外源性镁离子对重型颅脑创伤患者的治疗作用

A study of the effect of extrinsic ionized magnesium treatment in the patients with severe traumatic brain injury

目的探讨重型颅脑创伤(sTBI)患者硫酸镁治疗与患者血清丙二醛(MDA)含量及预后的关系。方法 54例人选病例按入院先后随机分为治疗组和对照组。治疗组首先15min内静脉滴注2．5g硫酸镁,接着10g硫酸镁24h持续静滴,连用3天。对照组除硫酸镁外其他治疗完全相同。两组再按人院GCS评分分为特重组(GCS 3—5分)和重型组(GCS 6～8分),住院期间监测患者血清镁和MDA含量,伤后3个月纪录患者GOS评分。结果治疗组MDA含量低于对照组,特重组MDA含量高于重型组,血清镁离子含量低于重型组(P<0．05)。治疗组GOS评分好于对照组, 但没有统计学意义。结论分sTBI患者,伤情越重,血清MDA含量越高,血清镁离子含量越低。硫酸镁能降低sTBI患者血清MDA含量,有改善预后的趋势。

Objective To investigate the relationship between MgSO4 therapy and serum Methylene dianiline （MDA） , outcome in the patients with severe traumatic brain injury （sTBI） . Methods A prospective randomized single-blind clinical trial of MgSO4 therapy was performed in 54 cases of the patients with sTBI who were enrolled within 12 hours after injury, and given intravenous MgSO4 in the treatment group, which was initiated with a bolus of 2.5g in a 100ml solution of 0.9% NaCl over 15 minutes, followed by continuous infusion at 0.4g/hour （10g in a 500rnl solution of 0.9% NaCl at 22.5 ml/hour） for 3 days. In control group, clinical management principles were the same as treatment group except MgSO4. the Two group were subdivided into sTBI group （GCS 6-8） and special severe traumatic brain injury （ssTBI） group （GCS 3-5）. Daily serum Mg^2＋ and MDA were monitored, and clinical outcomes were valued using the Glasgow Outcome Scale score （GOSs） at 3 months after injury. Results Decreased serum MDA were observed in the patients with treatment group compared to control group and sTBI group compared to ssTBI group （P〈 0.05）. In ssTBI group, serum Mg^2＋ is lower than sTBI group （P〈 0.05）. There was a slight but not significantly better GOS score in treatment group compared to control group. Conclusion The severer TBI is, the lower serum Mg^2＋ and the higher serum MDA are. Intravenous MgSO4 can significantly reduce their serum MDA. Mg^2＋ may act as a neuroprotective agent, and there is a trend of improving these patients＇ outcome.