硫酸镁与米力农对动脉瘤性蛛网膜下腔出血后脑血管痉挛的影响：一项随机研究
[Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study].
作者信息
Soliman Rabie, Zohry Gomaa
机构信息
Cairo University, Department of Anesthesia, Cairo, Egito.
Cairo University, Department of Anesthesia, Cairo, Egito.
出版信息
Braz J Anesthesiol. 2019 Jan-Feb;69(1):64-71. doi: 10.1016/j.bjan.2018.09.005. Epub 2018 Nov 6.
BACKGROUND
Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage.
METHODS
The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500 mg.day without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5 μg.kg.min without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity ≥ 120 cm.s), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%).
RESULTS
The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 ( < 0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone ( = 0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 ( = 0.036, = 0.012, = 0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium ( = 0.012).
CONCLUSIONS
The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.
背景
动脉瘤性蛛网膜下腔出血是全球过早死亡和残疾的重要原因。硫酸镁显示具有神经保护作用，可逆转脑血管痉挛。米力农也用于治疗脑血管痉挛。本研究的目的是比较预防性使用硫酸镁和米力农对蛛网膜下腔出血后脑血管痉挛发生率的影响。
方法
该研究纳入90例动脉瘤性蛛网膜下腔出血患者，通过简单随机化随机分为两组：A组：给予硫酸镁静脉输注，剂量为500mg/天，无负荷剂量，持续21天。B组：给予米力农静脉输注，剂量为0.5μg/kg·min，无负荷剂量，持续21天。通过受累脑动脉的平均脑血流速度（平均流速≥120cm/s）、格拉斯哥昏迷量表评估的神经功能恶化或血管造影（受累脑动脉直径减小>25%）诊断脑血管痉挛。
结果
在第7天、第14天和第21天，硫酸镁组的平均脑血流速度与米力农组相比显著降低（P<0.001）。与米力农相比，硫酸镁组的脑血管痉挛发生率显著降低（P=0.007）。在第7天、第14天和第21天，硫酸镁组的格拉斯哥昏迷量表评分与米力农组相比显著改善（分别为P=0.036、P=0.012、P=0.016）。米力农组的低血压发生率高于硫酸镁组（P=0.012）。
结论
与米力农相比，动脉瘤性蛛网膜下腔出血后使用硫酸镁时脑血管痉挛的发生率显著降低，格拉斯哥昏迷量表评分显著更好。与硫酸镁相比，米力农与更高的低血压发生率以及多巴胺和去甲肾上腺素的使用需求相关。
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