48例和对照组47例,对照组给予妊娠期高血压疾病常规综合治疗,观察组在对照组基础上,联合硝苯地平片、维生素E软胶囊、维D钙咀嚼片治疗,均连续治疗4周。比较两组治疗前后血压、24 h尿蛋白、临床症状、凝血纤溶功能的变化,并比较妊娠结局。结果治疗后,两组收缩压(SBP)、舒张压(DBP)、24 h尿蛋白均显著降低(P<0.01),观察组SBP、DBP、24 h尿蛋白均明显低于对照组(P<0.01);治疗后,两组头晕眼花、胸闷、上腹不适、消化系统症状发生率均明显改善(P<0.05,P<0.01),观察组头晕眼花、胸闷、上腹不适、消化系统症状发生率明显低于对照组(P<0.05);治疗后,两组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)较治疗前均明显延长(P<0.01),纤维蛋白原(FIB)、D二聚体(D-D)、纤维蛋白降解产物(FDP)水平明显降低(P<0.01),观察组PT、APTT、TT明显长于对照组(P<0.05,P<0.01),FIB、D-D、FDP明显低于对照组(P<0.01);观察组早产、剖宫产、胎儿宫内窘迫发生率明显低于对照组(4.17%vs.17.02%,16.67%vs.36.17%,4.17%vs.19.15%,P<0.05),两组新生儿窒息、死亡率比较差异无统计学意义(P>0.05)。结论在妊娠期高血压疾病患者中使用硝苯地平片联合维生素E及钙剂效果显著,可有效降低血压、缓解临床症状、调节凝血纤溶功能,改善妊娠结局,且安全性高,值得应用推广。
Objective To study the effect of nifedipine tablets combined with vitamin E and calcium on pregnancy outcome and coagulation and fibrinolysis function in patients with pregnancy-induced hypertension.Methods Totally 95 patients with pregnancy-induced hypertension who received treatment from October 2015 to October 2017 in our hospital were selected as research objects,and according to the random number table,these patients were divided into observation group(n=48)and control group(n=47).Control group was given routine comprehensive treatment for pregnancy-induced hypertension,and observation group was treated with nifedipine tablets,vitamin E soft capsule and D-cal on the basis of treatment for control group;they were treated continuously for 4 weeks.The changes of blood pressure,24 h urine protein,clinical symptoms,and coagulation and fibrinolysis function were compared between the two groups before and after treatment,and the outcome of pregnancy was compared.Results After treatment,the systolic blood pressure(SBP),diastolic blood pressure(DBP)and 24 h urine protein of the two groups were significantly lower than those before treatment(P<0.01);the SBP,DBP and 24 h urine protein in observation group were lower than those in control group(P<0.01).After treatment,the incidence of dizziness,chest tightness,upper abdominal discomfort,and digestive system symptoms of the two groups were significantly improved(P<0.05,P<0.01),and the incidence of dizziness,chest tightness,upper abdominal discomfort and digestive system symptoms in observation group was significantly lower than that in control group(P<0.05);after treatment,the prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)of the two groups were significantly longer(P<0.01);the fibrinogen(FIB),D dimer(D-D),and fibrin degradation product(FDP)were significantly reduced(P<0.01); the PT,APTT and TT in observation group were significantly longer than those in control group(P<0.05,P<0.01),and the levels of FIB,D-D and FDP were significantly lower than those of control group(P<0.01);the incidence of premature delivery,cesarean section and fetal distress in observation group was significantly lower than that in control group(4.17% vs.17.02%,16.67% vs.36.17%,4.17% vs.19.15%,P<0.05),respectively;there was no significant difference in asphyxia or mortality of the neonates between the two groups(P>0.05).Conclusion Nifedipine tablets combined with vitamin E and calcium has significant effect on pregnancy-induced hypertension,which can effectively reduce the blood pressure,relieve the clinical symptoms,regulate the coagulation and fibrinolysis function,improve the pregnancy outcome,and has high safety.It is worthy of application and promotion.
