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🤱 产科与新生儿 · 第2课，共6课 · 7 min

子痫前期、Magnesium 和你需要检查的反射

Preeclampsia, Magnesium and the Reflexes You Check

🩺 血压 162/112，妊娠 34 周，头痛，尿蛋白 3+。你输注的药物可以止住抽搐，也可以让她停止呼吸。区别就在于一把叩诊锤。

🩺 Blood pressure 162/112 at 34 weeks, a headache, and 3+ protein in the urine. The drug you hang can stop a seizure or stop her breathing. The difference is a reflex hammer.

💡 核心要点

子痫前期是血压达到 140/90、发生在妊娠 20 周后并伴有蛋白尿或器官征象。Magnesium 预防抽搐发作；反射消失、呼吸缓慢和尿量减少意味着毒性反应。Calcium gluconate 放在床旁。

Preeclampsia is 140/90 after 20 weeks with protein or organ signs. Magnesium prevents seizures; lost reflexes, slow breathing and low urine mean toxicity. Calcium gluconate at the bedside.

🧠 为什么重要

子痫前期是新发的高血压（收缩压 140 或更高，或舒张压 90 或更高，两次测量间隔至少 4 小时），发生在妊娠 20 周后，伴有蛋白尿或器官受累；重度特征包括收缩压达到 160 或更高，或舒张压达到 110 或更高、严重头痛、视力障碍、上腹部或右上腹疼痛、肺水肿以及血小板减少。HELLP 综合征（溶血、肝酶升高、血小板减少）是一种重度变异型。子痫是伴有抽搐发作的子痫前期。magnesium sulfate 可预防抽搐发作：通过输液泵 IV 给药，先给予负荷剂量再进行维持，护士需监测毒性反应：深腱反射消失（最早出现的征象）、呼吸少于 12 次、尿量少于 30 mL/hr，以及镁水平高于约 4 至 7 mEq/L 的治疗范围。在床旁备好 calcium gluconate 作为解毒剂。针对重度血压的降压药包括 labetalol、hydralazine 和 nifedipine。护理措施包括：安静昏暗的病房、抽搐预防措施、侧卧位、严格记录出入量、每日称体重，并监测胎儿。抽搐发作期间，保护患者，将她侧卧，不要约束；发作后，评估气道、胎儿状况以及是否有胎盘早剥。分娩是治愈方法，magnesium 通常会持续使用至产后约 24 小时。

PREECLAMPSIA is new hypertension (systolic 140 or higher OR diastolic 90 or higher on two readings at least 4 hours apart) after 20 weeks with proteinuria or organ involvement; severe features include a systolic pressure of 160 or more OR a diastolic pressure of 110 or more, severe headache, visual disturbances, epigastric or right upper quadrant pain, pulmonary edema and low platelets. HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a severe variant. ECLAMPSIA is preeclampsia with seizures. MAGNESIUM SULFATE prevents seizures: it is given IV by pump with a loading dose then maintenance, and the nurse monitors for TOXICITY: loss of DEEP TENDON REFLEXES (the earliest sign), respirations under 12, urine output under 30 mL/hr, and a magnesium level above the therapeutic range of about 4 to 7 mEq/L. Keep CALCIUM GLUCONATE at the bedside as the antidote. Antihypertensives for severe pressures include labetalol, hydralazine and nifedipine. Nursing care: quiet dim room, seizure precautions, side-lying, strict intake and output, daily weights, and monitoring the fetus. During a seizure, protect the client, turn her to the side, and do not restrain; after it, assess the airway, fetal status and for placental abruption. Delivery is the cure, and magnesium usually continues for about 24 hours postpartum.

🏥 真实场景

🔨 输注 magnesium 的第六个小时：护士叩击髌腱却毫无反应，呼吸 11 次，Foley 导尿袋中只有过去一小时的 20 mL 尿液。停止输注，按医嘱给予 calcium gluconate，并通知医生。magnesium 所预防的那次抽搐是真实存在的；而它差点造成的呼吸停止，被一次反射检查阻止了。

🔨 Hour six of a magnesium infusion: the nurse taps the patellar tendon and gets nothing, respirations are 11, and the Foley bag holds 20 mL from the last hour. The infusion is stopped, calcium gluconate is given per order, and the provider is called. The seizure the magnesium prevented was real; the respiratory arrest it nearly caused was prevented by a reflex check.

