Tandoğan BÜLENT, EBRU ÇÖĞENDEZ, Oral ÖZAY

Ağır preeklamptik gebelerle intravenöz nimodipin'in maternal ve fetal etkileri

Amaç: Ağır preeklamptik gebelerde etkin bir serebral vazodilatatör olan kalsiyum kanal blokeri nimodipin'in anne ve fetüs üzerine etkilerini araştırmaktır. Materyel ve Metod: Ağır preeklampsi nedeniyle hastaneye yatırılan on gebede intravenöz (IV) nimodipin tedavisinin yan etki, maternal prodromal belirtiler, arterial kan basıncı ve fetal umblikal arter doppler indeksleri üzerine etkisi değerlendirildi. Bulgular: Başvuru anında yedi hastada başağrısı, bir hastada görme bozukluğu, bir hastada bulantı ve kusma mevcuttu. Bir hastada ise başvuru öncesi başlayan baş ağrısı mevcuttu. IV nimodipin tedavisi başladıktan bir saat sonra hastaların tamamında baş ağrısı ortadan kalktı. Görme bozukluğu olan hastada ve bulantı ve kusması olan hastada semptomlar tedaviye başladıktan 2 saat sonra geriledi. İki hastada tedavi başladıktan sonra oluşan ancak rahatsız edici olmayan başağrısı 15 dakika sonra kayboldu. IV nimodipin infüzyonu sonrası 0., 1., 2. ve 3. saatlerde arterial kan basıncı değerlendirildiğinde, 3. saatte arterial kan basıncında anlamlı düşüş olduğu saptandı (p0.05). Nimodipin tedavisi sırasında hiçbir hastada konvülzüyon görülmedi. Sonuç: Nimodipin ağır preeklampsinin sık görülen belirtilerinden baş ağrısı ve görme bozukluğunu ortadan kaldırmaktadır. Yan etki azlığı ve yakın monitörizasyon gerektirmemesi nedeniyle eklampsi proflaksisinde magnezyum sülfat tedavisi yerine kullanılabilir. Ancak etkinliğinin ortaya konması için daha geniş hasta gruplarında yapılacak araştırmalara ihtiyaç vardır.

Anahtar Kelimeler:

Preeklampsi, Nimodipin, Enjeksiyon, ven içi, İleriye dönük çalışma, Baş ağrısı, Görme bozuklukları

Maternal and fetal effects of intravenous nimodipine in severe preeclamptic pregnants

Objective: The aim of this study is to investigate on maternal and fetal effects of calcium channel blocker nimodipine which is an effective cerebral vasodilator, in severe preeclamptic women. Material and Methods: The effects of intravenous nimodipine on side effects, maternal prodromal symptoms, arterial blood pressure and fetal umblical artery doppler indices were assessed on ten patients hospitalized for severe preeclampsia. Results: At hospitalization seven patients had headache, one had visual disturbances, one had nausea and vomiting. One patient had headache prior to hospitalization. Following the infusion of nimodipine the symptoms of all patients with headache.was disappeared one hour later. Patients with nausea and vomiting and visual disturbances also had significant amelioration of their symptoms two hours later. In two patients that had minor headache following the infusion of the drug, but the symptom regressed in 15 minutes. When arterial blood pressure was evaluated at 0,1, 2 and 3 hours post infusion of nimodipine there was a significant fall in blood pressure at 3 hours(p0.05). None of the patients had convulsions during nimodipine treatment. Conclusion: Nimodipine removes headache and visual disturbances which are common Symptoms seen in severe preeclampsia. Since it has few side effects and does not require intense monitorization, it may be used instead of magnesium sülfat for prophylaxis of eclampsia. However large studies are needed to prove the effectiveness of the drug.

Keywords:

Pre-Eclampsia, Nimodipine, Injections, Intravenous, Prospective Studies, Headache, Vision Disorders,

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