硝苯地平联合酚妥拉明及硫酸镁对妊娠高血压血管内皮功能及肾脏血流动力学影响
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摘要
目的 :探讨硝苯地平联合酚妥拉明及硫酸镁对妊娠高血压血管内皮功能及肾脏血流动力学的影响。方法 :随机选择2014年1月～2017年1月在本院就诊的妊娠期高血压患者124例,按随机数字表法分为观察组和对照组,各62例。对照组予硫酸镁治疗,观察组予硝苯地平、酚妥拉明及硫酸镁联合治疗,治疗7天后观察两组患者的疗效、血压的变化、血管内皮细胞的功能、肾脏的血流动力学以及妊娠的结局、不良反应。结果 :观察组总有效率为91.94%,对照组为64.52%,观察组显著高于对照组,差异有统计学意义;治疗前,两组患者血压、血管内皮功能(ET-1(内皮素-1,endothelin-1)、NO(一氧化氮,nitric oxide))、肾脏血流动力学无显著差异;治疗后,两组患者血压均显著降低,且观察组显著低于对照组,治疗后两组血清ET-1显著降低且观察组显著低于对照组,两组血清NO显著升高且观察组显著高于对照组,差异有统计学意义;治疗后两组患者的肾脏血流动力学均显著改善,但是观察组改善较对照组显著,差异有统计学意义;观察组的异常妊娠及不良反应显著低于对照组,差异有统计学意义。结论 :硝苯地平、酚妥拉明及硫酸镁联合治疗妊高症患者有较好的效果,可有效的改善血管内皮细胞的功能,改善肾脏的血流动力学,改善妊娠的结局且不良反应较少,在临床上可广泛使用。
Objective To investigate the effect of nifedipine combined with phentolamine and Magnesium Sulfate on vascular endothelial function and renal hemodynamics in pregnancy induced hypertension. Method 124 cases of hypertensive disorder complicating pregnancy in our hospital from January 2014 to January 2017 were randomly selected and divided into observation group and control group according to random number table, 62 cases in each group. The control group was treated with Magnesium Sulfate,and the observation group was treated with nifedipine, phentolamine and Magnesium Sulfate. After 7 days of treatment, the efficacy,blood pressure, endothelial function, renal hemodynamics, pregnancy outcome and adverse reactions of the two groups were observed.Result The total effective rate of the observation group was 91.94%, the control group was 64.52%, the observation group was significantly higher than the control group, the difference was statistically significant. Before treatment, there was no significant difference in blood pressure, vascular endothelial function(ET-1, NO) and renal hemodynamics between the two groups. After treatment, the blood pressure of the two groups was significantly lower, and the observation group was significantly lower than the control group. After treatment, the serum ET-1 of two groups decreased significantly, and the observation group was significantly lower than that of the control group. The serum NO of the two groups increased significantly, and the observation group was significantly higher than that of the control group, the difference was statistically significant. After treatment, the renal hemodynamics of the two groups were significantly improved, but the observation group was significantly better than the control group, the difference was statistically significant. The abnormal pregnancy and adverse reactions in the observation group were significantly lower than those in the control group, and the difference was statistically significant. Conclusion Nifedipine, phentolamine and Magnesium Sulfate have a good effect in the treatment of pregnancy induced hypertension, It can effectively improve the function of vascular endothelial cells, improve renal hemodynamics,improve pregnancy outcomes and have fewer adverse reactions, which can be widely used in clinic.
Objective To investigate the effect of nifedipine combined with phentolamine and Magnesium Sulfate on vascular endothelial function and renal hemodynamics in pregnancy induced hypertension. Method 124 cases of hypertensive disorder complicating pregnancy in our hospital from January 2014 to January 2017 were randomly selected and divided into observation group and control group according to random number table, 62 cases in each group. The control group was treated with Magnesium Sulfate,and the observation group was treated with nifedipine, phentolamine and Magnesium Sulfate. After 7 days of treatment, the efficacy,blood pressure, endothelial function, renal hemodynamics, pregnancy outcome and adverse reactions of the two groups were observed.Result The total effective rate of the observation group was 91.94%, the control group was 64.52%, the observation group was significantly higher than the control group, the difference was statistically significant. Before treatment, there was no significant difference in blood pressure, vascular endothelial function(ET-1, NO) and renal hemodynamics between the two groups. After treatment, the blood pressure of the two groups was significantly lower, and the observation group was significantly lower than the control group. After treatment, the serum ET-1 of two groups decreased significantly, and the observation group was significantly lower than that of the control group. The serum NO of the two groups increased significantly, and the observation group was significantly higher than that of the control group, the difference was statistically significant. After treatment, the renal hemodynamics of the two groups were significantly improved, but the observation group was significantly better than the control group, the difference was statistically significant. The abnormal pregnancy and adverse reactions in the observation group were significantly lower than those in the control group, and the difference was statistically significant. Conclusion Nifedipine, phentolamine and Magnesium Sulfate have a good effect in the treatment of pregnancy induced hypertension, It can effectively improve the function of vascular endothelial cells, improve renal hemodynamics,improve pregnancy outcomes and have fewer adverse reactions, which can be widely used in clinic.
引文
[1]Kintiraki E, Papakatsika S, Kotronis G, et al. Pregnancy-Induced hypertension[J]. Hormones, 2015, 14(2):211-214.
[2]Goswami D P R, Shah D S N, Rekhaiyer D. Histo-pathological changes of placenta in normal and pregnancy induced hypertension-[J]. Southeast Asian J Case Rep Rev, 2014, 5(23):231-234.
