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首页> 外文期刊>Neurosurgery >Intravenous magnesium versus nimodipine in the treatment of patients with aneurysmal subarachnoid hemorrhage: a randomized study.
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Intravenous magnesium versus nimodipine in the treatment of patients with aneurysmal subarachnoid hemorrhage: a randomized study.

机译：静脉使用镁与尼莫地平治疗动脉瘤性蛛网膜下腔出血的患者：一项随机研究。

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OBJECTIVE: The prophylactic use of nimodipine in patients with aneurysmal subarachnoid hemorrhage reduces the risk of ischemic brain damage. However, its efficacy seems to be rather moderate. The question arises whether other types of calcium antagonists offer better protection. Magnesium, nature's physiological calcium antagonist, is neuroprotective in animal models, promotes dilatation of cerebral arteries, and has an established safety profile. The aim of the current pilot study is to evaluate the efficacy of magnesium versus nimodipine to prevent delayed ischemic deficits after aneurysmal subarachnoid hemorrhage. METHODS: One hundred and thirteen patients with aneurysmal subarachnoid hemorrhage were enrolled in the study and were randomized to receive either magnesium sulfate (loading 10 mg/kg followed by 30 mg/kg daily) or nimodipine (48 mg/d) intravenously until at least postoperative Day 7. Primary outcome parameters were incidence of clinical vasospasm and infarction. Secondary outcome measureswere the incidence of transcranial Doppler/angiographic vasospasm, the neuronal markers (neuron-specific enolase, S-100), and the patients' Glasgow Outcome Scale scores at discharge and after 1 year. RESULTS: One hundred and four patients met the study requirements. In the magnesium group (n = 53), eight patients (15%) experienced clinical vasospasm and 20 (38%) experienced transcranial Doppler/angiographic vasospasm compared with 14 (27%) and 17 (33%) patients in the nimodipine group (n = 51). If clinical vasospasm occurred, 75% of the magnesium-treated versus 50% of the nimodipine-treated patients experienced cerebral infarction resulting in fatal outcome in 37 and 14%, respectively. Overall, the rate of infarction attributable to vasospasm was virtually the same (19 versus 22%). There was no difference in outcome between groups. CONCLUSION: The efficacy of magnesium in preventing delayed ischemic neurological deficits in patients with aneurysmal subarachnoid hemorrhage seems to be comparable with that of nimodipine. The difference in their pharmacological properties makes studies on the combined administration of magnesium and nimodipine seem promising.
机译：目的：尼莫地平在动脉瘤性蛛网膜下腔出血患者中的预防性使用可降低缺血性脑损伤的风险。但是，其功效似乎是中等的。问题是其他类型的钙拮抗剂是否提供更好的保护作用。镁是自然界中的生理钙拮抗剂，在动物模型中具有神经保护作用，可促进脑动脉扩张，并具有确定的安全性。当前试验研究的目的是评估镁与尼莫地平预防动脉瘤性蛛网膜下腔出血后延迟性缺血缺陷的功效。方法：113名患有动脉瘤性蛛网膜下腔出血的患者入选该研究，随机分配接受硫酸镁（负荷量为10 mg / kg，然后每天30 mg / kg）或尼莫地平（48 mg / d）的静脉注射，直至至少术后第7天。主要结局指标为临床血管痉挛和梗死的发生率。次要的结局指标是经颅多普勒/血管造影血管痉挛的发生率，神经元标志物（神经特异性烯醇化酶，S-100）以及患者出院时和术后1年的格拉斯哥预后量表得分。结果：104例患者符合研究要求。镁组（n = 53）中，有8例（15％）经历了临床血管痉挛，20例（38％）经历了经颅多普勒/血管造影血管痉挛，而尼莫地平组为14例（27％）和17例（33％）（ n = 51）。如果发生临床血管痉挛，镁治疗的患者中有75％的患者接受尼莫地平治疗，而尼莫地平治疗的患者中有50％的患者发生脑梗塞，分别导致37％和14％的致命结果。总体而言，归因于血管痉挛的梗死发生率实际上是相同的（19％对22％）。两组之间的结局无差异。结论：镁在预防动脉瘤性蛛网膜下腔出血患者延迟性缺血性神经功能缺损中的功效似乎与尼莫地平相当。它们药理特性的差异使得镁和尼莫地平联合给药的研究似乎很有希望。

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