硫酸镁注射液致视觉障碍1例并文献分析

Visual Disorder Induced by Magnesium Sulfate Injection:A Case Report and Literature Analysis

目的为临床安全使用硫酸镁注射液提供参考。方法分析某院收治的1例静脉滴注硫酸镁注射液过程中出现视觉障碍患者的治疗经过。结合文献资料分析其发生原因及防范措施。结果患者出现的视觉障碍与使用硫酸镁注射液的因果关系为“肯定”(Naranjo评分为13分)。该药品不良反应(ADR)的发生与药品(非质量)因素、患者个体差异及药物(镁离子)的体内蓄积等相关。防范方面需密切关注该药使用过程中有无异常表现,尤其要区分视觉障碍为先兆子痫(或子痫)还是使用硫酸镁引起,并对症处理。如已发生过类似情况,硫酸镁需减量使用或停用,或换用其他保胎药。结论临床应重视硫酸镁注射液引起的视觉障碍。该ADR因国内药品说明书尚未收载,属新的ADR,建议加强用药安全监测及风险识别防控,生产企业亦应及时完善药品说明书,促进临床安全用药。

Objective To provide a reference for the safe use of Magnesium Sulfate Injection in clinical practice.Methods The treatment process of a patient experienced visual disorder during the intravenous drip of Magnesium Sulfate Injection in a hospital was analyzed.The occurrence causes and preventive measures of this adverse drug reaction(ADR)were investigated based on relevant literature.Results The causal relationship between the patient's visual disorder and the use of Magnesium Sulfate Injection was″definite″(the Naranjo's score was 13 points).The occurrence of this ADR was related to drug factors(not involving drug quality),individual differences and drug(magnesium ions)accumulation in vivo.It was necessary to monitor closely the patients'abnormal conndition during the use of this drug,especially distinguishing the visual disorder was preeclampsia(or eclampsia)or the ADR induced by the use of magnesium sulfate,and symptomatic treatment needed to be carried out.If patient had experienced the above ADR before,magnesium sulfate needed to be reduced in dosage or discontinued,or replaced by other tocolytic agents.Conclusion We should pay attention to the visual disorder induced by Magnesium Sulfate Injection in clinical practice.This ADR is new and not included in the domestic drug instructions.Thus it is suggested the medication safety monitoring,risk identification,prevention and control should be strengthened,manufacturing enterprises should improve the drug instructions in time to promote clinical safe medication.