📌 要点总结

  • 重度特征：160/110、头痛、视力变化、上腹痛、血小板减少Severe features: 160/110, headache, visual changes, epigastric pain, low platelets
  • 镁中毒：反射消失最早出现，然后呼吸频率低于 12；尿量低于 30 mL/hr 会使 magnesium 蓄积，因此要报告Magnesium toxicity: absent reflexes first, then RR under 12; urine under 30 mL/hr lets magnesium build up, so report it
  • Calcium gluconate 放在床旁；分娩是治愈方法Calcium gluconate at the bedside; delivery is the cure

📖 本课术语

子痫前期 (Preeclampsia): 20周后新发的高血压，伴尿蛋白或器官受累；magnesium sulfate可预防癫痫发作。

Magnesium sulfate治疗水平 (Magnesium sulfate therapeutic level): 用于先兆子痫输注时约为4到7 mEq/L；深腱反射消失是毒性的首个征象，随后呼吸低于12，尿量低于30 mL/hr，calcium gluconate是床旁备用的解毒剂。

Hydralazine: 用于严重高血压的直接血管扩张药，包括与labetalol一起用于先兆子痫；预期会出现反射性心动过速、头痛和体位性血压下降，每次IV给药前后检查血压，并报告关节痛或皮疹，长期使用可能提示狼疮样反应。

Magnesium sulfate: 预防先兆子痫患者惊厥发作的IV药物；每小时检查深腱反射、呼吸和尿量，反射消失、呼吸低于12或尿量低于每小时30 mL时停药，并备好calcium gluconate作为床旁解毒剂。

✅ 自我测试

一名因重度子痫前期正在接受 magnesium sulfate 的患者髌腱反射消失，呼吸频率为 10。护士首先应该做什么？A client receiving magnesium sulfate for severe preeclampsia has absent patellar reflexes and a respiratory rate of 10. What should the nurse do first?
  1. 停用 magnesium 并准备 calcium gluconateStop the magnesium and prepare calcium gluconate
  2. 让患者仰卧并抬高双腿Turn the client onto her back and elevate her legs
  3. 给予 labetalolAdminister labetalol
  4. 提高输注速度以预防子痫发作Increase the infusion rate to prevent an eclamptic seizure

答案: A · 停用 magnesium 并准备 calcium gluconate

这些是 magnesium 中毒的征象；停药并给予解毒剂可预防呼吸停止。Labetalol 治疗重度高血压，但这些发现指向药物毒性而非血压问题，且它对逆转呼吸抑制毫无作用。

These are signs of magnesium toxicity; stopping the drug and giving the antidote prevent respiratory arrest. Labetalol treats severe hypertension, but these findings point to drug toxicity, not blood pressure, and it does nothing to reverse respiratory depression.

子痫前期患者的哪项评估发现提示病情恶化？Which assessment finding in a client with preeclampsia indicates worsening disease?
  1. 一天结束时足部和踝部轻度水肿Mild edema of the feet and ankles at the end of the day
  2. 上腹痛和视力障碍Epigastric pain and visual disturbances
  3. 复测血压为 142/92Blood pressure of 142/92 on repeat measurement
  4. 常规尿试纸检测有微量蛋白Trace protein on a routine urine dipstick

答案: B · 上腹痛和视力障碍

上腹痛和视力变化是重度特征，常先于抽搐发作出现。血压 142/92 达到了子痫前期的阈值，但仍低于 160/110 的重度范围，因此单凭这一点并不提示病情恶化。

Epigastric pain and visual changes are severe features that often precede seizures. A blood pressure of 142/92 meets the threshold for preeclampsia but stays below the severe range of 160/110, so on its own it does not signal worsening.

在子痫发作期间，护士的优先事项是什么？During an eclamptic seizure, what is the nurse's priority?
  1. 在牙齿之间插入口腔气道Insert an oral airway between the teeth
  2. 保护患者免受伤害，并尽可能将她侧卧Protect the client from injury and turn her to the side when possible
  3. 约束患者的四肢Restrain the client's arms and legs
  4. 离开去呼叫医生Leave to call the provider

答案: B · 保护患者免受伤害，并尽可能将她侧卧

安全和气道保护是第一位的；不要将任何东西放入口中，也绝不约束患者。

Safety and airway protection come first; nothing goes in the mouth and the client is never restrained.

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