硫酸镁在麻醉镇痛中的应用现状

由于Mg2+具有拮抗N-甲基-天门冬氨酸(N-methyl-D-aspartment,NMDA)受体,抑制运动神经末梢乙酰胆碱和肾上腺髓质及交感能神经末梢肾上腺素等介质的释放等作用,常用以辅助全身麻醉、术后镇痛等,可明显减少麻醉镇痛药的消耗.     

硫酸镁对继发性脊髓损伤保护作用的实验研究

目的：探讨硫酸镁对继发性脊髓损伤的保护作用及其作用机制。方法：选健康新西兰大白兔36只，随机分为3组：A组为正常组，仅行L1～L3椎板减压；B组和C组分别为对照组和治疗组，行L1～L3椎板减压后采用Allen’s重物打击法致伤脊髓．伤后30min时B组经腹腔注射蒸馏水600mg／kg，C组经腹腔注射硫酸镁600mg／kg。48h后切取伤段脊髓组织分别测定水、钙、镁含量，观察局部组织病理学改变、超微结构变化及单位面积凋亡细胞数。结果：与A组比较，B、C组伤段脊髓组织水、钙含量增多，镁含量减少，组织病理学改变及超微结构破坏严重，细胞凋亡数上升，且C组较对B组轻。结论：早期应用硫酸镁治疗可减轻脊髓损伤后的继发性损伤。     

Effects of magnesium sulfate on traumatic brain edema in rats

svarietyofneuroprotectiveagentshavebeensynthesized .However ,besidessomeagentspresentlybeingevaluatedinclinicaltrails ,mostofthesecompoundshavelimitedclinicalusebecauseofneurotoxicityandbehavioralsideeffects .Recently ,severalstudiesdemonstratedthattraumaticinjurytothebraincausesadecreaseinmagnesiumconcentrationcorrelatedwithinjuryseverity .1Sincethen ,moreandmoreattentionhasbeen paidtoMgSO4 foritsneuroprotectiveeffects .Magnesiumsulfatehasbeenwidelyusedinclinicalpracticeforalmost 10 0 years.…     

硫酸镁对术中瑞芬太尼用量及术后镇痛的影响

目的 观察全凭静脉麻醉时硫酸镁对瑞芬太尼用苣及术后镇痛的影响.方法 80例ASA I或Ⅱ级,行腹腔镜手术患者随机均分为两组:硫酸镁组(A组)和生理盐水组(B组).比较两组术中瑞芬太尼平均每小时用量及术后视觉模拟(VAS)疼痛评分、舒适度(BCS)评分及首次使用镇痛药时间.结果 与B组比较,A组瑞芬太尼用量减少(P<0.01),术后VAS疼痛评分降低(P<0.05),BCS评分增高(P<0.01),首次使用镇痛药时间延长(P-C0.01).结论 全凭静脉麻醉术中使用硫酸镁能减少瑞芬太尼用量.并缓解术后疼痛.     

硫酸镁对瑞芬太尼引起痛觉过敏的影响

目的研究大鼠切口痛模型中硫酸镁对瑞芬太尼诱发的痛觉过敏的影响。方法 42只雄性SD大鼠,随机均分为七组:切口痛组(I组)、瑞芬太尼组(R组)、切口痛+硫酸镁组(MgI组)、切口痛+瑞芬太尼+硫酸镁(250、500、1 000 mg/kg)组(MgR1、MgR2、MgR3组)、对照组(C组)。MgI、MgR组均于麻醉前10 min腹腔注射硫酸镁稀释液4 ml,余组给予相应生理盐水4 ml。除C组外,各组均制作切口痛模型。各组均测定并计算出术前24 h(T0),术后6、24、48 h(T1、T2、T3)大鼠右后爪的热缩足反射阈值(PWTL)及机械缩足反射阈值(PMW)。结果与I组比较,T1~T3时R组PWTL值明显缩短,PMW值明显减少(P<0.05);MgI组PWTL值缩短和PMW值减少(P<0.05)。与R组比较,MgR1、MgR2、MgR3组PWTL值缩短和PMW值减少(P<0.05)。结论硫酸镁可减轻大鼠切口周围组织疼痛,并能缓解由瑞芬太尼诱发的切口周围组织痛觉过敏。     

Spasmolytic effect of magnesium sulfate on serotonin-induced pulmonary hypertension and bronchoconstriction in dogs

