摘要
目的探讨硝苯地平与其他降压药物治疗重度子痫前期患者的有效性、不良反应及对围产儿结局的影响。方法采用计算机和手工检索主题词的方法，检索PubMed、EMBase、Cochrane图书馆、中国知网（CNKI）及维普数据库（VIP）等数据库，检索2012年1月以前关于硝苯地平治疗重度子痫前期患者的临床随机对照试验相关文献，对检索到的文献进行质量评价，纳入的文献采用RevMan5．1软件进行荟萃分析。结果共有9篇文献纳入荟萃分析，应用硝苯地平患者合计386例（硝苯地平组），应用其他降压药物患者378例（其他降压药物组），其他降压药物包括肼屈嗪（其他名称：肼苯哒嗪）、拉贝洛尔、哌唑嗪及硝酸甘油。（1）降压效果比较：硝苯地平组降压有效率为91．6％（327／357），明显高于其他降压药物组的81．0％（282／348），差异有统计学意义（OR=2．65，95％CI为1．65～4．25．P〈0．01）；初次用药后达到目标降压值的时间，两组比较，差异无统计学意义（WMD=-3．64，95％CI为-10．90～3．61，P=0．32）。（2）延长妊娠天数比较：硝苯地平组患者延长的妊娠天数多于其他降压药物组，差异有统计学意义（WMD=5．14，95％CI为3．29～6.99，P〈0.01）。（3）不良反应发生率比较：硝苯地平组患者与其他降压药物组在头痛（P=0．28）、心悸（P=0．06）、恶心与呕吐（P=0．28）药物不良反应方面比较，差异均无统计学意义。（4）新生儿Apgar评分比较：两组新生儿出生后5分钟Apgar评分比较，差异无统计学意义（WMD=-0．21，95％C1为-0．32～0．91，P=0．72）。（5）新生儿呼吸窘迫综合征发生率比较：硝苯地平不增加新生儿呼吸窘迫综合征的发生率，两组新生儿呼吸窘迫综合征发生率比较，差异无统计学意义（OR=1．24，95％CI为0．57～2．67，P=0．59）。（6）围产儿病死率比较：硝苯地平不增加围产儿病死率，硝苯地平组（5．0％，9／181）与其他降压药物组（10．2％，17／167）比较，差异无统计学意义（OR=0．49，95％叫为0．22～1．11，P=0．09）。结论硝苯地平用于重度子痫前期患者，较肼屈嗪、拉贝洛尔、哌唑嗪及硝酸甘油的降压效果更明显，可显著延长妊娠天数，但不增加围产儿呼吸窘迫综合征发生率和病死率。
Objective To assess the efficacy, side effects and perinatal outcome of nifedipine compared with other antihypertensives for treating severe preeclampsia in pregnant women. Methods Randomized controlled trials （RCTs） that comparing nifedipine with other autihypertensives for severe preeclampsia were searched in PubMed, EMBase, Coehrane library, CNKI and VIP database etc （till January 2012）. The quality of the included RCTs was evaluated, and Meta-analysis was performed with Rev Man 5.1 software. Results Nine trials were included, involving 386 women in the nifedipine group, and 378 women in other antihypertensives group. Compared with other antihyperteusives, nifidepine was associated with greater effective control of blood pressure （ OR = 2. 65, 95% CI： 1.65 - 4. 25, P 〈 0. 01 ）. There was no clear differenee in the time needed to control blood pressure （ WMD = - 3.64, 95% CI： - 10. 90 - 3.61, P = 0. 32）. Nifedipine could prolong gestation better than other antihypertensives （ WMD = 5.14, 95% CI： 3.29 -6. 99, P 〈0.01 ）. There were no clear differences in maternal side effects headache （P =0. 28）, palpitation （P = 0. 06） , and nausea vomiting （P = 0. 28 ）. No noticeable difference was found between the two groups in the Apgar score at five minutes （WMD= -0.21,95%CI： -0.32 -0.91,P=0.72）, neonatal respiratory distress syndrome （ OR = 1.24,95% CI：0. 57 - 2. 67,P = 0. 59）, or perinatal deaths （ OR =0. 49,95% CI：0. 22 - 1. 11 ,P = 0.09）. Conclusion Nifedipine is associated with greater effective control of blood pressure and prolongation of gestation, with no additional neonatal respiratory distress syndrome or perinatal deaths,compared with other antihypertensives for women with severe preeclampsia.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2012年第8期592-597,共6页
Chinese Journal of Obstetrics and Gynecology