Objective To study the effect of nifedipine tablets combined with vitamin E and calcium on pregnancy outcome and coagulation and fibrinolysis function in patients with pregnancy-induced hypertension.Methods Totally 95 patients with pregnancy-induced hypertension who received treatment from October 2015 to October 2017 in our hospital were selected as research objects,and according to the random number table,these patients were divided into observation group(n=48)and control group(n=47).Control group was given routine comprehensive treatment for pregnancy-induced hypertension,and observation group was treated with nifedipine tablets,vitamin E soft capsule and D-cal on the basis of treatment for control group;they were treated continuously for 4 weeks.The changes of blood pressure,24 h urine protein,clinical symptoms,and coagulation and fibrinolysis function were compared between the two groups before and after treatment,and the outcome of pregnancy was compared.Results After treatment,the systolic blood pressure(SBP),diastolic blood pressure(DBP)and 24 h urine protein of the two groups were significantly lower than those before treatment(P<0.01);the SBP,DBP and 24 h urine protein in observation group were lower than those in control group(P<0.01).After treatment,the incidence of dizziness,chest tightness,upper abdominal discomfort,and digestive system symptoms of the two groups were significantly improved(P<0.05,P<0.01),and the incidence of dizziness,chest tightness,upper abdominal discomfort and digestive system symptoms in observation group was significantly lower than that in control group(P<0.05);after treatment,the prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)of the two groups were significantly longer(P<0.01);the fibrinogen(FIB),D dimer(D-D),and fibrin degradation product(FDP)were significantly reduced(P<0.01); the PT,APTT and TT in observation group were significantly longer than those in control group(P<0.05,P<0.01),and the levels of FIB,D-D and FDP were significantly lower than those of control group(P<0.01);the incidence of premature delivery,cesarean section and fetal distress in observation group was significantly lower than that in control group(4.17% vs.17.02%,16.67% vs.36.17%,4.17% vs.19.15%,P<0.05),respectively;there was no significant difference in asphyxia or mortality of the neonates between the two groups(P>0.05).Conclusion Nifedipine tablets combined with vitamin E and calcium has significant effect on pregnancy-induced hypertension,which can effectively reduce the blood pressure,relieve the clinical symptoms,regulate the coagulation and fibrinolysis function,improve the pregnancy outcome,and has high safety.It is worthy of application and promotion.
引文
[1] 邓莉,方碧梅.妊娠期高血压疾病的临床流行病学分析[J].海南医学,2015,26(17):2602-2603.
[2] Li C,Peng W,Zhang H,et al.Association of angiotensin receptor 2 gene polymorphisms with pregnancy induced hypertension risk[J].Hypertens Pregnancy,2018,37(2):87-92.
[3] 史玉霞,杨一新,许倩,等.妊娠期高血压疾病患者血小板参数和凝血功能指标的变化及意义[J].海南医学院学报,2015,21(10):1384-1386.
[4] Sharma KJ,Kilpatrick SJ.Postpartum hypertension:etiology,diagnosis,and management[J].Obstet Gynecol Surv,2017,72(4):248-252.
[5] Duro-Gómez J,Rodríguez-Marín AB,De Azcárete MG,et al.A trial of oral nifedipine and oral labetalol in preeclampsia hypertensive emergency treatment[J].J Obstet Gynaecol,2017,37(7):864-866.
[6] 中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华产科急救电子杂志,2015,4(4):206-213.
[7] Pels A,BWJ M,Singer J,et al.Influence of gestational age at initiation of antihypertensive therapy:secondary analysis of CHIPS trial data(control of hypertension in pregnancy study)[J].Hypertension,2018,71(6):1170-1177.
[8] 杨孜.妊娠期高血压疾病分类及诊断的再认识[J].实用妇产科杂志,2014,30(6):401-403.
[9] 王建荣,綦丽霞,高辉.妊娠期高血压疾病与正常妊娠凝血功能及血栓前状态对比观察[J].贵州医药,2014,38(7):597-599.
[10] Ahmadzia HK,Lockhart EL,Thomas SM,et al.Using antifibrinolytics in the peripartum period-concern for a hypercoagulable effect[J].J Neonatal Perinatal Med,2017,10(1):1-7.
[11] Chen Y,Lin L.Potential value of coagulation parameters for suggesting preeclampsia during the third trimester of pregnancy[J].Am J Med Sci,2017,354(1):39-43.
[12] Slavik L,Novak M,Ulehlova J,et al.Possibility of coagulation system activation determination with tissue factor in pregnancy complications[J].Clin Lab,2016,62(10):1851-1856.
