Odom Mitchell J, Zuckerman Scott L, Mocco J
Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Neurol Res Int. 2013;2013:943914. doi: 10.1155/2013/943914. Epub 2013 May 21.
Subarachnoid hemorrhage (SAH) is characterized by bleeding into the subarachnoid space, often caused by ruptured aneurysm. Aneurysmal rupture occurs in 700,000 individuals per year worldwide, with 40,000 cases taking place in the United States. Beyond the high mortality associated with SAH alone, morbidity and mortality are further increased with the occurrence of cerebral vasospasm, a pathologic constriction of blood vessels that can lead to delayed ischemic neurologic deficits (DIND). Treatment of cerebral vasospasm is a source of contention. One extensively studied therapy is Magnesium (Mg) as both a competitive antagonist of calcium at the N-methyl D-aspartate (NMDA) receptor, and a noncompetitive antagonist of both IP3 and voltage-gated calcium channels, leading to smooth muscle relaxation. In our literature review, several animal and human studies are summarized in addition to two Phase III trials assessing the use of intravenous Mg in the treatment of SAH (IMASH and MASH-2). Though many studies have shown promise for the use of Mg in SAH, there has been inconsistency in study design and outcomes. Furthermore, the results of the recently completed clinical trials have shown no significant benefit from using intravenous Mg as adjuvant therapy in the treatment of cerebral vasospasm.
蛛网膜下腔出血（SAH）的特征是血液流入蛛网膜下腔，通常由动脉瘤破裂引起。全球每年有70万人发生动脉瘤破裂，其中美国有4万例。除了SAH本身具有的高死亡率外，脑血管痉挛的发生会进一步增加发病率和死亡率，脑血管痉挛是一种血管病理性收缩，可导致迟发性缺血性神经功能缺损（DIND）。脑血管痉挛的治疗存在争议。一种经过广泛研究的疗法是镁（Mg），它既是N-甲基-D-天冬氨酸（NMDA）受体处钙的竞争性拮抗剂，也是肌醇三磷酸（IP3）和电压门控钙通道的非竞争性拮抗剂，可导致平滑肌松弛。在我们的文献综述中，除了两项评估静脉注射Mg治疗SAH（IMASH和MASH-2）的III期试验外，还总结了几项动物和人体研究。尽管许多研究表明Mg在SAH治疗中有应用前景，但研究设计和结果存在不一致性。此外，最近完成的临床试验结果表明，静脉注射Mg作为辅助治疗脑血管痉挛并无显著益处。
