常量硫酸镁治疗重型颅脑损伤的临床研究

摘要

目的 探讨常量硫酸镁治疗重型颅脑损伤(sTBI)的临床效果、用药方案及其安全性.方法 将入选病例随机分为治疗组和对照组,每组30例.对照组按常规治疗,治疗组加用常量硫酸镁.正常组20例,为成年健康献血员.按预设时间抽取肘静脉血,采用原子分光光度法测定血清Mg2+浓度.患者入院时、入院2周分别记录GCS评分.3月随访记录GOS评级并量化评分.观察记录治疗组和对照组患者伤后5d的不良反应情况.应用SPSS13.0软件包分析数据.结果 sTBI后对照组患者血清Mg2+浓度立即下降,24h内最低,7～14d基本正常.治疗组患者伤后2～3d血清Mg2+浓度明显高于对照组(P<0.01),7～14d基本下降至正常.患者治疗2周后的GCS评分比较,治疗组高于对照组(P<0.05).3月GOS评分治疗组高于对照组,但差异无统计学意义.治疗组和对照组患者sTBI后5d内出现的不良反应比较,差异无统计学意义.结论 常量硫酸镁治疗sTBI的近期疗效良好;伤后24h内用药、连用5d的用药方案是科学、有效、安全的.%Objective To investigate the clinical efficacy, protocol and safety of routine-dose magnesium sulfate treatment in patients with severe traumatic brain injury (sTBI).Methods The enrolled patients were randomly assigned to experimental group and control group, 30 in each group.Patients in control group were treated with conventional therapy while those in experimental group were treated with routine-dose magnesium sulfate apart from conventional therapy.Normal group consisted of 20 healthy adult blood donors.We collected blood samples at the preset time from the cases.Serum Mg2+ level was measured by atomic spectrometry.Patients' GCS was recorded upon hospital admission and 2 weeks later respectively.Their GOS was recorded 3 months later; their adverse reactions were observed 5 days after injury.Then the data were analyzed by SPSS13.0 software package.Results The serum concentration of Mg2+ in control group dropped immediately and reached the floor level within 24 hours;it attained the normal level 7- 14 days after sTBI.The serum level of Mg2+ 2 - 3 days after sTBI was higher in experimental group than in control group (P＜0.01) and it dropped to the normal level 7- 14 days after injury.After 2 weeks, GCS of patients in experimental group was higher than that in control group (P＜0.05); 3 months later, the GOS of patients in experimental group was higher than that in control group, but without significant difference.Adverse reactions occurred 5 days after injury in experimental group and control group, but without significant difference.Conclusion A better short-term efficacy appears when sTBI is treated with routine-dose magnesium sulfate.The protocol has been proven scientific, effective and safe when routine-dose magnesium sulfate treatment in patients with sTBI begins within 24 hours of injury and lasts for 5 consecutive days.