[3]孙淑荣,董玲.妊娠期高血压疾病早期肾损害的监测进展[J].医学综述, 2015, 21(2):257-259.
[4]买苗,张晓莹,冯瑞,等.硝苯地平联合酚妥拉明及硫酸镁治疗妊娠期高血压的临床疗效观察[J].中国医药导刊, 2013, 6(10):1022-1023.
[5]谢幸,苟文丽.妇产科学.第8版[M].人民卫生出版社, 2013.
[6]陈园园,李红梅. VEGF和vWF与妊娠期高血压疾病发病机制的相关性探讨[J].西南国防医药, 2014, 6(8):917-919.
[7]Xin-Mei G E, Qiang G U. Research Progress in Pathogenesis and Control of Pregnancy Induced Hypertension Syndrome[J]. Medical Recapitulate, 2013, 6(35):431-435.
[8]Cai J, Zhang D. Diagnostic value of ET-1 and UA in early kidney injury of pregnancy-induced hypertension[J]. J Clin Nephrol, 2017, 8(11):26-29.
[9]廖运先,王晨虹.妊娠期高血压疾病硫酸镁及降压药的应用[J].中国计划生育和妇产科, 2016, 8(5):6-8.
[10] Jiang L. Clinical Observation of Treatment of Pregnancy-induced Hypertension Magnesium Sulfate Combined with Nifedipine[J]. China Health Standard Management, 2015, 9(52):94-97.
[11]唐未坤,王帆,张欣伟.硫酸镁、酚妥拉明和硝苯地平联合治疗对妊娠期高血压疾病患者血压变化、妊娠结局及不良反应的影响[J].中国妇幼保健, 2015, 30(15):2346-2348.
[12] Ren Y, Wang H, Qin H, et al. Vascular Endothelial Growth Factor expression in peripheral blood of patients with pregnancy induced hypertension syndrome and its clinical significance[J]. Pakistan J Med Sci Online, 2014, 30(3):634-637.
[13]王玉杰,张立军,吴荣秀.肾脏血流动力学与血管内皮功能及妊娠期高血压疾病相关性的研究[J].中国妇幼保健, 2014, 29(7):1006-1008.
[14] Ogunmoroti O A, Ayoola O O, Makinde O N, et al. Maternal renal artery Doppler sonographic changes in pregnancy-induced hypertension in South West Nigeria[J]. Niger Med J Med, 2015, 56(3):190-193.
[15]沈晓翀,赵长伟,姚健.妊娠期高血压疾病血ET-1与NO水平变化及其对肾动脉血流动力学的影响[J].中国妇幼健康研究, 2017,28(5):87-90.
[2]Goswami D P R, Shah D S N, Rekhaiyer D. Histo-pathological changes of placenta in normal and pregnancy induced hypertension-[J]. Southeast Asian J Case Rep Rev, 2014, 5(23):231-234.
[3]孙淑荣,董玲.妊娠期高血压疾病早期肾损害的监测进展[J].医学综述, 2015, 21(2):257-259.
[4]买苗,张晓莹,冯瑞,等.硝苯地平联合酚妥拉明及硫酸镁治疗妊娠期高血压的临床疗效观察[J].中国医药导刊, 2013, 6(10):1022-1023.
[5]谢幸,苟文丽.妇产科学.第8版[M].人民卫生出版社, 2013.
[6]陈园园,李红梅. VEGF和vWF与妊娠期高血压疾病发病机制的相关性探讨[J].西南国防医药, 2014, 6(8):917-919.
[7]Xin-Mei G E, Qiang G U. Research Progress in Pathogenesis and Control of Pregnancy Induced Hypertension Syndrome[J]. Medical Recapitulate, 2013, 6(35):431-435.
[8]Cai J, Zhang D. Diagnostic value of ET-1 and UA in early kidney injury of pregnancy-induced hypertension[J]. J Clin Nephrol, 2017, 8(11):26-29.
[9]廖运先,王晨虹.妊娠期高血压疾病硫酸镁及降压药的应用[J].中国计划生育和妇产科, 2016, 8(5):6-8.
[10] Jiang L. Clinical Observation of Treatment of Pregnancy-induced Hypertension Magnesium Sulfate Combined with Nifedipine[J]. China Health Standard Management, 2015, 9(52):94-97.
[11]唐未坤,王帆,张欣伟.硫酸镁、酚妥拉明和硝苯地平联合治疗对妊娠期高血压疾病患者血压变化、妊娠结局及不良反应的影响[J].中国妇幼保健, 2015, 30(15):2346-2348.
[12] Ren Y, Wang H, Qin H, et al. Vascular Endothelial Growth Factor expression in peripheral blood of patients with pregnancy induced hypertension syndrome and its clinical significance[J]. Pakistan J Med Sci Online, 2014, 30(3):634-637.
[13]王玉杰,张立军,吴荣秀.肾脏血流动力学与血管内皮功能及妊娠期高血压疾病相关性的研究[J].中国妇幼保健, 2014, 29(7):1006-1008.
[14] Ogunmoroti O A, Ayoola O O, Makinde O N, et al. Maternal renal artery Doppler sonographic changes in pregnancy-induced hypertension in South West Nigeria[J]. Niger Med J Med, 2015, 56(3):190-193.
[15]沈晓翀,赵长伟,姚健.妊娠期高血压疾病血ET-1与NO水平变化及其对肾动脉血流动力学的影响[J].中国妇幼健康研究, 2017,28(5):87-90.