BACKGROUND: Magnesium (Mg2+) has relaxant effects on histamine-induced bronchoconstriction. In addition, Mg2+ has been reported to reduce vascular smooth muscle tone and be clinically useful for treatment of persistent pulmonary hypertension of the newborn. In this study, we evaluated the relaxant effect of Mg2+ on serotonin (5HT)-induced bronchoconstriction and pulmonary hypertension. METHODS: Seven mongrel dogs were anesthetized with pentobarbital (30 mg x kg(-1) + 2 mg x kg(-1) x h(-1)) and paralyzed by pancuronium (0.2 mg x kg(-1) x h(-1)). Bronchoconstriction and pulmonary hypertension were elicited with 5HT (10 microg x kg(-1) + 1 mg x kg(-1) x h(-1)). Airway caliber was evaluated by changes in bronchial cross-sectional area (BCA) of the 3rd bronchial bifurcation measured by a fiberoptic bronchoscope method as previously reported. Pulmonary hypertension was assessed by changes in pulmonary vascular resistance (PVR). The BCA and PVR were expressed as per cent of the basal level. Thirty minutes after start of 5HT infusion, magnesium sulfate (MgSO4): 0 (saline), 1, 10, 100 and 1000 micromol x kg(-1) was given i.v.. Arterial blood was also collected to measure plasma level of Mg2+ and catecholamines. RESULTS: 5HT increased %PVR to 163+/-25% and decreased % BCA by 39.2+/-4.5%. Plasma level of Mg2+ following MgSO4 1000 micromol x kg(-1) i.v. exceeded its toxic level. The ED50s of MgSO4 (dose producing 50% relaxation of maximal constriction) was 47.8 micromol x kg(-1) and 1.09 mmol x kg(-1) for pulmonary hypertension and bronchoconstriction, respectively. The ratio of %PVR to %SVR was about 1.0 after MgSO4 0-100 micromol x kg(-1) i.v., although the ratio significantly increased after 1000 micromol x kg(-1) i.v.. CONCLUSION: In dogs, 5HT-induced pulmonary hypertension but not bronchoconstriction was significantly reduced by an iv bolus of MgSO4, resulting in a plasma concentration within the assumed therapeutic level.     

硫酸镁联合拉贝洛尔治疗重度妊娠高血压综合征临床疗效观察

目的探讨硫酸镁联合拉贝洛尔治疗重度妊娠高血压综合征（PIH）的临床疗效。方法选择笔者所在医院2009年1月～2011年2月收治的重度PIH孕妇86例,随机分为对照组和治疗组各43例,对照组给予硫酸镁常规解痉降压,观察组则在硫酸镁基础上,应用拉贝洛尔针加入5%葡萄糖注射液中静脉点滴。结果两组患者治疗后血压控制有效率观察组明显优于对照组,差异有统计学意义（P〈0.05）;并发症发生率上,两组患者在宫颈裂伤、子宫过度刺激、产后出血的发生率均有显著性差异（P〈0.05）。结论硫酸镁联合拉贝洛尔治疗重度PIH效果确切,能有效降低患者平均动脉血压,改善母婴结局,具有广阔的临床应用前景。     

The value of epidural magnesium sulfate as an adjuvant to bupivacaine and fentanyl for labor analgesia

ObjectiveWe conducted this clinical study to assess the adjuvant effects of single dose magnesium sulfate (Mg) when administered epidurally during labor with fentanyl and bupivacaine.MethodsEighty healthy nulliparous women in labor requesting epidural analgesia were divided into two groups. Group 1 received bupivacaine 0.125% with magnesium sulfate 50 mg and fentanyl 50 μg as a loading dose; group 2, received bupivacaine 0.125% and fentanyl 50 μg only. Hemodynamic parameters, motor and sensory evaluation, cervical dilation at time of consenting, the progress of labor, the visual analog pain score (VAS), Apgar score, cord blood acid base status, side effects as nausea, vomiting, itching and respiratory depression were recorded. Fetal heart rate tracings were also documented.ResultsEpidural single dose magnesium sulfate added to bupivacaine and fentanyl in labor resulted in significantly faster onset and longer duration of epidural analgesia (169 ± 50 min) in comparison to those patients who received bupivacaine and fentanyl only (105 ± 41 min), also there was a significant reduction in the number of women requiring additional boluses of bupivacaine when Mg was added (P = 0.016). The two groups had no significant differences as regards maternal satisfaction score, maternal and neonatal adverse effects.ConclusionMagnesium sulfate added to bupivacaine and fentanyl for labor epidural analgesia resulted in faster onset, longer duration of action and reduced the break through pain.     

