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Указанные обстоятельства заставляют многочисленных исследователей обращаться к вопросу об оптимизации лечения магнием, и в первую очередь – о минимально эффективных дозах препарата. Как клинический, так и токсический эффекты МС тесно связаны с его плазменной концентрацией. Лечение экламптических судорог обычно достигается при уровне магния 1,8–3,0 ммоль/л. Первые признаки токсичности для матери проявляются при концентрации 3,5–5 ммоль/л, паралич дыхания – 5–6,5 ммоль/л, нарушение сердечной проводимости – более 7,5 ммоль/л, остановка сердца – более 12,5 ммоль/л [47]. В качестве клинических признаков, позволяющих своевременно оценить наступление токсического эффекта, используются частота дыхания, диурез и состояние сухожильных рефлексов.
Традиционное дозирование МС в качестве антиконвульсанта предусматривает применение нагрузочной дозы в 4 г в/в и 10 г в/м с последующим назначением либо 5 г в/м каждые 4 часа, либо поддерживающей в/в инфузии 1–2 г/час. Вместе с тем есть данные об эффективности и более низких доз препарата. В частности, в исследовании [5] половина стандартной поддерживающей дозы МС оказалась достаточной для предупреждения судорог, а смертность при этом уменьшилась с 16 до 8% [4]. Закономерно, что пациентки, получавшие низкие поддерживающие дозы МС (2 г/час), имели меньшую частоту побочных эффектов по сравнению с теми, кто получал 5 г/ч [82].
Таким образом, к настоящему времени накоплено большое количество данных о возможностях применения препаратов магния в акушерской практике. Магний – жизненно необходимый микроэлемент, и его дефицит сопряжен с патологическим течением беременности и неблагоприятными исходами в отношении матери, плода и новорожденного. Применение препаратов магния оправдано при угрозе прерывания беременности и преждевременных родах, при лечении и профилактике поздних гестозов, повреждении мозга у плода. В то же время следует признать, что по многим аспектам применения магния в акушерской практике не достигнут консенсус, и далеко не все существующие практические рекомендации подтверждены с позиций доказательной медицины. Для прояснения нерешенных вопросов необходимы дальнейшие качественные научные исследования.
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