Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series.
Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series.
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DOI：
10.1186/1752-1947-4-100
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发表时间：
2010-03-31
影响因子：
1
通讯作者：
Filos KS
中科院分区：
文献类型：
--
作者：
Karanikolas M;Velissaris D;Marangos M;Karamouzos V;Fligou F;Filos KS
破伤风在发达国家很少发生，但它可能导致致命的并发症，包括由于全身肌肉痉挛引起的呼吸衰竭。镁输注已被用于治疗破伤风的痉挛状态，其有效性得到了几个病例报告和最近的随机对照试验的支持。2006年和2007年，三名年龄分别为30岁、50岁和77岁的希腊白人男子被诊断为破伤风，并因全身痉挛导致呼吸衰竭而住进普通12床重症监护室。重症监护室治疗包括抗生素、补液、肠内营养、早期气管切开和机械通气。静脉镁治疗控制痉挛，而不需要额外的肌肉松弛剂。他们的药物治疗持续了26天，并根据需要进行调整以控制痉挛。每天测量两次的血浆镁水平保持在3至4.5 mmol/L范围内。在这些患者中，我们没有观察到与镁治疗相关的血流动力学不稳定、心律失常或其他并发症。所有患者均好转，停止机械通气，并在病情稳定的情况下从重症监护室出院。与以前的报告相比，我们的病例系列提供了以下有意义的额外信息：静脉镁治疗用于已经需要机械通气的患者，并在两名患者中保持有效长达26天（明显长于以前的报告），无明显毒性。我们所有患者的总体结局均良好。然而，静脉镁治疗的最佳剂量、最佳持续时间和最大安全持续时间尚不清楚。因此，在获得更多关于镁治疗的安全性和有效性的数据之前，它的使用应仅限于仔细选择的破伤风病例。
Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition. In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports) without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases.