血镁水平对重型颅脑外伤患者预后的影响

Influence of plasma Mg^(2+) on outcome of severe traumatic brain injury

目的研究颅脑外伤(TBI)后血镁浓度及早期补充硫酸镁对TBI的治疗意义。方法检测231例TBI患者入院时的血镁浓度,并将其中62例重型TBI患者随机分为硫酸镁治疗组(n=32)及对照组(n=30)。硫酸镁治疗组除常规治疗外给予硫酸镁2 g(16 mmol),稀释至100 mL于15 min内推注,另加硫酸镁7.80 g(65 mmol)稀释至500 mL静滴24 h。对照组不补充硫酸镁,其余治疗同硫酸镁治疗组。检测患者入院时、入院第3天的血镁水平及入院时、入院1周时的血神经元烯醇化酶(NSE)浓度。6个月后以格拉斯哥预后评分(GOS)评估各组治疗结果。结果重型TBI患者入院时的血镁浓度与轻中型TBI患者相比,差异无统计学意义(P>0.05)。两组重型TBI患者伤后1周时的血NSE水平比较,差异无统计学意义(P>0.05)。伤后6个月,比较两组治疗结果(GOS)为较差和较好的比例,差异无统计学意义(P>0.05)。结论TBI后早期患者血镁浓度与伤情无必然联系;早期补充硫酸镁未能明显改善重型TBI的治疗结果。

Objective To detect the concentration of plasma Mg^2＋ after traumatic brain injury （TBI） and role of early supplement of MgSO4 in the treatment of TBI. Methods Two hundred and thirty-one patients with TBI were enrolled and the concentrations of plasma Mg^2＋ at admission were detected. Sixty-two patients with severe TBI were randomly divided into MgSO4 treatment group （n = 32） and control group （n = 30）. In MgSO4 treatment group, MgSO4 2 g （16 mmol） was diluted to 100 mL and injected in 15 min, then MgSO4 7.80 g （65 mmol） was diluted to 500 mL and maintained for 24 h. No MgSO4 was supplemented to control group. The concentrations of plasma Mg^2＋ at admission and on the 3rd day after admission, and plasma neuron specific enolase （NSE） at admission and on the 7th day after admission were detected. Glasgow outcome scale （GOS） was evaluated in all the patients 6 months after injury Results There was no significant difference in the concentration of plasma Mg^2＋ at admission between patients with severe TBI and those with mild to moderate TBI（P 〉0.05）. There was no significant difference in the concentration of plasma NSE on the 7th day after injury and in GOS 6 months after injury between the two groups of severe TBI （P 〉 0.05）. Conclusion There is no relationship between the concentration of plasma Mg^2＋ and traumatic condition early after injury, and early supplement of MgSO4 has no significant influence on the treatment of severe TBI.