妊娠高血压综合征治疗中硫酸镁的应用价值分析

目的：探讨硫酸镁在妊娠高血压综合征治疗中的应用价值。方法我院2012年1月～2013年12月间收治的妊娠高血压综合征患者84例,所有患者均给予硫酸镁治疗,观察治疗总有效率、治疗前后患者血压、血流变学变化及产后并发症发生情况。结果84例患者治疗总有效率达到95.24%（80/84）;治疗后患者舒张压及收缩压较治疗前均有明显下降,血流变学各观察指标均较治疗前明显下降（P＜0.05）;产后并发症发生率5.95%（5/84）,无一例新生儿窒息或死亡。结论硫酸镁治疗妊娠高血压综合征疗效较佳、且具有一定的安全性,临床推广应用价值显著。     

Effects of magnesium sulfate on neuromuscular function and spontaneous breathing during sevoflurane and spinal anesthesia

The purpose of the present study was to determine the effects of magnesium sulfate (MgSO⁴) on the neuromuscular function and spontaneous breathing of patients under sevoflurane and spinal anesthesia. Twenty-two patients with a history of arrhythmia undergoing elective knee surgery were randomly assigned to two groups: group M (n = 11), administered with MgSO⁴ 40 mg·kg⁻¹, and group S (n = 11), administered with saline. A combination of spinal anesthesia with 2% sevoflurane inhalation was applied to all patients under spontaneous breathing. Tidal volume (Vt), respiratory rate (RR) and end-tidal carbon dioxide (ET^{CO 2}) were measured before the MgSO⁴ or saline injection and measurements were repeated at 5, 15, 30, and 45 min after the injection. Neuromuscular function was continuously monitored with an acceleromyograph to record the acceleration of the adductor pollicis by stimulating the ulnar nerve at a frequency of 0.1 Hz. The Vt, RR, and ET^{CO 2} showed little change in either group, and there was no significant difference between, the groups. The single-twitch response showed significant differences between the two groups (P = 0.0006). The present study indicated that the MgSO⁴ had a minimal effect on spontaneous breathing in patients undergoing sevoflurane and spinal anaesthesia, but that it attenuated the safety margin of neuromuscular function.     

丹参酮Ⅱ A联合硫酸镁对兔脑急性缺血后钙超载的影响

目的观察丹参酮ⅡA(TSN)、硫酸镁(MS)及二者联合应用对兔脑急性缺血细胞钙超载的影响。方法40只大白兔随机分为五组:假手术组(Ⅰ组),缺血组(Ⅱ组),TSN组(Ⅲ组),MS组(Ⅳ组),TSN MS联合组(Ⅴ组),每组8只。采用夹闭双侧颈总动脉并放血致休克30min急性脑缺血再灌注模型。经股静脉注入伊文氏兰(EB)3mg/kg。Ⅰ、Ⅱ组静注生理盐水,Ⅲ组静脉输注TSN3mg·kg-1·h-1,Ⅳ组静注MS140mg·kg-1·15min-1 腹腔注射1g,Ⅴ组同时静注TSN及MS(方法同Ⅲ、Ⅳ组)。检测额皮层脑组织EB含量、细胞内游离钙(iCa2 )浓度、血浆和脑脊液的Ca2 和Mg2 浓度、血浆Ca2 /Mg2 比率和全血粘度。结果脑组织EB含量和iCa2 均以Ⅰ组最低,Ⅴ组次之,Ⅱ组最高(P<0.01);Ⅲ组和Ⅳ组间差异无显著意义(P>0.05)。血浆Ca2 浓度以Ⅲ组最高,脑脊液Ca2 浓度Ⅱ组最低(P<0.05)。血浆、脑脊液的Mg2 浓度以Ⅳ组及Ⅴ组明显增高(P<0.05)。Ca2 /Mg2 比率以Ⅱ组最低(P<0.05)。全血粘度以Ⅲ组及Ⅴ组最低(P<0.01)。结论TSN与MS均具有减轻急性脑缺血细胞钙超载,促进Mg2 通过血脑屏障和降低全血粘度的作用,两者联合应用可能有协同效果。     

