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| 早发型与晚发型子痫前期母血及胎儿脐静脉血拉贝洛尔浓度观察 |
| Observation of maternal blood and fetal umbilical vein labetalol concentration in early-and late-onset preeclampsia |
| 投稿时间：2021-12-13 |
| DOI：10.3969/j.issn.1000-0399.2022.05.006 |
| 中文关键词: 子痫前期 拉贝洛尔 药物浓度 胎盘屏障 |
| 英文关键词: Preeclampsia Labetalol Drug concentration Placental barrier |
| 基金项目:安徽省重点研究和开发计划项目(项目编号:1804h08020295) |
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| 中文摘要: |
| 目的 测定早发型与晚发型子痫前期孕妇母血和胎儿脐静脉血中拉贝洛尔的水平,明确拉贝洛尔胎盘滤过情况,研究子痫前期孕妇应用拉贝洛尔对围产儿安全性的影响。方法 选取2018年1月1日至2019年4月30日在安徽省妇幼保健院危重症产科住院分娩、单纯口服拉贝洛尔降压治疗达到目标血压的子痫前期孕产妇82例为研究对象,根据发病孕周将孕妇分为早发型子痫前期组(A组,46例)和晚发型子痫前期组(B组,36例),采用液相色谱串联质谱法(HPLC-MS/MS)检测两组孕妇静脉血及胎儿脐静脉血中拉贝洛尔药物浓度;选择分别与A组和B组分娩孕周相匹配的自发性早产(C组,30例)及自然临产(D组,30例)的新生儿为对照组,比较各组的围产儿不良结局发生情况。结果 ①A组和B组孕妇静脉血拉贝洛尔浓度均高于脐静脉血(P<0.05),且A组脐静脉血拉贝洛尔水平高于B组(P<0.05);②A组脐静脉血拉贝洛尔浓度与开始用药孕周呈负相关(r=-0.357, P<0.05);③A组新生儿心率低于C组(P<0.05),但B组新生儿心率与D组比较,差异无统计学意义(P>0.05)。结论 拉贝洛尔可通过胎盘屏障进入胎儿体内,在早发型子痫前期中,用药孕周越早拉贝洛尔越容易透过胎盘,晚发型子痫前期孕妇应用拉贝洛尔降压治疗相对于早发型子痫前期更安全。 |
| 英文摘要: |
| Objective To determine thelevels of labetalol in maternal blood and fetal umbilical vein of pregnant women with early onset preeclampsia and late onset preeclampsia, to clarify the placental transfer of labetalol, and to compare the perinatal safety of labetalol in pregnant women with early-onset preeclampsia and late-onset preeclampsia. Methods Eighty-two cases of patients with preeclampsia, who achieved target blood pressure with oral labetalol antihypertensive therapy alone, delivered in the Department of Obstetrics and Gynecology in Maternal and Child Care Hospital of Anhui Province from January 1, 2018 to April 30, 2019, were selected for the analysis. Pregnant Clin Nurs,2019,28(5/6):733-744. HEFFER T, WILLOUGHBY T. A count of coping strategies:a longitudinal study investigating an alternative method to understanding coping and adjustment. PLoS One,2017,12(10):e0186057. 孙蓉,高华,赵婧莎,等.癌症患者疾病应对方式和疾病获益感的关系:中介变量和调节变量的作用.临床与病理杂志,2019, 39 (1):143-150. 左宁.体检中乳腺疾病检出者心理弹性与医学应对方式及自我效能的相关性.影像学及诊断检验杂志, 2020,44 (1):33-40. 张子君.膀胱癌患者癌症复发恐惧现状及相关因素的研究.浙江:浙江大学,2019. 杨灵,宋伟平,陈锃丽,等.乳腺癌患者不同阶段的社会支持与生活质量的相究.中华肿瘤杂志,2017(3):202-206. SARKAR S,SAUTIER L,SCHILING G,et al. Anxiety and fear of cancer recurrence and its association with supportive are needs and health-care service utilization in cancer patients. J Cancer Surviv,2015,9(4):567-575. 卢美芬.肠造口患者术后心理状态与社会支持的相关性分析. 齐鲁护理杂志, 2021(2):104-106.(2021-12-08收稿) (本文编校:张迪,崔月婷)women were divided into early-onset preeclampsia group (group A, 46 cases) and late-onset preeclampsia group (group B, 36 cases) according to the gestational week of onset. Labetalol drug concentration in venous blood and fetal umbilical vein of the two groups of pregnant women was tested by liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Spontaneous preterm and spontaneously delivered newborns matched to the delivery gestational weeks in groups A and B, respectively, were selected as control groups (group C, 30 cases; group D, 30 cases), to compare the occurrence of adverse pregnant outcomes between groups A and C, and groups B and D.Results (1) Maternal blood labetalol concentrations were significantly higher than umbilical vein in both group A and group B (P<0.05). Labetalol concentration of umbilical vein was significantly higher in group A than in group B (P<0.05). (2) Labetalol concentration of umbilical vein was negative correlated with gestational week of drug initiation in group A (r=-0.357, P<0.05). (3) The heart rate of newborns in group A was significantly lower compared with group C (P<0.05), but there was no statistical difference between the heart rate of newborns in group B and group D (P>0.05).Conclusions Labetalol can cross the placental barrier into the fetus. In early-onset preeclampsia, the earlier of the gestational week for drug intakes, the easier the labetalol cross the placenta. It is safer to use labetalol in late-onset preeclampsia rather than early-onset preeclampsia. |
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