ニフェディピン対アトシバン 早期出産の危険性 (APOSTEL III):多センター,ランダム化制御試験
Elvira O G van Vliet1, Tobias A J Nijman1, Ewoud Schuit2
1Department of Obstetrics, Wilhelmina Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands.
Lancet (London, England)
|March 6, 2016
まとめ
ニフェディピンとアトシバンは,先天性出産を48時間遅らせるのに類似した有効性を示し, 予期せぬ出産の脅威の管理に関する決定的な結果のために,さらなる研究がプラセボ対照試験を調査する必要があります.
科学分野:
- 産前医学
- 産婦人科
- 新生児科
背景:
- 胎児の発症の危険性のある女性は,産前コルチコステロイドが新生児の発症を改善できるように,しばしば48時間,トコリチクスを投与します.
- 妊産婦と新生児に対する最適な毒解薬に関するコンセンサスは確立されていません.
- APOSTEL III試験では,ニフェディピンとアトシバンの比較が,早産の危険性について調査されました.
研究 の 目的:
- 早期出産のリスクのある女性におけるニフェディピンとアトシバンの有効性と安全性の比較
- これらのトコリチクスの複合的有害事象への影響を評価する.
主な方法:
- 妊娠25~34週間の508人の妊婦を対象とした多中心のランダム化比較試験です.
- 参加者はランダムに割り当てられ,口服用ニフェディピンまたは静脈内用アトシバンを48時間投与された.
- 死亡率と重症新生児の罹患率を含む,不良の周期のアウトカムを組み合わせた主なアウトカムでした.
主要な成果:
- 原発的複合性有害事象はニフェディピン群の14%とアトシバン群の15%で発生した (RR 0. 91,95%CI 0. 61-1.37).
- 統計的に有意ではないが,アトシバン群 (2%) に比べてニフェディピン群 (5%) で死亡者が多かった.
- 2つの治療群では母親による有害事象が類似した.
結論:
- ニフェディピンまたはアトシバンによる48時間のトコリシスは,早産の危険性のある女性において,類似した周産期の結果をもたらします.
- 将来の研究では,最終的な治療ガイドラインを確立するために,産前期的な結果のための大規模なプラセボ対照試験を優先すべきである.
関連する概念動画
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
1.4K
Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is...
1.4K
01:16Antianginal Drugs: Nitrates and β-Blockers
1.9K
In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
1.9K
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
946
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
946
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
1.8K
Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
1.8K
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
1.3K
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
1.3K
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
2.6K
Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
2.6K