van Norden A G W, van den Bergh W M, Rinkel G J E
Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Clin Pharm Ther. 2005 Oct;30(5):439-42. doi: 10.1111/j.1365-2710.2005.00642.x.
Magnesium is a neuroprotective agent that might prevent or reverse delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). We are presently running a randomized, placebo-controlled, double blind trial with magnesium sulphate (64 mmol/day intravenously). We studied whether this treatment regime resulted in our target serum magnesium levels of 1.0-2.0 mmol/L.
Magnesium sulphate was administered intravenously as soon as possible after admission and continued until 14 days after occlusion of the aneurysm. Serum magnesium measurements were done at baseline and at least every 2 days during administration of trial medication. For comparison we used the serum magnesium levels of the placebo-treated patients.
Magnesium therapy was begun in 94 patients. The mean magnesium level in the treatment period was 1.47 +/- 0.32 mmol/L. In 81 patients serum magnesium stayed within target levels during the entire treatment period. One patient had a serum magnesium level below 1.0 mmol/L (0.91 mmol/L) in a single measurement and 10 patients had serum magnesium levels above 2.0 mmol/L at one or more measurements. In six patients magnesium therapy was discontinued: in three because of nausea, headache, or both in combination with serum magnesium levels above 2.0 mmol/L and in the other three because of hypotension, phlebitis and renal failure.
With an intravenous dosage schedule of 64 mmol magnesium sulphate a day, serum magnesium levels of 1.0-2.0 mmol/L can easily be maintained without severe side effects for an extended period in a vast majority of patients with SAH.
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。我们目前正在进行一项使用硫酸镁（64 mmol/天静脉注射）的随机、安慰剂对照、双盲试验。我们研究了这种治疗方案是否能使血清镁水平达到我们的目标值1.0 - 2.0 mmol/L。
入院后尽快静脉注射硫酸镁，并持续至动脉瘤夹闭后14天。在基线时以及试验药物给药期间至少每2天进行一次血清镁测量。为作比较，我们采用了接受安慰剂治疗患者的血清镁水平。
94例患者开始接受镁治疗。治疗期间的平均镁水平为1.47 ± 0.32 mmol/L。81例患者在整个治疗期间血清镁水平维持在目标范围内。1例患者单次测量时血清镁水平低于1.0 mmol/L（0.91 mmol/L），10例患者在一次或多次测量时血清镁水平高于2.0 mmol/L。6例患者停止了镁治疗：3例是因为恶心、头痛或两者兼有且血清镁水平高于2.0 mmol/L，另外3例是因为低血压、静脉炎和肾衰竭。
对于绝大多数SAH患者，采用每天64 mmol硫酸镁的静脉给药方案，能够轻松维持血清镁水平在1.0 - 2.0 mmol/L，且长时间无严重副作用。
