目的 系统分析产前使用硫酸镁对胎儿神经的保护作用. 方法 检索 PubMed, Cochrane 图书馆, EMBASE, 中国期刊全文数据库, 中国生物医学文献数据库, 中文科技期刊全文数据库收录的公开发表与研究目的相关的随机对照研究文献, 对满足条件的数据进行合并分析, Meta 分析软件用 RevMan 5.0. 评价指标包括: 胎儿出生后 18~ 24 个月发生脑瘫并围产儿死亡, 脑瘫, 中-重度脑瘫, 中-重度脑瘫并围产儿死亡, 围产儿死亡, 根据使用硫酸镁时的妊娠周数来分析其对胎儿神经系统的保护作用. 结果 5 个随机对照研究 (5 235 名胎儿/新生儿) 纳入分析. 妊娠 30~ 34 周使用硫酸镁并不能减少脑瘫并围产儿死亡的发生率 (相对危险度 0.93, 95% 可信区间 0.79~ 1.09), 但是单独发生的脑瘫 (相对危险度 0.70, 95% 可信区间 0.54~ 0.90), 中-重度脑瘫 (相对危险度 0.61, 95% 可信区间 0.44~ 0.84) 明显减少, 而围产儿死亡率 (相对危险度 0.99, 95% 可信区间 0.82~ 1.19) 并未增加. 对于妊娠不足 30 周的胎儿进行研究得出同样的结论. 对单纯从胎儿神经保护作用出发产前使用硫酸镁的 4 个研究 (涉及胎儿 4 324 名) 进行分析, 结果为母体产前使用硫酸镁可以减少脑瘫的发生. 结论 对于有早产风险的孕妇使用硫酸镁可以减少胎儿出生后脑瘫的发生率, 而不会增加死胎的发生.

Abstract: Objective To review the evidence regarding neuroprotective effects of antenatal exposure to magnesium sulfate. Methods We conducted database searches of PubMed, Cochrane library, EMBASE, China Journal Full-text Database, Chinese Biomedical Database, Chinese Scientific Journals Full-text Database. Randomized controlled trials comparing Magnesium Sulfate with placebo/other treatment in patients at risk of preterm labor were evaluated for inclusion and methodological quality. The data was analyzed by RevMan 5.0. The outcomes were death with cerebral palsy by 18~ 24 months corrected age, death, cerebral palsy, moderate-severe cerebral palsy, and death with moderate-severe cerebral palsy. Result Five randomized controlled trials were included (5 235 fetuses/infants). When analyzed by GA (gestational age) at randomization, in utero exposure to magnesium sulfate during 30~ 34 weeks did not reduce the rate of death or cerebral palsy (RR 0.93, 95% CI 0.79~ 1.09). However, cerebral palsy (RR 0.70, 95% CI 0.54~ 0.90), moderate-severe cerebral palsy (RR 0.61, 95% CI 0.44~ 0.84), and death with moderate-severe cerebral palsy were significantly reduced, without an evident increase in risk death (RR 0.99, 95% CI 0.82~ 1.19). Similar results were obtained when the GA at randomization was less than 30 weeks. When only neuroprotection trials (four trials, 4 324 fetuses/infants) are analyzed, in utero exposure to Magnesium Sulfate additionally reduced the outcome of cerebral palsy. Conclusion Fetal exposure to Magnesium Sulfate in women at risk of preterm delivery significantly reduces the risk of cerebral palsy without increasing the risk of death.