硫酸镁对兔脊髓缺血再灌注损伤保护作用的研究

目的:探讨硫酸镁对兔脊髓缺血再灌注损伤的保护效果。方法:27只新西兰大白兔,随机分为A组(硫酸镁处理组)、B组(生理盐水)和C组(假手术对照组)。A、B两组参照Tetik方法建立兔脊髓腰骶段缺血模型,比较三组动物不同时间点的体感诱发电位(SEP)、后肢运动功能评分及缺血再灌注后48h的病理学改变。结果:C组SEP没有明显变化,动物均完全康复。缺血30min时B组波形消失,A组波幅降为基线的(29.3±1.9)%。再灌注60min后A组、B组SEP波幅分别渐升致基线的(74.5±2.3)%和(49.2±2.1)%。A组N1、P1波峰潜伏期在缺血30min及再灌注60min时均明显优于B组(P<0.05);再灌注24h和48h后,A组的后肢运动功能评分均显著高于B组(P<0.05);再灌注48h后A组的脊髓前角神经细胞计数显著高于B组(P<0.01)。结论:硫酸镁具有减轻兔脊髓缺血再灌注损伤及保护神经功能的作用。     

硫酸镁对子痫前期产妇硬膜外分娩镇痛产时发热的影响

目的 探讨硫酸镁对子痫前期产妇硬膜外分娩镇痛产时发热的疗效及安全性.方法 选择单胎、头位、子痫前期初产妇125例,年龄23～33岁,BMI 23～29 kg/m2,ASAⅡ或Ⅲ级.随机分为两组,硫酸镁组(M组,n=66)和对照组(C组,n=59).M组分娩镇痛前经静脉输注硫酸镁50 mg/kg,持续20 min;C组同...     

艾司氯胺酮与硫酸镁用于腹腔镜全子宫切除术后镇痛效果的比较

目的 观察和比较艾司氯胺酮与硫酸镁用于腹腔镜全子宫切除术后镇痛的效果。
方法 选择择期在全麻下行腹腔镜全子宫切除术患者135例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组：艾司氯胺酮组（E组，n=67）和硫酸镁组（M组，n=68）。E组在手术开始前静脉注射艾司氯胺酮0.25 mg/kg，随后持续静脉泵注0.15 mg·kg^-1·h^-1；M组在手术开始前静脉注射硫酸镁50 mg/kg，随后持续静脉泵注8 mg·kg^-1·h^-1。术后行患者自控静脉镇痛（PCIA），配方为氢吗啡酮0.1 mg/kg+帕洛诺司琼0.25 mg。记录术中丙泊酚、瑞芬太尼用量和苏醒时间。记录术后2、6、12、24、48 h氢吗啡酮消耗量（等效界值为0.25 mg）、静息和活动时VAS疼痛评分。记录术后0~2 h、2~6 h、6~12 h、12~24 h和24~48 h内镇痛泵按压次数。记录术后补救镇痛、术后24 h内不良反应发生情况。
结果 与M组比较，E组术中丙泊酚及瑞芬太尼用量明显增加（P＜0.05），苏醒时间明显延长（P＜0.05）。两组术后2、6、12、24、48 h氢吗啡酮消耗量、静息和活动时VAS疼痛评分、术后0~2 h、2~6 h、6~12 h、12~24 h和24~48 h内镇痛泵按压次数、术后补救镇痛率和术后24 h内不良反应发生率差异无统计学意义。
结论 艾司氯胺酮可为腹腔镜全子宫切除术患者提供与硫酸镁相似的术后镇痛效果。     

硫酸镁:一种老药的新应用

背景 近几年,随着临床医学的飞速发展,药物应用的不断实践、探索和总结,硫酸镁在各个学科领域的应用越来越广泛. 目的 综述硫酸镁在临床中的新用途及对传统应用的新认识,为临床用药提供参考. 内容 介绍硫酸镁多种药理学作用在临床中的应用进展,进一步拓宽其应用领域. 趋向 使硫酸镁更加安全、有效、广泛地应用于临床.     

