硫酸镁在妊娠期高血压疾病患者中的浓度监测及分析

Monitoring serum concentration of magnesium sulfate in hypertension disorders of pregnanct women: a retrospective analysis

目的:回顾性分析硫酸镁在妊娠期高血压疾病患者中的浓度监测及达标情况。方法:采用回顾性研究方法,对南京医科大学附属苏州医院2018年1月至2018年12月使用硫酸镁治疗的妊娠期高血压疾病患者的血清镁离子浓度(简称血镁浓度)及相关信息进行统计分析。结果:(1)入选患者108例,血镁浓度监测点124个。硫酸镁维持给药期间的血镁浓度达标率为52.17%,硫酸镁维持给药结束后的血镁浓度达标率为21.51%,所有患者均无子痫发作。(2)在所有达标患者中给予硫酸镁负荷剂量的比例显著高于未达标患者(P<0.05),硫酸镁维持给药结束后达标的患者对血镁浓度的测定时间(指测定血镁浓度距离维持剂量给药结束的时间间隔)为4.00(2.00,8.00)h,未达标患者的为10.00(7.00,12.00)h,差异具有统计学意义(P<0.05)。维持给药期间血镁浓度达标患者对血镁浓度测定时间(指测定血镁浓度时距离维持剂量给药开始时间)与未达标组相比无显著性差异(P>0.05)。(3)维持给药期间及维持给药结束后血镁浓度达标患者与未达标患者在年龄、体质指数(BMI)、孕周、诊断、浓度测定前的硫酸镁使用量、基线血镁浓度、延长孕周时间及妊娠结局方面均无显著差异(P>0.05)。结论:妊娠期高血压疾病患者使用硫酸镁后血镁浓度水平波动较大,维持给药期间和维持给药结束后的血镁浓度的达标率均较低,有必要规范硫酸镁给药方案,给予负荷剂量硫酸镁,必要时延长维持给药时间。

OBJECTIVE To review the use of magnesium sulfate in hypertension disorders of pregnant women through monitoring of serum magnesium concentration and the attaining rate of therapeutic serum level 1 of magnesium.METHODS From January 2018 to December 2018,at Department of Obstetrics, Affiliated Suzhou Hospital, 108 pregnant women with hypertension disorders receiving intravenous infusion(IV)of magnesium sulfate were retrospectively reviewed.The maternal demographic characteristics, dosing regimens of magnesium sulfate and serum magnesium concentrations were collected.The monitoring of serum magnesium concentrations and the rate of attaining therapeutic serum magnesium levels were analyzed.RESULTS A total of 224 serum magnesium concentrations from 108 hypertensive pregnant women were retrospectively collected.And there were 52.17% of attainers during IV infusion of maintenance dose and 21.51% of attainers after IV infusion of maintenance dose.None of them had eclampsia.The proportion of magnesium sulfate loading dose in attainers during and after maintenance administration was significantly higher than non-attainers(75.00% vs.27.27%,80.00% vs.26.03%,P<0.05).The measurement time of serum magnesium concentration(referring to time interval from measurement of blood magnesium concentration to the end of maintenance dosing)in attainers after IV infusion of a maintenance dose was less than that in non-attainers and the difference was statistically significant(4.00 vs.10.00,P<0.05).However, no significant difference existed in the measurement time of serum magnesium concentration(referring to time interval from measurement of blood magnesium concentration to the beginning of maintenance dosing)between attainers and non-attainers during IV infusion of a maintenance dose(P>0.05).During and after IV infusion of a maintenance dose of magnesium sulfate, no significant inter-group differences existed in age, body mass index(BMI),gestational age, diagnosis, total amount of magnesium sulfate administered before monitoring of serum magnesium concentrations, baseline serum magnesium concentrations, prolongation of pregnancy or obstetric outcomes(P>0.05).CONCLUSION The serum levels of magnesium concentration fluctuate greatly after dosing of magnesium sulfate for pregnant women with hypertension disorders.There is a low rate of attaining therapeutic serum magnesium levels during and after IV infusion of a maintenance dose of magnesium sulfate.Thus it is necessary to normalize the use of magnesium sulfate, offer a loading dose of magnesium sulfate and extend the duration and maintenance dosing if necessary.