Magnesium sulfate in the management of patients with Fisher Grade 3 subarachnoid hemorrhage: A pilot study
Magnesium sulfate in the management of patients with Fisher Grade 3 subarachnoid hemorrhage: A pilot study
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DOI：
10.1097/00006123-200009000-00014
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发表时间：
2000-09-01
期刊：
影响因子：
4.8
通讯作者：
Mee, E
中科院分区：
文献类型：
--
作者：
Boet, R;Mee, E
目的：目的：探讨硫酸镁（MgSO 4）对严重蛛网膜下腔出血（SAH）患者临床病程的影响。患者在发作后10天内给予推注以及持续静脉输注MgSO 4。获得血镁水平以调整MgSO 4的每日需要量。目标是将血清水平升高至2.0 - 2.5 mmol/L或基线血清水平的两倍。每日经颅多普勒（TCD）超声检查每例患者，脑前动脉和大脑中动脉。进一步的管理遵循标准协议，包括使用尼莫地平和高血容量治疗。记录TCD超声检查结果以及脑血管痉挛的临床证据。所有患者进行了3个月的评估，使用格拉斯哥Outcome Scale.RESULTS：20 mmol硫酸镁推注和平均每日连续输注84.7 mmol后，10例患者中有8例达到预定的血清镁水平。输注期间未观察到不良反应。5例患者经颅多普勒超声检查显示血管痉挛; 2例患者血管痉挛严重（速度>200 cm/s）。三名患者，包括两名经颅多普勒超声检查显示严重血管痉挛的患者，表现出血管痉挛的临床证据。2例患者的格拉斯哥结局量表评分为3分，其余患者的格拉斯哥结局量表评分为5分。结论：建立了硫酸镁治疗蛛网膜下腔出血的给药指南。需要一项前瞻性双盲安慰剂对照试验来确定MgSO 4治疗蛛网膜下腔出血血管痉挛的有效性。
OBJECTIVE: To evaluate the effect of magnesium sulfate (MgSO4) on the clinical course of patients with severe aneurysmal subarachnoid hemorrhage (SAH).METHODS: Ten patients with Fisher Grade 3 aneurysmal SAH were evaluated. The patients were given a bolus as well as a constant infusion of intravenous MgSO4 up to 10 days postictus. Blood magnesium levels were obtained to adjust the daily requirement of MgSO4. The goal was to raise the serum level to 2.0 to 2.5 mmol/L or twice the baseline serum level. Daily transcranial Doppler (TCD) ultrasonography was performed on each patient, insonating both anterior cerebral and middle cerebral arteries. Further management followed standard protocols, including the use of nimodipine and hypervolemic therapy. TCD ultrasonographic findings, as well as clinical evidence of cerebral vasospasm, were documented. All patients had a 3-month assessment using the Glasgow Outcome Scale.RESULTS: After administration of a 20 mmol MgSO4 bolus infusion and an average daily continuous infusion of 84.7 mmol, 8 of 10 patients achieved the predetermined serum magnesium levels. No adverse affects were noted during the infusions. Five patients exhibited evidence of vasospasm on TCD ultrasonography; vasospasm was severe in two patients (velocities, >200 cm/s). Three patients, including the two patients in whom TCD ultrasonography demonstrated severe vasospasm, exhibited clinical evidence of vasospasm. Two patients had a Glasgow Outcome Scale score of 3; the remainder had Glasgow Outcome Scale scores of 5.CONCLUSION: Administration guidelines for the use of MgSO4 in aneurysmal SAH were established. A prospective double-blind placebo-controlled trial is required to establish the effectiveness of MgSO4 for treating vasospasm in aneurysmal SAH.