CAJ | 학술논문

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（5235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4324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。
목적：계통분석산전사용류산미대태인신경적보호작용。방법검색 PubMed、Cochrane 도서관、EMBASE、중국기간전문수거고、중국생물의학문헌수거고、중문과기기간전문수거고수록적공개발표여연구목적상관적수궤대조연구문헌，대만족조건적수거진행합병분석，Meta 분석연건용RevMan 5．0。평개지표포괄：태인출생후18～24개월발생뇌탄병위산인사망、뇌탄、중-중도뇌탄、중-중도뇌탄병위산인사망、위산인사망，근거사용류산미시적임신주수래분석기대태인신경계통적보호작용。결과5개수궤대조연구（5235명태인/신생인）납입분석。임신30～34주사용류산미병불능감소뇌탄병위산인사망적발생솔（상대위험도0．93，95％가신구간0．79～1．09），단시단독발생적뇌탄（상대위험도0．70，95％가신구간0．54～0．90）、중-중도뇌탄（상대위험도0．61，95％가신구간0．44～0．84）명현감소，이위산인사망솔（상대위험도0．99，95％가신구간0．82～1．19）병미증가。대우임신불족30주적태인진행연구득출동양적결론。대단순종태인신경보호작용출발산전사용류산미적4개연구（섭급태인4324명）진행분석，결과위모체산전사용류산미가이감소뇌탄적발생。결론대우유조산풍험적잉부사용류산미가이감소태인출생후뇌탄적발생솔，이불회증가사태적발생。
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.