van den Bergh Walter M, Algra Ale, van der Sprenkel Jan Willem Berkelbach, Tulleken Cornelis A F, Rinkel Gabriël J E
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Neurosurgery. 2003 Feb;52(2):276-81; discussion 281-2. doi: 10.1227/01.neu.0000043984.42487.0e.
Hypomagnesemia frequently occurs in hospitalized patients, and it is associated with poor outcome. We assessed the frequency and time distribution of hypomagnesemia after aneurysmal subarachnoid hemorrhage (SAH) and its relationship to the severity of SAH, delayed cerebral ischemia (DCI), and outcome after 3 months.
Serum magnesium was measured in 107 consecutive patients admitted within 48 hours after SAH. Hypomagnesemia (serum magnesium <0.70 mmol/L) at admission was related to clinical and initial computed tomographic characteristics by means of the Mann-Whitney U test. Hypomagnesemia at admission and during the DCI onset period (Days 2-12) was related to the occurrence of DCI and hypomagnesemia at admission, and hypomagnesemia that occurred any time during the first 3 weeks after SAH was related to outcome.
Hypomagnesemia at admission was found in 41 patients (38%) and was associated with more cisternal (P = 0.006) and ventricular (P = 0.005) blood, a longer duration of unconsciousness (P = 0.007), and a worse World Federation of Neurosurgical Societies scale score at admission (P = 0.001). The crude hazard ratio for DCI with hypomagnesemia at admission was 2.4 (95% confidence interval, 1.0-5.6), and after multivariate adjustment it was 1.9 (95% confidence interval, 0.7-4.7). The hazard ratio of hypomagnesemia from Days 2 to 12 for patients with DCI was 3.2 (range, 1.1-8.9) after multivariate adjustment. The crude odds ratio for poor outcome (Glasgow Outcome Scale score, 1-3) with hypomagnesemia at admission was 2.5 (range, 1.1-5.5). Hypomagnesemia at admission did not contribute to the prediction of outcome in the multivariate model.
Hypomagnesemia is frequently present after SAH and is associated with severity of SAH. Hypomagnesemia occurring between Days 2 and 12 after SAH predicts DCI.
低镁血症在住院患者中经常发生，且与不良预后相关。我们评估了动脉瘤性蛛网膜下腔出血（SAH）后低镁血症的发生频率和时间分布，及其与SAH严重程度、迟发性脑缺血（DCI）和3个月后预后的关系。
对107例在SAH后48小时内入院的连续患者测定血清镁。入院时低镁血症（血清镁<0.70 mmol/L）通过Mann-Whitney U检验与临床和初始计算机断层扫描特征相关。入院时及DCI发病期（第2 - 12天）的低镁血症与DCI的发生及入院时的低镁血症相关，SAH后前3周内任何时间发生的低镁血症与预后相关。
41例患者（38%）入院时存在低镁血症，且与更多的脑池（P = 0.006）和脑室（P = 0.005）积血、更长的昏迷持续时间（P = 0.007）以及入院时更差的世界神经外科协会联合会量表评分（P = 0.001）相关。入院时低镁血症患者发生DCI的粗风险比为2.4（95%置信区间，1.0 - 5.6），多因素调整后为1.（95%置信区间，0.7 - 4.7）。多因素调整后，DCI患者在第2至12天发生低镁血症的风险比为3.2（范围，1.1 - 8.9）。入院时低镁血症患者预后不良（格拉斯哥预后量表评分，1 - 3）的粗比值比为2.5（范围，1.1 - 5.5）。在多因素模型中，入院时低镁血症对预后的预测无贡献。
SAH后经常出现低镁血症，且与SAH的严重程度相关。SAH后第2至12天发生的低镁血症可预测DCI。
