van den Bergh W M, Albrecht K W, Berkelbach van der Sprenkel J W, Rinkel G J E
Department of Neurosurgery, Room G03.124, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Acta Neurochir (Wien). 2003 Mar;145(3):195-9; discussion 199. doi: 10.1007/s00701-002-1064-9.
Magnesium is a neuroprotective agent which might prevent or reverse delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH). Although the dosage for short-term magnesium therapy is well established, there is lack of knowledge on the dosage for extended use of magnesium. Our aim was to find a dosage schedule of magnesium sulphate to maintain a serum magnesium level of 1.0-2.0 mmol/L for 14 days to cover the period of DCI.
We prospectively studied 14 patients admitted within 48 hours after aneurysmal subarachnoid haemorrhage (SAH) to our hospital. Magnesium sulphate was administrated intravenously for 14 days, using 3 different dosage schedules. Group A (n=3) received a bolus injection of 16 mmol magnesium sulphate followed by a continuous infusion of 16 mmol/daily; group B (n=6) a continuous infusion of 30 mmol/daily; and group C (n=5) a continuous infusion of 64 mmol/daily. Serum magnesium was measured at least every two days and all patients were under continuous observation during magnesium treatment. Renal magnesium excretion was measured only in group C.
In treatment group A the mean serum magnesium level during treatment was 1.03+/-0.14 (range 0.82-1.34) mmol/L, in group B 1.10+/-0.15 (range 0.87-1.43) mmol/L, and in group C 1.38+/-0.18 (range 1.11-1.98) mmol/L. The renal magnesium excretion in group C was equal to the administrated doses within 48 hours after treatment had started. All patients in group A reported a flushing sensation during the bolus injection; no other side effects were noted.
With a continuous intravenous dosage of 64 mmol/L per day, serum magnesium levels maintained within the range of 1.0-2.0 mmol/L for 14 days.
镁是一种神经保护剂，可能预防或逆转动脉瘤性蛛网膜下腔出血（SAH）后的迟发性脑缺血（DCI）。尽管短期镁治疗的剂量已明确，但对于镁长期使用的剂量仍缺乏了解。我们的目的是找到硫酸镁的剂量方案，以维持血清镁水平在1.0 - 2.0 mmol/L达14天，覆盖DCI发生的时间段。
我们前瞻性研究了14例在动脉瘤性蛛网膜下腔出血（SAH）后48小时内入院至我院的患者。硫酸镁静脉给药14天，采用3种不同的剂量方案。A组（n = 3）先静脉推注16 mmol硫酸镁，随后持续输注16 mmol/天；B组（n = 6）持续输注30 mmol/天；C组（n = 5）持续输注64 mmol/天。至少每两天测量一次血清镁，且所有患者在镁治疗期间均接受持续观察。仅在C组测量肾脏镁排泄量。
治疗组A治疗期间的平均血清镁水平为1.03±0.14（范围0.82 - 1.34）mmol/L，B组为1.10±0.15（范围0.87 - 1.43）mmol/L，C组为1.38±0.18（范围1.11 - 1.98）mmol/L。C组肾脏镁排泄量在治疗开始后48小时内与给药剂量相当。A组所有患者在推注期间均报告有潮热感；未观察到其他副作用。
每天持续静脉输注64 mmol/L时，血清镁水平可维持在1.0 - 2.0 mmol/L范围内达14天。
