硫酸镁治疗前置胎盘所致的妊娠晚期阴道出血

Treatment of 230 Cases of Vaginal Bleeding in Late Pregnancy Caused by Placenta Previa with Magnesium Sulfate

目的 :观察硫酸镁治疗前置胎盘效果和安全性。方法 :前置胎盘患者 2 3 0例作为治疗组 ,3 0min内快速静脉输入硫酸镁负荷量 4g(10 %葡萄糖注射液 2 5 0mL加 2 5 %硫酸镁溶液 16mL) ,随后以 1.5g·h 1维持 (10 %葡萄糖注射液5 0 0mL加 2 5 %硫酸镁溶液 40mL) ,宫缩消失及阴道流血停止 12h后停药。如复发 ,从负荷量开始重复治疗 ,但每天不应超过 3 0g。同期条件相同 5 0例前置胎盘患者为对照组 ,肌肉注射苯巴比妥钠 0 .2～ 0 .3g ,每 4～ 6h 1次。结果 :治疗组有效 2 2 7例 (98.7% ) ,对照组有效 17例 (3 4.0 % ) ,两组差异有极显著性 (P <0 .0 1)。治疗组新生儿窒息率低于对照组 (P<0 .0 1)。两组产后出血量及出血率差异均无显著性 (P >0 .0 5 )。结论 :硫酸镁治疗前置胎盘疗效显著 ,应用安全 ,可作为首选药物。

Objective:To Survey the efficacy and safety rate of intravenous administration of magnesium sulfate in the treatment of vaginal bleeding caused by placenta previa. Methods:The treatment group comprised 230 cases of placenta previa. Each of these patients was given a loading dose of 4 g of magnesium sulfate 16 ml of 25% magnesium sulfate in 250 ml of 10% glucose solution by rapid intravenous infusion within 30min,followed by maintaining intravenous dripping of 1.5 g of magnesium sulfate per hour (40 mL of 25% magnesium sulfate in 500 mL of 10% glucose solution). The treatment was discontinued 12 h after the uterine contractions disappeared and vaginal bleeding stopped. If bleeding recurred, the treatment was repeated, beginning from the loading dose. However, the total daily dose of magnesium sulfate should not exceed 30 g. In the same period of time, 50 patients with placenta previa of similar conditions served as controls, who were given each an intramuscular injection of 0.2-0.3 g phenobarbital sodium every 4-6 hours. Results:Magnesium sulfate treatment was successful in 227 patients (98.7%) of the treatment group, while only 17 cases(34.0%) of the controls responded well to phenobarbital sodium therapy. The difference was highly significant( P <0.01). However, the differences between the rate and amount of postpartum hemorrhage of the two groups were insignificant( P >0.05). No side effects were noticed during magnesium sulfate administration, either in the mother or in the fetus. Conclusion:Intravenous adminustration of magnesium sulfate was fairly effective and safe in the treatment of patients with placenta previa and thus may be the drug of first choice.