Savla Paras, Marino Maxwell A, Marotta Dario A, Brazdzionis James, Farr Saman, Podkovik Stacey, Wiginton James, Tayag Emilio C, Cortez Vladimir, Miulli Dan E
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA.
Cureus. 2022 Mar 14;14(3):e23161. doi: 10.7759/cureus.23161. eCollection 2022 Mar.
Introduction Vasospasm is a significant cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to evaluate a possible link between vasospasm in patients with aneurysmal SAH and magnesium and blood pressure levels. Methods Subjects were selected based on chart review of patients presenting to a comprehensive stroke center in Southern California with aneurysmal SAH. 27 were included based on the following criteria: patients greater than 18 years of age, aneurysmal SAH, clinically symptomatic vasospasms and at least one diagnostic confirmation - either from a transcranial doppler (TCD) or digital subtraction angiogram (DSA). The following exclusion criteria also applied: 1) incomplete documentation in the medical record; 2) patients <18 years of age; and 3) patients without TCD measurements. Results In an overall analysis of all patients with or without vasospasm, it was found that the presence of vasospasm was significantly correlated with diastolic blood pressures (DBPs) on day of vasospasm with an r value of 0.418 and p<0.001. Average daily DBPs throughout hospital stay were also correlated with vasospasm with an r-value of 0.455 and p<0.001. Changes in magnesium overall were also significantly related to left Lindegaard ratios with an r value of -0.201 and p value of 0.032. Lindegaard ratios were significantly correlated with age with r values of 0.510, p<0.001, and r=-0.482, p<0.001 for left and right, respectively. A change in magnesium was inversely correlated to the left Lindegaard ratio with an n of 31 and p value of 0.014 (r= -0.439) in patients with vasospasm. We also found a lower incidence of vasospasm in patients older than 65. Conclusion Monitoring magnesium and increases in DBP might be effective as a prophylactic adjunct method in patients with SAH in an effort to predict clinical vasospasm.
引言 血管痉挛是动脉瘤性蛛网膜下腔出血（SAH）患者发病和死亡的重要原因。本研究的目的是评估动脉瘤性SAH患者的血管痉挛与镁及血压水平之间可能存在的联系。方法 通过对南加州一家综合卒中中心收治的动脉瘤性SAH患者的病历进行回顾来选择研究对象。基于以下标准纳入了27例患者：年龄大于18岁、动脉瘤性SAH、临床上有症状的血管痉挛且至少有一项诊断确认——经颅多普勒（TCD）或数字减影血管造影（DSA）。以下排除标准也适用：1）病历记录不完整；2）年龄<18岁的患者；3）未进行TCD测量的患者。结果 在对所有有或无血管痉挛的患者进行的总体分析中，发现血管痉挛的存在与血管痉挛当天的舒张压（DBP）显著相关，r值为0.418，p<0.001。整个住院期间的平均每日DBP也与血管痉挛相关，r值为0.455，p<0.001。总体镁的变化也与左侧Lindegaard比值显著相关，r值为 -0.201，p值为0.032。Lindegaard比值与年龄显著相关，左侧和右侧的r值分别为0.510，p<0.001和r = -0.482，p<0.001。在有血管痉挛的患者中，镁的变化与左侧Lindegaard比值呈负相关，n为31，p值为0.014（r = -0.439）。我们还发现65岁以上患者的血管痉挛发生率较低。结论 监测镁和DBP升高可能作为SAH患者的一种预防性辅助方法有效，以预测临床血管痉挛。