硫酸镁在肌间沟臂丛神经阻滞上肢手术中的应用

目的观察超声引导下硫酸镁肌间沟臂丛神经阻滞(ISBPB)对上肢手术麻醉效果和镇痛时间的影响。方法选择ISBPB复合喉罩全麻拟行上肢手术的患者54例,男34例,女20例,年龄37~73岁,ASAⅠ或Ⅱ级,随机均分为两组:硫酸镁组(M组),超声引导下ISBPB,用药0.5%罗哌卡因8ml(40mg)加10%硫酸镁2ml(0.5g);对照组(N组),超声引导下ISBPB,用药0.5%罗哌卡因8ml加生理盐水2ml(40mg)。待神经阻滞完全起效后,静脉诱导插入喉罩通气,术中七氟醚(呼末MAC 0.8)维持。分别记录局麻药注射后感觉和运动阻滞的起效时间和持续时间,术后镇痛时间,术后4、8、12、24h的疼痛视觉模拟评分(VAS)以及术后不良反应。结果两组感觉和运动阻滞起效时间差异无统计学意义,M组的感觉阻滞持续时间和镇痛时间明显长于N组(P0.05)。术后8、12、24h M组的VAS评分明显低于N组(P0.05)。两组的术后补救用镇痛药、芬太尼用量差异无统计学意义。两组恶心呕吐的发生率差异无统计学意义。所有患者均未出现肌力减弱、麻木、瘙痒、寻麻疹等不良反应。结论超声引导下ISBPB注射0.5%罗哌卡因复合硫酸镁能延长感觉阻滞持续时间,降低术后疼痛程度,延长镇痛时间。     

The first micturition times of the newborns whose mothers were treated with magnesium sulfate

Background: The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. Methods: The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. Results: All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. Conclusions: From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants. This revised version was published online in June 2006 with corrections to the Cover Date.     

Intravenous magnesium sulfate as a preanesthetic medication: A double-blind study on its effects on hemodynamic stabilization at the time of tracheal intubation

The effects of magnesium sulfate (MgSO₄) as a preanesthetic medication were studied with regard to whether it can sedate or relieve a patient who is scheduled to undergo surgery, and whether it can control the hemodynamic response to tracheal intubation. Twenty adult patients in ASA status 1–2 undergoing elective surgery were studied. Ten patients received 50 mg·g⁻¹ MgSO₄ intravenously by drip infusion from 30 min before the induction of anesthesia, and another ten patients received saline as a control. The changes in mean arterial pressure (MAP) and rate pressure product (RPP) after the intubation were significantly suppressed in magnesium-treated patients, but a sedative effect was not observed. Therefore, MgSO₄ was useful as a preanesthetic medication in suppressing the hemodynamic response associated with tracheal intubation.     

硫酸镁对脑外伤后兔血中一氧化氮合成酶动态影响的实验研究

目的探探讨硫酸镁的脑保护作用及对脑外伤后兔血中NOS的动态影响.方法新西兰大白兔40只,随机分为对照组和治疗组(硫酸镁组),采用改良Feeney自由落体脑损伤装置制作重型脑外伤模型,脑外伤后对照组给予甘露醇生理盐水静滴,硫酸镁组则在此基础上给予硫酸镁.分别于伤前(0 h)及伤后3 h、12 h、24h、48 h、72 h、96 h、120h检测血浆NOS.结果重型脑外伤后3小时起,硫酸镁治疗组NOS含量较对照组明显下降.治疗组死亡率比对照组死亡率低.结论硫酸镁在脑外伤后早期(5天内),通过抑制NOS升高而起脑保护作用并降低重型脑外伤的死亡率.     

Inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated pregnant human myometrium

BACKGROUND: In this study, we investigated the inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated human myometrium. METHODS: Following delivery of the infant and placenta, a small segment of myometrium was excised from the upper incisional surface of the lower uterine segment and 20 strips, randomly assigned into two groups (n = 10), were obtained from 20 non-laboring term parturients. The study protocol consisted of a 60-min period of spontaneous contractions, control recording with oxytocin 2 x 10(9) m (10-min period), washout interval of 10 min, volatile administration (three times per 15-min period) of 0.5, 1 and 2 minimum alveolar concentration (MAC), response to oxytocin (10-min period), a further washout interval (10-min period) and subsequent control recording with oxytocin without anesthetics. RESULTS: After oxytocin administration, the frequency and amplitude of contractions increased (P < 0.05) and the duration decreased (P < 0.05). The frequency and amplitude of contractions induced with oxytocin decreased significantly at 0.5, 1 and 2 MAC of desflurane and sevoflurane (P < 0.05). The amplitude of contractions was significantly different at 1 MAC between the two groups (P < 0.05). The duration of contractions at 2 MAC decreased in both groups (P < 0.05). CONCLUSIONS: Desflurane and sevoflurane at 0.5, 1 and 2 MAC inhibit the frequency and amplitude of myometrial contractions induced with oxytocin in a dose-dependent manner. However, desflurane inhibits the amplitude less than sevoflurane at 1 MAC. We suggest that 0.5 MAC of both agents and 1 MAC of desflurane may be safely used in the presence of oxytocin following delivery of the infant and placenta during Cesarean section without fear of uterine atony and hemorrhage.