Emergency Department, Cairns Base Hospital, Cairns, Queensland, Australia.
Emerg Med Australas. 2012 Oct;24(5):560-5. doi: 10.1111/j.1742-6723.2012.01602.x. Epub 2012 Sep 11.
Irukandji syndrome is a distressing condition characterised by pain, hypertension and tachycardia. Some develop cardiac failure and there have been two reported deaths. Magnesium sulphate has become the standard of care despite minimal evidence. The aim of this study was to investigate if magnesium would reduce analgesic requirement and length of stay for patients with Irukandji syndrome.
This was a double-blind, randomised controlled clinical trial. Patients with Irukandji syndrome who required parenteral opioid analgesia were randomised to receive either 10 mmol of magnesium as a bolus, and then a 5 mmol/h magnesium infusion for 6 h or saline. Fentanyl patient-controlled analgesia was commenced to allow patients to self-regulate their pain relief. The primary outcome measure of the study was comparison of total analgesic requirements between the two groups. The secondary outcome measure was to compare length of stay.
The study ran from November 2003 to May 2007. Thirty-nine patients were enrolled in the study; 26 were male with a median age of 28. Twenty-two received magnesium. There was no significant difference in the morphine equivalent dose used, peak CK, peak troponin, peak pulse, peak blood pressure, peak mean arterial pressure (MAP), percentage MAP rise and length of stay for those receiving magnesium compared with placebo.
Our study did not demonstrate a benefit in the use of magnesium in the treatment of Irukandji syndrome. As such the current use of magnesium needs to be reconsidered until there is good evidence to support its use.
伊鲁坎吉综合征是一种以疼痛、高血压和心动过速为特征的令人痛苦的病症。一些患者会出现心力衰竭，并有两例死亡报告。尽管证据不足，但硫酸镁已成为标准治疗方法。本研究旨在探讨镁是否会减少伊鲁坎吉综合征患者的镇痛需求和住院时间。
这是一项双盲、随机对照临床试验。需要静脉注射阿片类镇痛药的伊鲁坎吉综合征患者被随机分为两组，分别接受 10mmol 镁作为推注，然后以 5mmol/h 的速度输注镁 6 小时，或接受生理盐水。开始使用芬太尼患者自控镇痛，以使患者能够自我调节疼痛缓解。该研究的主要观察指标是比较两组患者的总镇痛需求。次要观察指标是比较住院时间。
该研究于 2003 年 11 月至 2007 年 5 月进行。共有 39 名患者入组该研究；26 名男性，中位年龄 28 岁。22 名患者接受了镁治疗。与安慰剂组相比，接受镁治疗的患者使用的吗啡等效剂量、肌酸激酶峰值、肌钙蛋白峰值、脉搏峰值、血压峰值、平均动脉压峰值、平均动脉压升高百分比和住院时间均无显著差异。
我们的研究并未显示镁在伊鲁坎吉综合征治疗中的益处。因此，在有充分证据支持其使用之前，需要重新考虑目前镁的使用。
