对一名蛛网膜下腔出血后难治性血管痉挛患者静脉注射硫酸镁。

Intravenous magnesium sulfate administration in a patient with refractory vasospasm following subarachnoid hemorrhage.

作者信息

Barile Maria, van De Wyngaert Françoise, Mbia Jean-Jacques Essama, Jativa Mijael, Grandin Cécile, Rooijakkers Herbert, Hantson Philippe

机构信息

Department of Intensive Care, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.

出版信息

Intensive Care Med. 2003 Jul;29(7):1182-5. doi: 10.1007/s00134-003-1752-9. Epub 2003 Apr 16.

DOI:10.1007/s00134-003-1752-9

PMID:12698248

Abstract

OBJECTIVE

Magnesium sulfate is being investigated for the prevention or treatment of vasospasm following subarachnoid hemorrhage.

PATIENT

A 45-year-old woman suffered subarachnoid hemorrhage and developed after 8 days symptomatic vasospasm in the left middle cerebral artery (MCA) while she was receiving nimodipine prophylactically.

METHODS AND RESULTS

Transcranial Doppler monitoring was performed. Cerebral autoregulation was abolished in the left MCA. Despite this finding the administration of a bolus dose of MgSO(4), followed by a continuous infusion in order to achieve serum magnesium levels in the range of 4-4.5 mg/dl (1.65-1.85 mmol/l), resulted in a marked decrease (12.2%) of the left MCA mean blood flow velocity, without clinically relevant change in systemic blood pressure (3%). This effect was maintained for at least 4 h. It did not prevent the development of ischemic lesions.

摘要

目的

正在研究硫酸镁用于预防或治疗蛛网膜下腔出血后的血管痉挛。

患者

一名45岁女性发生蛛网膜下腔出血，在预防性接受尼莫地平治疗8天后，左侧大脑中动脉（MCA）出现症状性血管痉挛。

方法与结果

进行经颅多普勒监测。左侧大脑中动脉的脑自动调节功能丧失。尽管有这一发现，但给予一次大剂量硫酸镁，随后持续输注以达到血清镁水平在4 - 4.5 mg/dl（1.65 - 1.85 mmol/l）范围内，导致左侧大脑中动脉平均血流速度显著降低（12.2%），而全身血压无临床相关变化（3%）。这种效应至少维持了4小时。它并未阻止缺血性病变的发生。