Brown University Alpert School of Medicine, Women & Infants Hospital, Department of Obstetrics and Gynecology, Providence, Rhode Island.
Obstet Gynecol. 2013 Feb;121(2 Pt 1):235-240. doi: 10.1097/AOG.0b013e31827c5cf8.
Clinical trials support the efficacy and safety of magnesium sulfate for cerebral palsy prevention. We evaluated the implementation of a clinical protocol for the use of magnesium for cerebral palsy prevention in our large women's hospital, focusing on uptake, indications, and safety.
We performed a review of selected gravidas with threatened or planned delivery before 32 weeks of gestation from October 2007 to February 2011. The primary study outcome was the change in the rate of predelivery administration of magnesium sulfate over this time period.
Three hundred seventy-three patients were included. In 2007, before guideline implementation, 20% of eligible gravidas (95% confidence interval [CI] 9.1-35.6%) received magnesium before delivery compared with 93.9% (95% CI 79.8-99.3%) in the final 2 months of the study period (P<.001). Dosing did not vary significantly over the 4 study years: the median number of treatments was one, the total predelivery median dose ranged from 15 to 48 g, and the median duration of therapy ranged from 3 to 12 hours. After 3 years, magnesium administration was almost universal among patients diagnosed with preeclampsia, preterm labor, or preterm premature rupture of membranes (95.4%), whereas patients delivered preterm for fetal growth restriction were significantly less likely to receive predelivery magnesium (44%, P<.001). No maternal or perinatal magnesium-attributable morbidity was noted. Among patients eligible for the protocol who received magnesium, 84.2% delivered before 32 weeks of gestation.
It is feasible to implement a magnesium sulfate cerebral palsy prevention protocol into clinical practice.
III.
临床试验支持硫酸镁用于预防脑瘫的疗效和安全性。我们评估了在我们的大型妇女医院中使用硫酸镁预防脑瘫的临床方案的实施情况，重点关注采用率、适应证和安全性。
我们对 2007 年 10 月至 2011 年 2 月期间有早产或计划早产风险的部分孕妇进行了回顾性研究。主要研究结局是在此期间硫酸镁产前应用率的变化。
共纳入 373 例患者。在 2007 年，即指南实施之前，95%可信区间（9.1%～35.6%）的符合条件孕妇中只有 20%在分娩前接受了硫酸镁治疗，而在研究最后 2 个月这一比例达到 93.9%（95%CI 79.8%～99.3%）（P<.001）。4 年研究期间，硫酸镁的给药剂量无显著变化：中位数治疗次数为 1 次，总产前中位数剂量为 15～48 g，中位治疗持续时间为 3～12 小时。3 年后，硫酸镁的应用几乎在所有被诊断为先兆子痫、早产临产或早产胎膜早破的患者中都非常普遍（95.4%），而接受治疗的胎儿生长受限患者接受产前硫酸镁治疗的可能性明显较低（44%，P<.001）。未观察到与镁剂相关的母体或围产儿发病率。在符合方案且接受硫酸镁治疗的患者中，84.2%在 32 孕周前分娩。
将硫酸镁预防脑瘫的方案应用于临床实践是可行的。
III 级。
