Repke J T, Friedman S A, Kaplan P W
Johns Hopkins Hospital, Baltimore, Maryland.
Clin Obstet Gynecol. 1992 Jun;35(2):365-74.
Treatment of this pathophysiologically poorly understood disease is controversial. Despite this uncertainty, the goals of management of the patient with preeclampsia and eclampsia are diagnosis, stabilization, and delivery of the baby. Stabilization refers to both mother and fetus and should include the prevention of eclampsia or the recurrence of eclamptic seizures. There are empiric data supporting the use of magnesium sulfate for the management of preeclampsia and eclampsia in North America, but there are few data to support its efficacy as a classic anticonvulsant. Until controlled trials are completed, we suggest that magnesium sulfate continue to be used in preeclampsia, with the addition of established anticonvulsant medications when eclampsia occurs. Data on established antiepileptic drugs such as diazepam and phenytoin support their use in treating patients with eclamptic seizures. As stated in an earlier review, "in treating preeclampsia, magnesium sulfate therapy may have a role and may moderate factors leading to eclampsia. Whether magnesium sulfate therapy may have some as yet unproved effect on epileptogenic foci or seizure propagation is not the important issue for the physician caring for the eclamptic patient. Until adequately designed therapeutic trials are available, it is our opinion that treatment should be based on the use of anticonvulsant drugs of established efficacy in seizure control and prophylaxis (p. 1363)."
这种病理生理机制尚不清楚的疾病的治疗存在争议。尽管存在这种不确定性，但子痫前期和子痫患者的管理目标是诊断、稳定病情并分娩胎儿。稳定病情涉及母亲和胎儿，应包括预防子痫或子痫发作的复发。在北美，有经验性数据支持使用硫酸镁来管理子痫前期和子痫，但几乎没有数据支持其作为经典抗惊厥药的疗效。在完成对照试验之前，我们建议继续在子痫前期中使用硫酸镁，子痫发生时添加已确定的抗惊厥药物。关于地西泮和苯妥英钠等已确定的抗癫痫药物的数据支持它们用于治疗子痫发作的患者。正如之前一篇综述中所述，“在治疗子痫前期时，硫酸镁疗法可能起作用，并且可能减轻导致子痫的因素。硫酸镁疗法是否可能对致痫灶或癫痫发作传播有一些尚未得到证实的作用，对于照顾子痫患者的医生来说并非重要问题。在有充分设计的治疗试验可用之前，我们认为治疗应基于使用已确定对癫痫控制和预防有效的抗惊厥药物（第1363页）。”