[13] 李晓丹,张锋,吴林斌,等.妊娠期高血压疾病凝血和纤溶实验室指标变化的临床意义[J].中华全科医学,2014,12(9):1424-1426.
[14] Angeli F,Angeli E,Verdecchia P.Novel electrocardiographic patterns for the prediction of hypertensive disorders of pregnancy--from pathophysiology to practical implications[J].Int J Mol Sci,2015,16(8):18454-18473.
[15] 徐珂,侯江红,吴秀娟,等.硝苯地平缓释片联合缬沙坦治疗原发性高血压疗效和安全性的Meta分析[J].现代生物医学进展,2014,14(8):1554-1558.
[16] 韩秋玥,马海英,王晓帆,等.硫酸镁联合拉贝洛尔对妊娠高血压患者血清丙二醛和谷胱甘肽过氧化酶及血浆总抗氧化能力与超氧化物歧化酶的影响[J].中国医药,2017,12(4):589-592.
[17] 詹前美,陈坤,冯金,等.硝苯地平联合硫酸镁对妊娠期高血压患者血液流变学及凝血指标的影响[J].海南医学院学报,2017,23(5):645-647.
[2] Li C,Peng W,Zhang H,et al.Association of angiotensin receptor 2 gene polymorphisms with pregnancy induced hypertension risk[J].Hypertens Pregnancy,2018,37(2):87-92.
[3] 史玉霞,杨一新,许倩,等.妊娠期高血压疾病患者血小板参数和凝血功能指标的变化及意义[J].海南医学院学报,2015,21(10):1384-1386.
[4] Sharma KJ,Kilpatrick SJ.Postpartum hypertension:etiology,diagnosis,and management[J].Obstet Gynecol Surv,2017,72(4):248-252.
[5] Duro-Gómez J,Rodríguez-Marín AB,De Azcárete MG,et al.A trial of oral nifedipine and oral labetalol in preeclampsia hypertensive emergency treatment[J].J Obstet Gynaecol,2017,37(7):864-866.
[6] 中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华产科急救电子杂志,2015,4(4):206-213.
[7] Pels A,BWJ M,Singer J,et al.Influence of gestational age at initiation of antihypertensive therapy:secondary analysis of CHIPS trial data(control of hypertension in pregnancy study)[J].Hypertension,2018,71(6):1170-1177.
[8] 杨孜.妊娠期高血压疾病分类及诊断的再认识[J].实用妇产科杂志,2014,30(6):401-403.
[9] 王建荣,綦丽霞,高辉.妊娠期高血压疾病与正常妊娠凝血功能及血栓前状态对比观察[J].贵州医药,2014,38(7):597-599.
[10] Ahmadzia HK,Lockhart EL,Thomas SM,et al.Using antifibrinolytics in the peripartum period-concern for a hypercoagulable effect[J].J Neonatal Perinatal Med,2017,10(1):1-7.
[11] Chen Y,Lin L.Potential value of coagulation parameters for suggesting preeclampsia during the third trimester of pregnancy[J].Am J Med Sci,2017,354(1):39-43.
[12] Slavik L,Novak M,Ulehlova J,et al.Possibility of coagulation system activation determination with tissue factor in pregnancy complications[J].Clin Lab,2016,62(10):1851-1856.
[13] 李晓丹,张锋,吴林斌,等.妊娠期高血压疾病凝血和纤溶实验室指标变化的临床意义[J].中华全科医学,2014,12(9):1424-1426.
[14] Angeli F,Angeli E,Verdecchia P.Novel electrocardiographic patterns for the prediction of hypertensive disorders of pregnancy--from pathophysiology to practical implications[J].Int J Mol Sci,2015,16(8):18454-18473.
[15] 徐珂,侯江红,吴秀娟,等.硝苯地平缓释片联合缬沙坦治疗原发性高血压疗效和安全性的Meta分析[J].现代生物医学进展,2014,14(8):1554-1558.
[16] 韩秋玥,马海英,王晓帆,等.硫酸镁联合拉贝洛尔对妊娠高血压患者血清丙二醛和谷胱甘肽过氧化酶及血浆总抗氧化能力与超氧化物歧化酶的影响[J].中国医药,2017,12(4):589-592.
[17] 詹前美,陈坤,冯金,等.硝苯地平联合硫酸镁对妊娠期高血压患者血液流变学及凝血指标的影响[J].海南医学院学报,2017,23(5):645-647.