Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage
Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage
复制标题
DOI：
10.3171/jns.2002.96.3.0510
复制
发表时间：
2002-03-01
影响因子：
4.1
通讯作者：
Malik, GM
中科院分区：
文献类型：
--
作者：
Veyna, RS;Seyfried, D;Malik, GM
Object.血管痉挛仍然是蛛网膜下腔出血（SAH）后神经系统发病率和死亡率的重要来源，尽管目前的医疗，外科手术和血管内治疗的进步。硫酸镁治疗已被证明是安全和有效的预防神经系统并发症的产科患者子痫。使用脑损伤、脑缺血和SAH的实验模型获得的证据表明，Mg也可能具有神经保护剂的作用。作者假设硫酸镁治疗是安全可行的，对血管痉挛有有益的影响，并最终对蛛网膜下腔出血后的神经功能结局有有益的影响。在40例SAH后72小时内入组的患者中进行了一项前瞻性随机单盲临床试验，在SAH（Hunt和Hess分级II-IV）后进行大剂量MgSO 4治疗，并给予静脉MgSO 4或对照溶液10天。在整个治疗期间，血清Mg++水平维持在4 - 5.5 mg/dl范围内。两组的临床管理原则相同（包括早期使用手术或血管内治疗，随后进行积极的血管痉挛预防和治疗）。每天进行经颅多普勒（TCD）超声记录，并使用格拉斯哥结局量表（GOS）测量临床结局。采用独立t检验分析患者的GOS评分和TCD记录。40例患者入组研究：20例（15例女性和5例男性患者）接受治疗，20例（11例女性和9例男性患者）作为对照组。这两组患者的平均年龄分别为46岁和51岁，MgSO 4治疗组的平均临床Hunt和Hess分级为2.6 ± 0.68，对照组为2.3 ± 0.73（平均标准差）。[SD]，p = 0.87）。两组的Fisher分级相似。MgSO 4治疗组的平均大脑中动脉流速为93 +/- 27 cm/s，对照组为102 +/- 34 cm/s（平均值+/- SD，p = 0.41）。经血管造影证实的症状性血管痉挛发生在20例接受MgSO 4治疗的患者中的6例和16例接受安慰剂治疗的患者中的5例。治疗组和对照组的平均GOS评分分别为3.8 +/- 1.6和3.6 +/- 1.5（平均值+/- SD，p = 0.74）。MgSO 4治疗的显著不良反应没有发生，结论。大剂量MgSO 4在蛛网膜下腔出血后给药是安全的，Mg++水平稳定在4 ~ 5.5 mg/dl范围内。这种治疗不会干扰神经系统评估、手术期间的麻醉管理或临床护理的其他方面。我们观察到一种趋势，即在用MgSO 4治疗的组中获得GOS评分为4或5的患者百分比较高，但该趋势未达到统计学显著水平。需要更大规模的研究来进一步评估这一趋势。
Object. Vasospasm remains a significant source of neurological morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH), despite advances in current medical, surgical, and endovascular therapies. Magnesium sulfate therapy has been demonstrated to be both safe and effective in preventing neurological complications in obstetrical patients with eclampsia. Evidence obtained using experimental models of brain injury, cerebral ischemia, and SAH indicate that Mg may also have a role as a neuroprotective agent. The authors hypothesize that MgSO4 therapy is safe, feasible, and has a beneficial effect on vasospasm and, ultimately, on neurological outcome following aneurysmal SAH.Methods. A prospective randomized single-blind clinical trial of high-dose MgSO4 therapy following aneurysmal SAH (Hunt and Hess Grades II-IV) was performed in 40 patients, who were enrolled within 72 hours following SAH and given intravenous MgSO4 or control solution for 10 days. Serum Mg++ levels were maintained in the 4 to 5.5 mg/dl range throughout the treatment period. Clinical management principles were the same between groups (including early use of surgery or endovascular treatment, followed by aggressive vasospasm prophylaxis and treatment). Daily transcranial Doppler (TCD) ultrasonographic recordings were obtained, and clinical outcomes were measured using the Glasgow Outcome Scale (GOS). The patients' GOS scores and the TCD recordings were analyzed using the independent t-test.Forty patients were enrolled in the study: 20 (15 female and five male patients) received treatment and 20 (11 female and nine male patients) comprised a control group. The mean ages of the patients in these groups were 46 and 5 1, respectively, and the mean clinical Hunt and Hess grades were 2.6 +/- 0.68 in the MgSO4 treatment group and 2.3 +/- 0.73, in the control group (mean standard deviation.[SD], p = 0.87). Fisher grades were similar in both groups. Mean middle cerebral artery velocities were 93 +/- 27 cm/second in MgSO4-treated patients and 102 +/- 34 cm/second in the control group (mean +/- SD, p = 0.41). Symptomatic vasospasm, confirmed by angiography, occurred in six of 20 patients receiving MgSO4 and in five of 16 patients receiving placebo. Mean GOS scores were 3.8 +/- 1.6 and 3.6 +/- 1.5 (mean +/- SD, p = 0.74) in the treatment and control groups, respectively. Significant adverse effects from treatment with MgSO4 did not occur,Conclusions. Administration of high-dose MgSO4 following aneurysmal SAH is safe, and steady Mg++ levels in the range of 4 to 5.5 mg/dl are easily maintained. This treatment does not interfere with neurological assessment, administration of anesthesia during surgery, or other aspects of clinical care. We observed a trend in which a higher percentage of patients obtained GOS scores of 4 or 5 in the group treated with MgSO4, but the trend did not reach a statistically significant level. A larger study is needed to evaluate this trend further.