硫酸镁对颅内动脉瘤性蛛网膜下腔出血后脑血管痉挛的治疗作用

目的观察硫酸镁对动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛和神经功能预后的治疗作用。方法39例动脉瘤性蛛网膜下腔出血患者在发病48 h内,随机分到生理盐水组(A组)、硫酸镁治疗1组(B组)、硫酸镁治疗2组(C组),B组首次静脉推注25％硫酸镁10 mL后,继以每日25％硫酸镁40 mL静脉滴注,C组首次静脉推注25％硫酸镁20 mL后,继以每日25％硫酸镁80 mL静脉滴注,A组输入等量生理盐水,均连续输入14 d并每日检测血清Mg2+浓度、血压及TCD检测大脑中动脉平均血流速度。6个月后随访并记录患者Glasgow Outcome Scall-Extended、Modified Rankin Scall用以评价患者神经功能预后情况。结果17例患者发生症状性脑血管痉挛,A组7例,B组5例、C组5例;17例症状性脑血管痉挛患者的6个月GOSE评分,A组1／7例,B组3／5例、C组3／5例患者神经功能恢复良好;39例患者中硫酸镁治疗组患者6个月后GOSE、Modified Rankin Scale评分与生理盐水组比较,神经功能预后有改善倾向。然而,这些疗效评分差异均没有达到统计学意义(P>0．05)。结论硫酸镁治疗安全且血清Mg2+水平较容易维持,硫酸镁有减少症状性脑血管痉挛发生和改善患者神经功能预后的趋势,但由于样本例数较少,其治疗作用仍有待于进一步研究证实。

Intravenous magnesium sulfate in aneurysmal subarachnoid hemorrhage

Objective To investigate the safety and efficacy of MgSO4 infusion on symptomatic vasospasm and functional outcome in patients with aneurysmal SAH. Methods 39 patients were enrolled in the study winthin 48 hours following aneurysmal SAH. Patients were randomly located to saline infusion( group A) and intravenous MgSO4 40 mL/day ( group B) , 80 mL/day (group C ) for 14 days. Magnesium concentration, blood pressure and the mean flow velocity of MCA were checked for 14 days. Disability and the long-term functional outcomes were assessed by GOSE, Modified Ranking Scale. Results symptomatic vasospasm occurred 17 of 39 patients,7 patients in group A,5 patients in group B,5 patiets in group C; patients with symptomatic vasospasm receiving MgSO4 have better functional recovery and an improved score in GOSE 6 months follow-up. However, none of these outcomes variable reach a statistically significant level. Conclusion Administration of MgSO4 following aneurysmal SAH is safe and steady Mg2 + levels are easily maintained. This treatment may be useful in producing better outcomes. A larger study is required to confirm the effect of MgSO4.