Chia R Y, Hughes R S, Morgan M K
Dalcross Private Hospital, Killara, The University of Sydney, Australia.
J Clin Neurosci. 2002 May;9(3):279-81. doi: 10.1054/jocn.2001.1039.
Despite recent advances in the management of aneurysmal subarachnoid haemorrhage delayed ischaemic deficits from cerebral vasospasm remains a major cause of morbidity and mortality. As magnesium is a potent cerebral vasodilator we have introduced routine supplementation in patients presented with subarachnoid haemorrhage to determine whether there has been a reduction in the incidence of cerebral vasospasm.
All patients presented with aneurysmal subarachnoid haemorrhage from February 1997 were included except those who presented after day 5 following bleed. Identical management protocol was used except intravenous magnesium supplementation which was introduced to all patients from May 1999. Incidence of cerebral vasospasm on angiograms among the two groups was analysed.
Seven out of 10 patients who did not receive magnesium supplement developed vasospasm requiring intra-arterial papaverine compared with 2 of 13 patients among the treated group (P<0.008).
From our pilot study it appears that magnesium supplement has a beneficial role in the prevention of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Further studies would seem justified.
尽管在动脉瘤性蛛网膜下腔出血的治疗方面最近取得了进展，但脑血管痉挛导致的迟发性缺血性神经功能缺损仍然是发病和死亡的主要原因。由于镁是一种有效的脑血管扩张剂，我们对蛛网膜下腔出血患者引入了常规补充镁的方法，以确定脑血管痉挛的发生率是否有所降低。
纳入1997年2月以来所有动脉瘤性蛛网膜下腔出血患者，但出血后第5天以后就诊的患者除外。除了对所有患者从1999年5月开始静脉补充镁外，采用相同的治疗方案。分析两组患者血管造影显示的脑血管痉挛发生率。
10例未补充镁的患者中有7例发生血管痉挛，需要动脉内注射罂粟碱，而治疗组13例患者中有2例发生血管痉挛（P<0.008）。
从我们的初步研究来看，补充镁在预防动脉瘤性蛛网膜下腔出血后的脑血管痉挛方面似乎具有有益作用。进一步的研究似乎是有必要的。
