一家二级医院中2例硫酸镁治疗子痫患者的癫痫复发

Recurrent Seizures in 2 Patients with Magnesium Sulfate-Treated Eclampsia at a Secondary Hospital.

作者信息

Harsono Alfonsus Adrian Hadikusumo, Achmadi Achmadi, Aldika Akbar Muhammad Ilham, Joewono Hermanto Tri

机构信息

Faculty of Medicine, Airlangga University, Surabaya, Indonesia.

Department of Obstetrics and Gynecology, Ibnu Sina General Hospital, Gresik, Indonesia.

出版信息

Am J Case Rep. 2018 Sep 25;19:1129-1134. doi: 10.12659/AJCR.911004.

Abstract

BACKGROUND Recurrent seizure in patients with magnesium sulfate-treated eclampsia is very rare and requires meticulous management due to poor prognosis. The development of eclamptic convulsions is considered a preventable obstetric situation. Magnesium sulfate has been the drug of choice in such cases. However, some cases are persistent and need more aggressive treatment. CASE REPORT First case: A 20-year-old, nulliparous woman was referred from a private midwifery practice with history of convulsion, 40 weeks of gestational age (GA), and in the active phase of labor. She had been treated with magnesium sulfate and nifedipine beforehand. Her fetus was tachycardic, so an emergency caesarean section was done and placental abruption was found. The day after the surgery, the patient had recurrent seizures despite receiving a maintenance dose of magnesium sulfate. The patient then received thiopental sodium and remained stable. Second case: A 19-year-old, nulliparous woman came to the hospital with 40 weeks of GA, prolonged premature rupture of the membrane (PROM), preeclampsia, and cephalopelvic disproportion (CPD). An emergency caesarean section was performed. Eighteen hours after surgery, the patient had convulsions despite receiving magnesium sulfate maintenance therapy. We repeated the loading dose of 2 g magnesium sulfate, but the seizures persisted. Hence, midazolam was given and the seizures remained controlled. Both babies were delivered without any significant complications. CONCLUSIONS We report 2 cases of GIP0-0 women with 40 weeks GA who had magnesium sulfate-resistant eclampsia and needed additional anticonvulsant drugs. These cases show the importance of comprehensive management and the need for alternative drugs in eclampsia.

摘要

背景

硫酸镁治疗的子痫患者反复惊厥非常罕见,由于预后不良,需要精心管理。子痫惊厥的发生被认为是一种可预防的产科情况。硫酸镁一直是此类病例的首选药物。然而,有些病例持续存在,需要更积极的治疗。病例报告:首例:一名20岁未生育女性从一家私人助产诊所转诊而来,有惊厥史,孕40周,处于产程活跃期。她此前已接受硫酸镁和硝苯地平治疗。她的胎儿心动过速,因此进行了急诊剖宫产,发现胎盘早剥。术后第二天,尽管给予了硫酸镁维持剂量,患者仍反复惊厥。患者随后接受硫喷妥钠治疗并保持稳定。第二例:一名19岁未生育女性因孕40周、胎膜早破时间延长(PROM)、子痫前期和头盆不称(CPD)入院。进行了急诊剖宫产。术后18小时,尽管接受了硫酸镁维持治疗,患者仍发生惊厥。我们重复给予2g硫酸镁负荷剂量,但惊厥仍持续。因此,给予咪达唑仑,惊厥得到控制。两名婴儿均顺利分娩,无任何严重并发症。结论:我们报告了2例孕40周的GIP0-0女性,她们患有硫酸镁抵抗性子痫,需要额外的抗惊厥药物。这些病例显示了综合管理的重要性以及子痫中使用替代药物的必要性。

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